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JAMA Psychia:抑郁症和糖尿病患者易患痴呆

新药编辑:新特药 更新时间:2015-04-19

2015年4月19日 讯 /tumor.net.cn/ --近日,发表于国际杂志JAMA Psychiatry上的研究论文中,来自华盛顿大学医学院的研究者通过研究表示,抑郁症和2型糖尿病或许都和痴呆症的风险增加直接相关,而该风险在那些被诊断既是抑郁症又是糖尿病的患者中尤其高。糖尿病和严重抑郁在西方国家非常常见,大约有20%的糖尿病患者会患上抑郁症。

研究者Dimitry Davydow表示,我们对240万丹麦居民进行了相关研究,检测了抑郁症患者、2型糖尿病患者以及同时患两种病的患者相比未患病的患者患痴呆症的风险,参与者年龄都在50岁及以上,其在2007年至2013年均无痴呆症病症表现。总的来讲,研究小组中有19.4%的个体为抑郁症(477,133名个体),有9.1%的个体为2型糖尿病(223,174名个体),有3.9%的个体均患上了两种病(95,691名个体),起初诊断为2型糖尿病的个体年龄为63.1岁,最初被诊断为抑郁症的年龄则为58.5岁。

研究者表示,在研究期间有2.4%的个体患上了痴呆症(59,663名个体),平均年龄为81岁,在患痴呆症的个体中,15729名个体(26.4%)仅为抑郁症患者,6466名个体(10.8%)仅为2型糖尿病患者,同时4022名个体(6.7%)均患上了两种疾病。研究结果表明,仅患2型糖尿病和痴呆症风险增加20%直接相关,而仅患抑郁症则和痴呆症风险增加83%相关,共患两种病则和痴呆症风险增加117%相关,而且痴呆症的患病风险似乎在65岁以上的参与者中尤其高。

从慢性病增加社会负担的角度考虑,未来研究中研究者需要阐明和抑郁症,2型糖尿病发生相关的病理学机制,以及揭示引发患者不良后果的原因,比如痴呆症等,从而为开发新型干预措施来抑制相关疾病并发症的发生提供新的线索和思路。(tumor.net.cn)

Promoting Healthy Brain Aging

Charles F. Reynolds III, MD1,2,3

The co-occurrence of diabetes mellitus and depression, especially in persons younger than 65 years, poses an important hazard to healthy brain aging and cognitive fitness in the later years of life. Katon and colleagues1 from Denmark contribute this key observation in this issue of JAMA Psychiatry. This observation raises questions about the biology of aging and about promotion of ways of aging well, not just living a long life. First, with respect to the basic biology of aging, how does aging enable disease? Second, from the perspective of population health, how can we narrow the gap between life span and health span, compressing the period of functional morbidity (especially related to dementia) in the later years of life? The answers to the first question will likely provide important clues for answering the second.


Effect of Depression and Diabetes Mellitus on the Risk for Dementia A National Population-Based Cohort Study

Wayne Katon, MD?1; Henrik Sondergaard Pedersen, MSc2; Anette Riisgaard Ribe, MD2; Morten Fenger-Gr?n, MSc2; Dimitry Davydow, MD, MPH1; Frans Boch Waldorff, MD, PhD3; Mogens Vestergaard, MD, PhD2

Importance Although depression and type 2 diabetes mellitus (DM) may independently increase the risk for dementia, no studies have examined whether the risk for dementia among people with comorbid depression and DM is higher than the sum of each exposure individually. Objective To examine the risk for all-cause dementia among persons with depression, DM, or both compared with persons with neither exposure. Design, Setting, and Participants We performed a national population-based cohort study of 2?454?532 adults, including 477?133 (19.4%) with depression, 223?174 (9.1%) with DM, and 95?691 (3.9%) with both. We included all living Danish citizens 50 years or older who were free of dementia from January 1, 2007, through December 31, 2013 (followed up through December 31, 2013). Dementia was ascertained by physician diagnosis from the Danish National Patient Register or the Danish Psychiatric Central Register and/or by prescription of a cholinesterase inhibitor or memantine hydrochloride from the Danish National Prescription Registry. Depression was ascertained by psychiatrist diagnosis from the Danish Psychiatric Central Research Register or by prescription of an antidepressant from the Danish National Prescription Registry. Diabetes mellitus was identified using the National Diabetes Register. Main Outcomes and Measures We estimated the risk for all-cause dementia associated with DM, depression, or both using Cox proportional hazards regression models that adjusted for potential confounding factors (eg, demographics) and potential intermediates (eg, medical comorbidities). Results During 13?834?645 person-years of follow-up, 59?663 participants (2.4%) developed dementia; of these, 6466 (10.8%) had DM, 15?729 (26.4%) had depression, and 4022 (6.7%) had both. The adjusted hazard ratio for developing all-cause dementia was 1.83 (95% CI, 1.80-1.87) for persons with depression, 1.20 (95% CI, 1.17-1.23) for persons with DM, and 2.17 (95% CI, 2.10-2.24) for those with both compared with persons who had neither exposure. The excess risk for all-cause dementia observed for individuals with comorbid depression and DM surpassed the summed risk associated with each exposure individually, especially for persons younger than 65 years (hazard ratio, 4.84 [95% CI, 4.21-5.55]). The corresponding attributable proportion due to the interaction of comorbid depression and DM was 0.25 (95% CI, 0.13-0.36; P?<?.001) for those younger than 65 years and 0.06 (95% CI, 0.02-0.10; P?=?.001) for those 65 years or older. Conclusions and Relevance Depression and DM were independently associated with a greater risk for dementia, and the combined association of both exposures with the risk for all-cause dementia was stronger than the additive association.2

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