Vascular depression: A distinct diagnostic entity?

血管抑制：一个独特的诊断实体？

• 批准号: 7104733
• 负责人: JOEL R. SNEED
• 金额: $ 17.61万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-01 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7104733
• 关键词: African American; behavioral /social science research tag; cerebrovascular disorder diagnosis; citalopram; clinical research; clinical trials; diagnosis quality /standard; disease /disorder classification; drug screening /evaluation; executive function; human subject; human therapy evaluation; magnetic resonance imaging; major depression; mental disorder chemotherapy; mental disorder diagnosis; neuroimaging; neuropsychological tests; patient oriented research; psychological aspect of aging; psychomotor disorders; racial /ethnic difference; serotonin inhibitor; statistics /biometry

DESCRIPTION (provided by applicant): This is a request for a Mentored Patient-Oriented Research Career Development Award (K23). The training and research components of this proposal provide the applicant with the skills and research settings necessary to test the internal (construct) validity and external (concurrent and predictive) validity of the vascular depression construct. The applicant's career goal is to become an expert in the nosology of late-life neuropsychiatric disorders. The 4-year training plan focuses primarily on the development of expertise in the statistical methods used to carry out thorough psychometric evaluations of diagnostic entities in order to arrive at valid diagnostic criteria. Since diagnostic criteria for late-life disorders may encompass more than phenomenology, secondary training goals are to develop expertise in identifying MRI hyper-intensities and in neuropsychological contributions to the differential diagnosis of depression and dementia. The 4-year research plan complements the training plan by proposing a series of sequential studies that operationalize and test specific diagnostic criteria for vascular depression. The research plan has the following aims: 1. to test the internal (construct) validity of the nosological entity, vascular depression, and determine the diagnostic criteria that most accurately identify its occurrence by applying latent class cluster analysis to three existing late-life depression datasets; 2. To test the external validity of the vascular depression construct by classifying patients from two completed late-life depression treatment trials as vascular depressed or not (non-vascular) according to criteria established in Aim 1, and then comparing the groups with respect to concurrent (phenomenology at baseline) and predictive (short-term treatment response) validity; 3. To test prospectively the external validity of the nosological construct in an 8-week open treatment trial of escitalopram and to determine whether African Americans have a higher than expected rate of vascular depression. In summary, this proposal is the first to attempt a systematic psychometric evaluation of the internal and external validity of the proposed diagnostic category, vascular depression. The strategies applied in this proposal move beyond the use of expert consensus that has dominated previous DSM classification efforts and the diagnostic criteria validated here will likely include MRI and neuropsychological test scores. Thus, vascular depression may serve as a prototype for future diagnostic classifications both in terms of methodology and content; that is, the criteria for vascular depression will likely rely on a combination of phenomenology and laboratory tests in addition to requiring evidence of internal and external validity. This application addresses a major public health concern, the identification and treatment of depression in older adults, the fastest growing segment of the population. It specifically focuses on African American older adults, who have especially high rates of hypertension and may be particularly prone to vascular depression.

描述（由申请人提供）：这是向受过指导的以患者为导向的研究职业发展奖（K23）的请求。该提案的培训和研究组成部分为申请人提供了测试血管抑郁型结构的内部（构造）有效性以及外部（同时和预测性）有效性所需的技能和研究环境。申请人的职业目标是成为晚期神经精神疾病的肿瘤学专家。为期4年的培训计划主要侧重于用于对诊断实体进行彻底心理测量评估的统计方法的专业知识的发展，以达到有效的诊断标准。由于晚期疾病的诊断标准可能不仅仅包括现象学，因此二级培训目标是在识别MRI高强度和对抑郁症和痴呆症的鉴别诊断中的神经心理学贡献方面发展专业知识。为期4年的研究计划通过提出一系列顺序研究来补充培训计划，该研究对血管抑郁症进行特定的诊断标准进行操作和测试。该研究计划的目的是：1。测试病理学实体，血管抑郁症的内部（构造）有效性，并确定最准确地确定其发生的诊断标准，通过将潜在的类群集分析应用于三个现有的晚期抑郁症数据集； 2。通过根据AIM 1中建立的标准将两项完整的晚期抑郁症治疗试验的患者分类为血管抑郁症的外部有效性，然后根据AIM 1中建立的标准进行比较，然后比较相对于同步（基线现象学）和预测性（短期治疗响应）的同一体（现象学）; 3。在为期8周的依源瓜的开放式治疗试验中，前瞻性地测试了病学结构的外部有效性，并确定非裔美国人是否具有高于预期的血管抑郁率。总而言之，该建议是第一个尝试对拟议诊断类别的内部和外部有效性进行系统心理测量评估，即血管抑郁症。该提案中应用的策略超出了主导以前的DSM分类工作和此处验证的诊断标准的专家共识的使用，可能包括MRI和神经心理学测试分数。因此，在方法和内容方面，血管抑郁症可以作为未来诊断分类的原型。也就是说，除需要内部和外部有效性的证据外，血管抑郁的标准还可能依赖于现象学和实验室测试的组合。该申请涉及一个主要的公共卫生问题，老年人的抑郁症鉴定和治疗，这是人口中增长最快的部分。它特别关注非裔美国人老年人，他们的高血压率特别高，可能特别容易出现血管抑郁症。