心脏代谢多发病和抑郁症对认知功能的独立和联合关联:多地区队列的研究结果以及从社区到临床的普遍性

IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Xuhao Zhao , Xiaolin Xu , Yifan Yan , Darren M. Lipnicki , Ting Pang , John D. Crawford , Christopher Chen , Ching-Yu Cheng , Narayanaswamy Venketasubramanian , Eddie Chong , Sergio Luis Blay , Maria Fernanda Lima-Costa , Erico Castro-Costa , Richard B. Lipton , Mindy J. Katz , Karen Ritchie , Nikolaos Scarmeas , Mary Yannakoulia , Mary H. Kosmidis , Oye Gureje , Xin Xu
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引用次数: 0

摘要

背景心血管代谢多病症(CMM)和抑郁症经常同时出现在老年人中,并与神经退行性疾病相关。本研究旨在估算CMM和抑郁症在多地区队列中对认知功能的独立和联合关联,并在包括临床在内的更多环境中验证研究结果的普适性。方法在国际队列记忆研究(COSMIC)小组的14项纵向队列研究中进行数据协调,这些研究横跨北美、南美、欧洲、非洲、亚洲和澳大利亚。此外,还采用了三项不同背景的外部验证研究来进行推广。如果参与者有 CMM 数据,并且基线时没有痴呆症,则有资格被纳入研究。基线CMM定义为1) CMM 5,在高血压、高脂血症、糖尿病、中风和心脏病中≥2;2) CMM 3(与之前的研究一致),在糖尿病、中风和心脏病中≥2。基线抑郁的主要特征是采用老年抑郁量表和流行病学研究中心抑郁量表对抑郁症状进行二元分类测量。通过协调多种认知测量方法,将总体认知标准化为z分数。纵向认知度按总体认知度 z 值的变化计算。在COSMIC研究中,利用汇集的个体参与者数据(IPD)分析来估计CMM和抑郁对认知结果的独立和联合关联,包括横向和纵向关联。在14个COSMIC队列的32931名老年人中,我们纳入了30382名有完整基线CMM、抑郁和认知评估数据的参与者,进行横断面分析。其中,22,599 名参与者至少接受了一次随访认知评估,被纳入纵向分析。三项外部验证研究的1964名参与者来自三个不同环境(社区、记忆诊所和中风后研究)的多种族亚洲老年人队列。在COSMIC研究中,CMM和抑郁各自与横断面和纵向认知功能独立相关,两者之间没有显著的交互作用(Ps > 0.05)。同时患有CMM和抑郁症的参与者的横断面认知能力较低(例如,CMM5 (+)/ 抑郁症(+) β = -0.207,95% CI = (-0.255, -0.159)),认知能力下降速度较快(例如,CMM5 (+)/ 抑郁症(+) β = -0.040,95% CI = (-0.047, -0.034))。在对 APOE 基因型进行额外调整后,这些关联仍保持一致,并且在两步随机效应 IPD 分析中也很稳健。有关 CMM 和抑郁症对认知功能的共同影响的研究结果在三项外部验证研究中得到了重复。我们的研究结果强调了从多维角度研究与年龄相关的合并疾病的重要性,同时针对心脏代谢和心理状况来预防认知功能衰退可以提高有效性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic

Background

Cardiometabolic multimorbidity (CMM) and depression are often co-occurring in older adults and associated with neurodegenerative outcomes. The present study aimed to estimate the independent and joint associations of CMM and depression on cognitive function in multi-regional cohorts, and to validate the generalizability of the findings in additional settings, including clinical.

Methods

Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed for generalization. Participants were eligible for inclusion if they had data for CMM and were free of dementia at baseline. Baseline CMM was defined as: 1) CMM 5, ≥2 among hypertension, hyperlipidemia, diabetes, stroke, and heart disease and 2) CMM 3 (aligned with previous studies), ≥2 among diabetes, stroke, and heart disease. Baseline depression was primarily characterized by binary classification of depressive symptom measurements, employing the Geriatric Depression Scale and the Center for Epidemiological Studies-Depression scale. Global cognition was standardized as z-scores through harmonizing multiple cognitive measures. Longitudinal cognition was calculated as changes in global cognitive z-scores. A pooled individual participant data (IPD) analysis was utilized to estimate the independent and joint associations of CMM and depression on cognitive outcomes in COSMIC studies, both cross-sectionally and longitudinally. Repeated analyses were performed in three external validation studies.

Findings

Of the 32,931 older adults in the 14 COSMIC cohorts, we included 30,382 participants with complete data on baseline CMM, depression, and cognitive assessments for cross-sectional analyses. Among them, 22,599 who had at least 1 follow-up cognitive assessment were included in the longitudinal analyses. The three external studies for validation had 1964 participants from 3 multi-ethnic Asian older adult cohorts in different settings (community-based, memory clinic, and post-stroke study). In COSMIC studies, each of CMM and depression was independently associated with cross-sectional and longitudinal cognitive function, without significant interactions between them (Ps > 0.05). Participants with both CMM and depression had lower cross-sectional cognitive performance (e.g. β = −0.207, 95% CI = (−0.255, −0.159) for CMM5 (+)/depression (+)) and a faster rate of cognitive decline (e.g. β = −0.040, 95% CI = (−0.047, −0.034) for CMM5 (+)/depression (+)), compared with those without either condition. These associations remained consistent after additional adjustment for APOE genotype and were robust in two-step random-effects IPD analyses. The findings regarding the joint association of CMM and depression on cognitive function were reproduced in the three external validation studies.

Interpretation

Our findings highlighted the importance of investigating age-related co-morbidities in a multi-dimensional perspective. Targeting both cardiometabolic and psychological conditions to prevent cognitive decline could enhance effectiveness.

Funding

Natural Science Foundation of China and National Institute on Aging/National Institutes of Health.

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来源期刊
The Lancet Regional Health: Western Pacific
The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health
CiteScore
8.80
自引率
2.80%
发文量
305
审稿时长
11 weeks
期刊介绍: The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.
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