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Role of Depressive Symptoms in Cardiovascular Disease, Cognitive Decline, and Mortality
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| 자료유형 | 학위논문 |
|---|---|
| 서명/저자사항 | Role of Depressive Symptoms in Cardiovascular Disease, Cognitive Decline, and Mortality. |
| 개인저자 | Armstrong, Nicole M. |
| 단체저자명 | The Johns Hopkins University. Epidemiology. |
| 발행사항 | [S.l.]: The Johns Hopkins University., 2017. |
| 발행사항 | Ann Arbor: ProQuest Dissertations & Theses, 2017. |
| 형태사항 | 150 p. |
| 기본자료 저록 | Dissertations Abstracts International 81-06B. Dissertation Abstract International |
| ISBN | 9781687988461 |
| 학위논문주기 | Thesis (Ph.D.)--The Johns Hopkins University, 2017. |
| 일반주기 |
Source: Dissertations Abstracts International, Volume: 81-06, Section: B.
Advisor: Bandeen-Roche, Karen. |
| 이용제한사항 | This item must not be sold to any third party vendors. |
| 요약 | Background and Purpose: Depression is increasingly prevalent as adults age, but is undertreated in older adults. As populations in the US and the world are aging, it is important to evaluate the contributions of depression to cardiovascular risk factors, cognitive decline, and mortality. The proposed study will examine avenues by which vascular depression is associated with cognitive decline, dementia, and all-cause mortality. First, we will examine the timing of the effect of vascular burden and cardiovascular risk factors (hypertension, hyperlipidemia, diabetes, ever smoking status, and overweight/obesity status) on onset of late-life depression. We will then determine whether depressive symptoms partially mediate the association of subclinical cardiovascular disease (CVD) with cognitive decline and dementia. Finally, we will evaluate the indirect effect of persistent depressive symptoms on the association between subclinical CVD and all-cause mortality.Methods: We investigated the effect of vascular burden and cardiovascular risk factors on the onset of late-life depression, using 1,190 former male medical students from the Johns Hopkins Precursors Study. Cox proportional hazards models using discrete time were used to evaluate the effect of vascular burden and cardiovascular risk factors occurring before and after age 65 on the onset of depression. Competing risks analysis, using the Long and Gray method, were used to account for the competing risk of mortality in later life. Also, we examined the role of persistent depressive symptoms as potential mediators in the associations of subclinical cardiovascular disease with onset of mild cognitive impairment (MCI) and dementia as well as all-cause mortality. To this, we applied the counterfactual approach to causal mediation using time-to-event data from the Cardiovascular Health Study. Accelerated failure time models with Weibull distribution were used to examine the total, direct, and indirect effects of the association between subclinical CVD and MCI/dementia onset via persistent depressive symptoms, since the proportionality hazard assumption was not met. Cox proportional hazards models were used to evaluate total, direct, and indirect effects of subclinical cardiovascular disease on all-cause mortality via persistent depressive symptoms, since the proportionality hazard assumption was met. Both models were weighted by estimates of multivariable logistic regression models of persistent depressive symptoms on subclinical cardiovascular disease and baseline covariates.Results: Diabetes, hypertension, and hyperlipidemia before age 65 as well as vascular burden and diabetes after age 65 were associated with incident depression after age 65 among participants who were depression-free up to age 65. Cardiovascular risk factors and vascular burden before age 65 were not associated with incident depression up at age 65 with the exception of overweight/obese status having a protective effect against incident depression. Persistent depressive symptoms partially mediated the association between subclinical CVD with MCI/dementia onset, not all-cause mortality. Subclinical CVD was an independent risk factor of all-cause mortality.Conclusions: These results support the vascular depression hypothesis. Findings suggest that screening and treatment of depressive symptoms may reduce or delay the risk of incident MCI and dementia in older adults with subclinical CVD. Moreover, subclinical CVD was a strong predictor of all-cause mortality, independent of persistent depressive symptoms. Subclinical CVD and persistent depressive symptoms may lead to all-cause mortality on different pathways. Future directions involve the evaluation of domains of depressive symptoms and their potential mediating roles in common disease pathways in older adults. |
| 일반주제명 | Public health. Mental health. Epidemiology. |
| 언어 | 영어 |
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: 이 자료의 원문은 한국교육학술정보원에서 제공합니다. |
