Longitudinal follow-up of depressive symptoms among normal versus cognitively impaired elderly

被引:80
作者
Li, YS
Meyer, JS
Thornby, J
机构
[1] Vet Adm Med Ctr, Cerebrovasc Res Labs, Houston, TX 77030 USA
[2] Vet Adm Med Ctr, Biostat Lab, Houston, TX 77030 USA
[3] Baylor Coll Med, Dept Neurol, Houston, TX 77030 USA
关键词
Alzheimer's dementia; vascular dementia; mild cognitive impairment; depressive symptoms; prevalence; incidence; treatment; risk factors;
D O I
10.1002/gps.423
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Objectives This prospectively designed longitudinal study assesses prevalence, incidence and prognosis of depressive symptoms among cognitively normal elderly volunteers compared with patients with mild cognitive impairment (MCI), dementia of Alzheimer type (DAT), and vascular dementia (VAD). Possible relationships between depressive symptoms, cognitive performance, disease types, and effects of antidepressant treatment were analyzed. Methods Two hundred and ninety four subjects exhibiting different levels of cognitive performance were admitted to this study. Demographics, cardiovascular and neurodegenerative risk factors, together with measures of neuropsychological test performance, were obtained at sequential visits. Depressive symptoms were selectively treated with antidepressant medications. Results One hundred and forty six subjects with normal cognition, 19 subjects with MCI, 42 patients with DAT. and 32 patients with VAD were followed for a mean of 3.5 years. With the passage of time, there were trends showing prevalence of depressive symptoms to decrease among DAT and to increase among VAD patients. VAD patients exhibited the highest incidences of new-onset depressive symptoms, followed in incidence by DAT and MCI groups. Depressive symptoms among VAD and MCI patients were more persistent and refractory to antidepressant medications than for DAT patients, Trends suggested that antidepressant treatment might benefit MCI and VAD subjects more than DAT patients. Motivationally related depressive symptoms accounted for major components of elevated Hamilton depression rating scale scores. Conclusions Depressive symptoms among DAT patients have higher rates of spontaneous resolution, without requiring intensive drug treatment, than among VAD patients in whom depressive symptoms are more persistent and refractory to drug treatment. Early depressive symptoms among subjects with MCI may represent a preclinical sign and should be considered as a risk factor for impending DAT or VAD among the elderly. Copyright (C) 2001 John Wiley & Sons, Ltd.
引用
收藏
页码:718 / 727
页数:10
相关论文
共 62 条
[1]  
Alexopoulos GS, 1997, ARCH GEN PSYCHIAT, V54, P915
[2]  
[Anonymous], 1987, DIAGNOSTIC STAT MANU, V4th
[3]   The influence of depressive symptomatology on episodic memory functioning among clinically nondepressed older adults [J].
Backman, L ;
Hill, RD ;
Forsell, Y .
JOURNAL OF ABNORMAL PSYCHOLOGY, 1996, 105 (01) :97-105
[4]   The prevalence, associations and symptoms of depression amongst dementia sufferers [J].
Ballard, C ;
Bannister, C ;
Solis, M ;
Oyebode, F ;
Wilcock, G .
JOURNAL OF AFFECTIVE DISORDERS, 1996, 36 (3-4) :135-144
[5]   A one-year follow-up study of depression in dementia sufferers [J].
Ballard, CG ;
Patel, A ;
Solis, M ;
Lowe, K ;
Wilcock, G .
BRITISH JOURNAL OF PSYCHIATRY, 1996, 168 (03) :287-291
[6]   The occurrence of depressive symptoms in the preclinical phase of AD -: A population-based study [J].
Berger, AK ;
Fratiglioni, L ;
Forsell, Y ;
Winblad, B ;
Bäckman, L .
NEUROLOGY, 1999, 53 (09) :1998-2002
[7]   The neuropsychology of preclinical Alzheimer's disease and mild cognitive impairment [J].
Collie, A ;
Maruff, P .
NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS, 2000, 24 (03) :365-374
[8]   Age-Associated Memory Impairment: Proposed Diagnostic Criteria and Measures of Clinical Change - Report of a National Institute of Mental Health Work Group [J].
Crook, Thomas ;
Bartus, Raymond T. ;
Ferris, Steven H. ;
Whitehouse, Peter ;
Cohen, Gene D. ;
Gershon, Samuel .
DEVELOPMENTAL NEUROPSYCHOLOGY, 1986, 2 (04) :261-276
[9]  
Cummings J L, 1989, J Neuropsychiatry Clin Neurosci, V1, P236
[10]   Neuropsychiatric aspects of Alzheimer's disease: The cholinergic hypothesis revisited [J].
Cummings, JL ;
Kaufer, D .
NEUROLOGY, 1996, 47 (04) :876-883