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20 March 2006

Depression appears to increase the risk of mild cognitive impairment (MCI) developing in elderly individuals, researchers report in the Archives or Neurology.

The association between depression and MCI appeared to be stronger in men than in women, although not significantly, but it was not influenced by the severity or duration of depression.

Yonas Geda (Mayo Clinic College of Medicine, Rochester, Minnesota, USA) and colleagues also found that there was a positive interaction between apolipoprotein E (APOE) genotype and depression, whereby people with depression and the APOE genotypes ε3/ε4 or ε4/ ε4 were more likely to develop MCI than people with either of these features alone.

The researchers explored whether depression increased the risk of developing incident MCI in 840 cognitively normal elderly individuals aged between 50 and 102 years.

All the participants were free of depression and cognitive impairment at the start of the study and were followed-up for a median of 3.5 years.

A total of 143 (17%) individuals developed depression during follow-up, with scores on the Geriatric Depression Scale (GDS) of 6 points in 47.6% of patients, 7 to 11 points in 50.4% of patients, and 12 to 15 points in 2.1% of patients.

Among the patients with depression, 13.3% developed MCI, compared with just 4.9% of those without the psychiatric disorder.

The hazard ratio for MCI for patients with depression, compared with those without depression, was 2.2, after taking into account age, education, and gender, and considering dementia as a competing outcome.

Patients with depression were also more likely than those without depression to develop the secondary outcome of incident MCI or dementia, with frequencies of 22.4% versus 7.2%.

The association between depression and MCI increased when APOE genotype was included in the model. Compared with controls, the hazard ratio for MCI among patients without depression who had the ε3/ ε4 or ε4/ ε4 genotypes was 1.6, while individuals with depression and either type of genotype had a hazard ratio for MCI of 5.1.

"Our study suggests that cognitively normal elderly individuals who develop depression are at increased risk of subsequent MCI," write Geda and team.

"In addition, there may be a synergistic interaction between APOE genotype and depression."



Source: Arch Neurol 2006; 63: 435–440