台灣中老年人憂鬱與認知功能之相向因果關係：休閒活動之中介效應

中文摘要前言：台灣老人憂鬱症與失智症盛行率分別為21.7%、8.3%，休閒活動能減緩憂鬱與認知功能下降。然憂鬱與認知功能下降之因果關係及中介效應尚不清楚。故本研究探討不同憂鬱軌跡對後續認知功能異常之影響、不同認知功能軌跡對後續憂鬱之影響，以及憂鬱與認知功能異常相關性之休閒活動的中介效應。材料方法：以國民健康署「台灣中年身心社會狀況長期追蹤調查」， 2003、2007、2011年三波之調查，其憂鬱(CES-D10)和認知功能(SPMSQ)至少有兩次資料才納入分析。憂鬱軌跡對後續認知功能異常使用多變量邏輯式迴歸，反之亦然。結果：憂鬱軌跡有五種型態，「持續無憂鬱」、「持續低憂鬱」、「有憂鬱到無憂鬱」、「無憂鬱到有憂鬱」以及「持續高憂鬱」，各憂鬱軌跡進行與後續認知功能異常之相關性分析。「持續高憂鬱」者相較於「持續無憂鬱」者，後續認知功能異常風險顯著較高(OR=2.3)，分層分析顯示女性、年齡越大、無伴侶、有糖尿病及有心臟病者，其憂鬱軌跡對後續認知功能異常更形嚴重。認知功能軌跡分為五種型態，「無認知異常」、「無認知異常到邊際認知異常」、「認知異常到無認知異常」、「認知快速惡化」以及「持續認知異常」，各認知功能軌跡進行與後續憂鬱之相關性分析。「無認知異常到邊際認知異常」、「認知快速惡化」者相較於「持續無認知異常」，後續憂鬱風險分別為(OR=1.4, OR=1.9)。憂鬱對後續認知異常的休閒活動中介效應，主要是智力型、運動型及園藝型休閒活動；而認知異常對後續憂鬱的休閒活動中介效應，主要是智力型和園藝型休閒活動。結論：憂鬱與認知功能異常間，具雙向之因果相關性，但憂鬱對後續認知功能異常之相關性較強。智力型及園藝型休閒活動為憂鬱與認知功能異常雙向因果關係之共同中介因子。

關鍵字

憂鬱；認知功能異常；休閒活動；中介因子；軌跡分析

並列摘要

Abstract Objectives: In Taiwan, the prevalence of elderly depression and dementia were 21.7% and 8.3%, respectively. Leisure activities can protect depression and cognitive decline. The causal relationships and mediation effect between depression and cognitive decline are still unclear. This longitudinal study aimed at the relationships between different depression trajectories on subsequent cognitive impairment, different cognition trajectories on subsequent depression, and mediation effect between depression and cognitive impairment. Methods: Three-wave (2003, 2007, 2011) investigations of ”The Survey of Health and Living Status of the Near Elderly and Elderly in Taiwan”, and at least completed two-wave CES-D10 and SPMSQ were included in this analysis. Multivariate logistic regression was applied to analyze the relationships of depression trajectories and subsequent cognitive impairment, and vice versa. Results: Five depression trajectories were characterized, ”No Depression”, ”Low depressive symptoms”, ”Remissive Depression”, ”Incident Depression”, ”Persistent Depression”, and their relationships to subsequent cognitive impairment, when ” Persistent Depression” compared to ”No Depression”, the incidence of subsequent cognitive impairment was significantly increased (OR=2.3); moreover, in stratification analysis, female, older adult, no spouse or partner, have diabetes or heart disease, the relationships between worse depression trajectories and subsequent cognitive impairment were even worsening. Five cognition trajectories were characterized, ”Good Cognitive Function”, ”Borderline Cognitive Impairment”, ”Remissive Cognitive Impairment”, ”Rapid Deterioration of Cognitive Function”, ”Persistent Cognitive Impairment”, and their relationships to subsequent depression, when ”Borderline Cognitive Impairment” and ”Rapid decline cognitive impairment” compared to ”Good Cognitive Function”, the incidences of subsequent depression were significantly increased (OR=1.4, 1.9). Mediators of the relationship between depression and subsequent cognitive impairment were intellectual, physical, gardening activities, respectively; and the mediators of the relationship between cognitive impairment and subsequent depression were intellectual activities and gardening activities. Conclusion: The relationship of depression trajectories and subsequent cognitive impairment was stronger than the relationship of cognitive trajectories and subsequent depression. Intellectual activities and gardening activities were important mediators in the bidirectional causal relationships of depression and cognitive impairment.

並列關鍵字

depression ； cognitive impairment ； leisure activity ； mediator ； trajectory analysis

參考文獻

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