体弱中老年人抑郁症状与认知功能轨迹：基于CHARLS队列的纵向分析（2011-2018）

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry Pub Date : 2025-08-08 DOI:10.1016/j.genhosppsych.2025.08.006

Ze Chang , Xiaoxuan Cao , Xueru Zhang , Yunmeng Chen, Liuding Wang, Yunfan Zhang, Jingjing Wei, Xiao Liang, Yunling Zhang

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引用次数: 0

摘要

背景随着全球人口老龄化，中老年人虚弱综合征与抑郁症状、认知能力下降之间的相互作用越来越受到人们的关注。这三个因素形成的恶性循环大大降低了生活质量，增加了医疗负担。目前，国内关于体弱人群抑郁症状与认知功能动态关系的纵向证据尚不足。方法基于2011 - 2018年中国健康与退休纵向研究（CHARLS）的数据，共纳入1279名符合体弱标准的中老年人。采用基于群体的轨迹模型（GBTM）识别认知功能轨迹，并利用贝叶斯信息准则（BIC）和平均后验概率等指标对模型拟合进行评估。采用多变量logistic回归模型分析体弱多病个体抑郁症状与不同认知轨迹之间的关系，剔除人口统计学特征、慢性病共病等混杂因素。结果本研究确定了6条认知功能发展轨迹，并分析了抑郁症状与不同认知轨迹之间的关系。结果显示，与认知正常稳定组相比，抑郁症状与所有不良认知轨迹显著相关。在未调整的模型中，抑郁症状使认知障碍-快速衰退组的风险增加1.72倍（OR = 2.72, 95% CI 1.56-4.72），使认知正常-晚期快速衰退组的风险增加0.95倍（OR = 1.95, 95% CI 1.19-3.18）。在对多个因素进行调整后，这种关联仍然显著。在完全调整模型（模型5）中，认知障碍快速下降组的风险进一步上升至2.10倍（OR = 3.10, 95% CI 1.69 - 5.69），而认知障碍持续低水平组（OR = 1.69, 95% CI 1.05-2.72）、认知正常波动组（OR = 1.65, 95% CI 1.03-2.62）和其他不良轨迹组的风险也显示出显著相关性(均p <；0.05)。这些结果表明，抑郁症状是多种认知功能不良轨迹的独立危险因素，其中认知能力快速下降组的相关性最强。结论本研究发现，抑郁症状是中老年体弱人群认知能力下降的独立危险因素，对认知能力快速下降和持续性认知障碍的预测尤为显著。抑郁症状筛查在体弱多病的中老年人的认知健康管理中具有重要的临床价值，特别是在识别认知能力快速下降风险最高的个体方面

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Depressive symptoms and cognitive function trajectories in frail middle-aged and older adults: A longitudinal analysis based on the CHARLS cohort (2011–2018)

Background

With the global aging of the population, the interaction between frailty syndrome in middle-aged and elderly people, depressive symptoms, and cognitive decline has attracted increasing attention. The vicious cycle formed by these three factors significantly reduces quality of life and increases the burden on medical care. Currently, there is still insufficient longitudinal evidence in China on the dynamic relationship between depressive symptoms and cognitive function in frail populations

Method

A total of 1279 middle-aged and elderly people who met the criteria for frailty were included in the study based on data from the China health and retirement longitudinal study (CHARLS) from 2011 to 2018. Group-based trajectory modeling (GBTM) was used to identify cognitive function trajectories, and model fitting was evaluated using indicators such as Bayesian information criterion (BIC) and average posterior probability. A multivariable logistic regression model was used to analyze the association between depressive symptoms in frail individuals and different cognitive trajectories, adjusting for confounding factors such as demographic characteristics and comorbid chronic diseases

Results

This study identified six cognitive function development trajectories and analyzed the association between depressive symptoms and different cognitive trajectories. The results showed that, compared with the cognitive Normal-stable group, depressive symptoms were significantly associated with all adverse cognitive trajectories. In the unadjusted model, depressive symptoms increased the risk of the cognitive impairment-rapid decline group by 1.72 times (OR = 2.72, 95 % CI 1.56–4.72) and increased the risk of the cognitive Normal-late rapid decline group by 0.95 times (OR = 1.95, 95 % CI 1.19–3.18). After adjusting for multiple factors, this association remained significant. In the fully adjusted model (model 5), the risk for the cognitive impairment-rapid decline group further rose to 2.10 times (OR = 3.10, 95 % CI 1.69–5.69), while the risk for the cognitive impairment-persistent low level group (OR = 1.69, 95 % CI 1.05–2.72), the cognitive Normal-fluctuating group (OR = 1.65, 95 % CI 1.03–2.62), and other adverse trajectory groups also showed significant associations (all p < 0.05). These results indicate that depressive symptoms are an independent risk factor for multiple adverse cognitive function trajectories, with the strongest association observed in the rapid cognitive decline group

Conclusion

This study found that depressive symptoms are an independent risk factor for cognitive decline in middle-aged and elderly frail populations, particularly significantly predicting rapid cognitive decline and persistent cognitive impairment. Depressive symptom screening demonstrates significant clinical value in cognitive health management for frail middle-aged and older adults, particularly for identifying individuals at highest risk of rapid cognitive decline

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来源期刊

General hospital psychiatry 医学-精神病学

CiteScore

9.60

自引率

2.90%

发文量

125

审稿时长

20 days

期刊介绍： General Hospital Psychiatry explores the many linkages among psychiatry, medicine, and primary care. In emphasizing a biopsychosocial approach to illness and health, the journal provides a forum for professionals with clinical, academic, and research interests in psychiatry''s role in the mainstream of medicine.