京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18858号 / 医博第3969号 / 新制||医||1008(附属図書館) / 31809 / 京都大学大学院医学研究科医学専攻 / (主査)教授 福原 俊一, 教授 古川 壽亮, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Emotional suffering in old age is largely caused by a variety of psychiatric disorders which are often, however, undertreated and underrecognized. This leads to reduced quality of life and functional status and increased morbidity and mortality. Dementia, delirium and depression are common disorders in the very old, and are similar in several ways. All have multiple causes and are diagnosed by means of symptomatic criteria, are challenging to diagnose and difficult to differentiate from each other in the very old. They often coexist in the same individual, and may have common risk factors. The overall aim of this thesis was to add to our knowledge about threats to successful aging, by investigating the prevalences of dementia, depression and delirium, and factors associated with these three disorders. Further aims were to measure change over time in the prevalence of dementia and depression, respectively, and to investigate the risk factors for incident depression. This thesis uses the population-based Umeå85+/GErontological Regional DAtabase (GERDA) material. In 2000-2002, every other 85-year-old, all 90-year-olds and all people ≥95 years living in six municipalities in Västerbotten, Sweden were invited to participate, and in 2005-2007 the process was repeated, with the additional inclusion of the corresponding populations of two municipalities in Österbotten, Finland. A third data collection was carried out in 2010-2012. Trained assessors carried out assessments in the form of structured interviews during one or more home visits, recorded current medication and reviewed medical records obtained from general practitioners and hospitals. In 2000-2002 the prevalence of dementia was 17% among 85-year-olds, 24% among 90-year-olds and 46% among those aged ≥95 years. In 2005-2007 dementia prevalence reached 28% among 85-year-olds, 40% among 90-yearolds and 45% among those aged ≥95 years. The prevalence of dementia in the total sample was 27% in 2000-2002 and 37% in 2005-2007 (p=0.001). In 2000-2002 the prevalence of depressive disorders was 24% among 85-yearolds, 34% among 90-year-olds and 31% among those aged ≥95 years. In 2005-2007 the prevalence of depressive disorders was 33% among 85-year-olds, 39% among 90-year-olds and 38% among those aged ≥95 years. The prevalence of depressive disorders in the total sample was 29% in 2000-2002 and 37% in 2005-2007 (p=0.025). Among participants not depressed at baseline, 26% had developed depression after five years. Factors independently associated with new cases of depression at follow-up were hypertension, a history of stroke and a higher score on the 15-item Geriatric Depression Scale at baseline. The thirtyday prevalence of delirium in 2005-2007 was 17% among 85-year-olds, 21% among 90-year-olds and 39% among participants aged ≥95 years. Delirium prevalence among individuals with dementia was higher than among those without dementia (52% vs. 5%, p<.001). Factors independently associated with delirium superimposed on dementia in a multivariate logistic regression model were depression, heart failure, living in an institution and prescribed antipsychotics. There was a high prevalence of dementia, depression and delirium in the papers comprising this thesis, and 55% had at least one of the three disorders. The prevalence of dementia and depression also increased between 2000-2002 and 2005-2007, after controlling for age and sex. Dementia and depression were important associated factors for delirium and half of those with dementia were depressed. The increasing age-specific prevalence of depression seems to be associated with the increasing age-specific prevalence of dementia. The papers presented are among the first to report a significantly increasing age-specific prevalence of dementia and depression among very old people. More knowledge about associated factors and risk factors concerning these disorders may be helpful for carers and decision-makers, as well as providing reference values for studies in other regions. Further efforts are needed in both care and research to better prevent, screen for, diagnose and treat dementia, depression and delirium, especially considering the growing number of very old people. / Umeå85+/GERDA

Made available in DSpace on 2014-12-17T14:13:33Z (GMT). No. of bitstreams: 1 PatriciaEMM_Tese.pdf: 847319 bytes, checksum: 45c87b0995e32e622482e82ba5c34d31 (MD5) Previous issue date: 2009-10-09 / The aim of the present study was to assess the presence of depressive symptomatology among elderly residents in long-stay institutions (LSI) and in the community of Recife, Brazil. In total, 81 long-stay elderly patients (mean age of 75.55 ? 9.18 years) and 132 elderly (mean age of 73.14 ? 8.27 years) individuals from the community were evaluated. Depressive symptomatology was assessed by the Geriatric Depression Scale (GDS-15), cognitive status by the Mini Mental State Examination (MMSE) and capacity to perform the activities of daily living (ADL) by the Katz Index. Comorbities and the use of medication were recorded. The LSI elderly exhibited more depressive symptoms (p < 0.001) and more dependency (p< 0.001). We observed no differences in MMSE (p = 0.058). The elderly in the community displayed more comorbidities and the LSI elderly consumed more medication (p < 0.001 and p < 0.001, respectively). According to multivariate analysis (logistic regression), being male, having no spouse and having a low schooling level are risk factors for depressive symptoms. In conclusion, most elderly with depressive symptoms received no medication fordepression. / Avaliar a preval?ncia de sintomas depressivos entre idosos e pacientes portadores de doen?a pulmonar obstrutiva cr?nica (DPOC) e suas rela??es com os n?veis de TNF-&#945; e IL-2 e o horm?nio cortisol, comorbidades, consumo de medicamentos, composi??o corporal e desempenho no teste de caminhada de seis minutos (TC6min). Metodologia: Foram avaliados idosos e pacientes com DPOC quanto a presen?a de sintomas depressivos (GDS-15), cogni??o (MMSE), atividades de vida di?ria (AVD), composi??o corporal (Bioimped?ncia El?trica), TC6min, cortisol s?rico (Eletroquimioluminesc?ncia), TNF-&#945; e IL-2 plasm?tico (Elisa). Resultados: Artigo 1. Os idosos das institui??es de longa perman?ncia (ILP) apresentaram mais sintomas depressivos, depend?ncia e maior consumo de medicamentos enquanto os da comunidade apresentaram mais comorbidades. Na an?lise multivariada, pertencer ao sexo masculino, n?o ter companheiro e ter baixa escolaridade se apresentaram como fatores de risco para a sintomatologia depressiva. Artigo 2.Os sintomas depressivos ocorreram em 22,5% dos pacientes com DPOC do sexo masculino. A deple??o muscular ocorreu a partir do n?vel leve de obstru??o entre aqueles sem sintomas e moderado entre aqueles com depress?o. A dist?ncia percorrida ficou abaixo do previsto e o tempo de caminhada com encorajamento foi maior no grupo sem sintomas. Artigo 3. A preval?ncia de sintomas depressivos foi maior no grupo dos pacientes DPOC. O n?mero de comorbidades foi maior entre aqueles com sintomas depressivos. N?o foram encontradas diferen?as quanto aos n?veis de TNF-&#945;, IL-2, cortisol, n?mero de anos de fumo e ma?os-ano entre os grupos. O grupo DPOC apresentou maior freq??ncia de deple??o nutricional em rela??o aos idosos. Conclus?o: Os sintomas depressivos foram mais prevalentes entre idosos das ILP e com DPOC, e esses n?o foram acompanhados de tratamento com antidepressivos. N?o foram observadas diferen?as entre os n?veis de TNF-&#945;, IL-2 e cortisol entre idosos da comunidade e com DPOC