Long Term Depressive Symptom Course & Adverse Health Outcomes among Older Women

描述（由申请人提供）：抑郁症状在老年人中非常常见，尤其是在女性中，并且与认知和身体残疾有关，尽管这种关联的性质和方向，包括因果解释，仍然存在争议。我们建议调查老年妇女的抑郁症状如何与认知功能相关， 和功能衰退。仅在一个时间点评估抑郁症状 (as几乎在所有以前的研究中已经完成）是不够的，因为抑郁症状通常随着时间的推移而变化，并且因为抑郁症状的累积影响可能需要时间才能显现出来。为了最好地调查抑郁症等慢性疾病的全面影响，我们需要研究其长期过程，与2008年NIMH战略计划雅阁，以绘制心理健康症状的轨迹，并与PA-07-163中表达的研究优先事项。我们还建议调查几个有针对性的生物学机制，这些机制可能是抑郁症状与认知和功能下降之间联系的基础。很少有研究（如果有的话）全面研究这些机制，然而，它们的发现可能会为预防和治疗提供重要机会，更不用说对抑郁症生物学的基本理解了。 最后，我们建议研究抑郁症状的影响，在最古老的老人。关于这一人群中抑郁症状的患病率和严重程度及其相关健康结果的信息很少，通常定义为年龄≥ 85岁的老年人，这是美国人口中增长最快的部分。根据我们的初步数据，大量的抑郁症状在这一人群中很常见，影响了15-25%的老年人。我们的目标将通过对10，000多名老年女性（包括3，800名最年长的老年人）进行的前瞻性研究来解决，这些女性在年龄= 65岁时入组，并已严格随访近20年。在一个极具成本效益的方法中，我们 将确定抑郁症状的长期病程以及这些症状如何与认知和功能衰退的发展相关。此外，我们将确定抑郁症状与这些结果之间的关联是否部分由关键的生物学途径解释，如炎症，睡眠质量，心血管疾病和血液淀粉样蛋白水平。从这一建议中获得的知识将是新颖的和关键的了解抑郁症状的影响，在老年妇女，包括最古老的老年人的健康结果在长期。它将为监测/治疗老年抑郁症状的临床需求以及可能将抑郁症与认知障碍和残疾联系起来的生物学机制提供重要见解。 公共卫生相关性：从这项建议中获得的知识将是新颖的和关键的理解老年抑郁症状对老年妇女，包括最古老的老年人与年龄相关的健康结果的影响。它将为监测/治疗有抑郁症状的老年人的临床需求以及可能将抑郁症与认知和功能下降联系起来的生物学机制提供重要见解。

DESCRIPTION (provided by applicant): Depressive symptoms are very common in the elderly, especially among women, and have been linked with cognitive and physical disability, although the nature and direction of this association, including the causal interpretation, remains controversial. We propose to investigate how depressive symptoms among elderly women are associated with cognitive and functional decline over the long term. Assessing depressive symptoms at only one timepoint (as has been done in almost all previous studies) is inadequate because depressive symptoms are commonly variable over time, and because the cumulative impact of depressive symptoms may take time to manifest itself. To best investigate the full impact of a chronic disease such as depression, we need to study its long-term course, in accord with the 2008 NIMH Strategic Plan to chart trajectories of mental health symptoms and with research priorities expressed in PA-07-163. We also propose to investigate several targeted biological mechanisms that may underlie the association between depressive symptoms and cognitive and functional decline. Few studies, if any, have comprehensively investigated these mechanisms and yet, their discovery could yield important opportunities for prevention and treatment, not to mention an essential understanding of the biology of depression. Finally we propose to study the effects of depressive symptoms in the oldest old. Little information exists on the prevalence and severity of depressive symptoms and their associated health outcomes in this population, typically defined as elders aged =85 years, and the fastest growing segment of the U.S. population. Based on our preliminary data, substantial depressive symptoms are common in this population, affecting 15-25% of the oldest old. Our aims will be addressed from ongoing prospective study of over 10,000 elderly women (including 3800 oldest old) who enrolled at age = 65 years and who have been rigorously followed for almost 20 years. In an extremely cost-effective approach, we will determine the long-term course of depressive symptoms and how these symptoms are associated with the development of cognitive and functional decline. In addition, we will determine if the association between depressive symptoms and these outcomes is partially explained by key biological pathways such as inflammation, sleep quality, cardiovascular disease and blood ¿-amyloid level. Knowledge gained from this proposal will be both novel and critical for understanding the impact of depressive symptoms over the long term on health outcomes in older women including the oldest old. It will shed important insights on both the clinical need for monitoring/treating the elderly with depressive symptoms and on the biological mechanisms that may link depression to cognitive impairment and disability. PUBLIC HEALTH RELEVANCE: Knowledge gained from this proposal will be both novel and critical for understanding the impact of geriatric depressive symptoms on age-related health outcomes in older women including the oldest old. It will shed important insights on both the clinical need for monitoring/treating the elderly with depressive symptoms and on the biological mechanisms that may link depression to cognitive and functional decline.