Objective

Older adults with type 2 diabetes (T2D) are at increased risk for depression, cognitive decline, and dementia compared to those without T2D. Little is known about the association of simultaneous changes in depression symptoms and cognitive decline over time.

Methods

Subjects (n=1021; mean age 71.6 [SD=4.6]; 41.2% female) were initially cognitively normal participants of the Israel Diabetes and Cognitive Decline study who underwent evaluations of depression and cognition approximately every 18 months. Cognitive tests were summarized into four cognitive domains: episodic memory, attention/working memory, executive functions, and semantic categorization. The average of the z-scores of the four domains defined global cognition. Depression symptoms were assessed using the Geriatric Depression Scale, 15-item version. We fit a random coefficients model of changes in depression and in cognitive functions, adjusting for baseline sociodemographic and cardiovascular variables.

Results

Higher number of depression symptoms at baseline was significantly associated with lower baseline cognitive scores in global cognition (estimate = −0.1175, SE = 0.021, DF = 1,014, t = −5.59; p < 0.001), executive functions (estimate = −0.186, SE = 0.036, DF = 1,013, t = −5.15; p = <0.001), semantic categorization (estimate = −0.155, SE = 0.029, DF = 1,008, t = −5.3; p < 0.001), and episodic memory (estimate = −0.08165, SE = 0.027, DF = 1,035, t = −2.92; p = 0.0036), but not with rate of decline in any cognitive domain. During follow-up, a larger increase in number of depression symptoms, was associated with worse cognitive outcomes in global cognition (estimate = −0.1053, SE = 0.027, DF = 1,612, t = −3.77; p = 0.0002), semantic categorization (estimate = −0.123, SE = 0.036, DF = 1,583, t = −3.36; p = 0.0008), and in episodic memory (estimate = −0.165, SE = 0.055, DF = 1,622, t = −3.02; p = 0.003), but the size of this effect was constant over time.

Conclusion

In elderly with T2D, increase in depression symptoms over time is associated with parallel cognitive decline, indicating that the natural course of the two conditions progresses concurrently and suggesting common underlying mechanisms".

中文翻译：

---

随着时间的推移，抑郁症状数量的增加与患有 2 型糖尿病的老年人更糟糕的认知结果有关

客观的

与未患 2 型糖尿病 (T2D) 的老年人相比，患有 2 型糖尿病 (T2D) 的老年人患抑郁症、认知能力下降和痴呆的风险更高。随着时间的推移，人们对抑郁症状的同时变化和认知能力下降之间的关联知之甚少。

方法

受试者（n=1021；平均年龄 71.6 [SD=4.6]；41.2% 女性）最初是以色列糖尿病和认知衰退研究的认知正常参与者，他们大约每 18 个月接受一次抑郁和认知评估。认知测试概括为四个认知领域：情景记忆、注意力/工作记忆、执行功能和语义分类。四个域的 z 分数的平均值定义了全局认知。使用老年抑郁量表，15 项版本评估抑郁症状。我们拟合了抑郁症和认知功能变化的随机系数模型，调整了基线社会人口统计学和心血管变量。

结果

基线时抑郁症状的数量较多与整体认知（估计值 = -0.1175，SE = 0.021，D​​F = 1,014，t = -5.59；p < 0.001）、执行功能（估计值 = -0.186， SE = 0.036, DF = 1,013, t = -5.15; p = <0.001), 语义分类（估计 = -0.155, SE = 0.029, DF = 1,008, t = -5.3; p < 0.001），以及情景记忆= -0.08165, SE = 0.027, DF = 1,035, t = -2.92; p = 0.0036)，但在任何认知领域都没有下降率。在随访期间，抑郁症状数量增加较多，与整体认知（估计值 = -0.1053，SE = 0.027，DF = 1,612，t = -3.77；p = 0.0002）、语义分类（估计值 = -0.123, SE = 0.036, DF = 1,583, t = -3.36; p = 0.0008),

结论

在患有 T2D 的老年人中，随着时间的推移，抑郁症状的增加与平行的认知能力下降有关，这表明这两种疾病的自然过程是同时进行的，并表明了共同的潜在机制”。