Arch Gen Psychiatry：晚年抑郁症可能预示阿尔茨海默氏症

5月7日，发生在中年和晚年的抑郁症症状与血管性痴呆的风险增加有关，而在晚年生活中出现的症状更可能是阿尔茨海默氏症的早期征兆，根据美国加州大学旧金山的Kaiser Permanente研究人员完成的一项研究证实。

这项研究结果刊登在本期的Archives of General Psychiatry杂志上，是首次检查无论是中年或晚年抑郁症是否更容易导致长期阿尔茨海默氏症或血管性痴呆。研究人员解释说，血管性痴呆是第二、中最常见的痴呆类型，部分脑血流受损导致细胞失去营养和氧气。

加州大学旧金山分校精神病学和流行病学与生物统计学和旧金山退伍军人事务医疗中心的部门公共卫生硕士Deborah E. Barnes博士说：那些在中年和晚年抑郁症状的人更容易发展血管性痴呆。

研究人员表示：虽然更多的研究是需要的，但调查结果表明抑郁症在晚年开始可能是阿尔茨海默氏病的早期症状，慢性抑郁症可能会反映大脑血流量的长期变化过程以及血管性痴呆风险的增加。 

doi:10.1001/archgenpsychiatry.2011.1481
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Midlife vs Late-Life Depressive Symptoms and Risk of Dementia

Deborah E. Barnes, PhD, MPH; Kristine Yaffe, MD; Amy L. Byers, PhD, MPH; Mark McCormick, MD; Catherine Schaefer, MD; Rachel A. Whitmer, PhD

Context Depression and dementia are common in older adults and often co-occur, but it is unclear whether depression is an etiologic risk factor for dementia.

Objective To clarify the timing and nature of the association between depression and dementia.

Design We examined depressive symptoms assessed in midlife (1964-1973) and late life (1994-2000) and the risks of dementia, Alzheimer disease (AD), and vascular dementia (VaD) (2003-2009) in a retrospective cohort study. Depressive symptoms were categorized as none, midlife only, late life only, or both. Cox proportional hazards models (age as timescale) adjusted for demographics and medical comorbidities were used to examine depressive symptom category and risk of dementia, AD, or VaD.

Setting Kaiser Permanente Medical Care Program of Northern California.

Participants Thirteen thousand five hundred thirty-five long-term Kaiser Permanente members.

Main Outcome Measure Any medical record diagnosis of dementia or neurology clinic diagnosis of AD or VaD.

Results Subjects had a mean (SD) age of 81.1 (4.5) years in 2003, 57.9% were women, and 24.2% were nonwhite. Depressive symptoms were present in 14.1% of subjects in midlife only, 9.2% in late life only, and 4.2% in both. During 6 years of follow-up, 22.5% were diagnosed with dementia (5.5% with AD and 2.3% with VaD). The adjusted hazard of dementia was increased by approximately 20% for midlife depressive symptoms only (hazard ratio, 1.19 [95% CI, 1.07-1.32]), 70% for late-life symptoms only (1.72 [1.54-1.92]), and 80% for both (1.77 [1.52-2.06]). When we examined AD and VaD separately, subjects with late-life depressive symptoms only had a 2-fold increase in AD risk (hazard ratio, 2.06 [95% CI, 1.67-2.55]), whereas subjects with midlife and late-life symptoms had more than a 3-fold increase in VaD risk (3.51 [2.44-5.05]).

Conclusions Depressive symptoms in midlife or in late life are associated with an increased risk of developing dementia. Depression that begins in late life may be part of the AD prodrome, while recurrent depression may be etiologically associated with increased risk of VaD.