Vascular depression: A distinct diagnostic entity?

血管抑制：一个独特的诊断实体？

• 批准号: 7559823
• 负责人: JOEL R. SNEED
• 金额: $ 13.58万
• 依托单位: QUEENS COLLEGE
• 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/7559823
• 关键词: Acute; Address; African American; Age of Onset; Blood Vessels; Categories; Cerebrovascular Disorders; Class; Classification; Clinical; Cluster Analysis; Complement; Consensus; Data Set; Dementia; Depressed mood; Development; Diagnosis; Diagnostic; Diagnostic and Statistical Manual; Differential Diagnosis; Disease; Elderly; Escitalopram; Evaluation; Family history of; Functional disorder; Future; Goals; Hypertension; Joints; Laboratories; Magnetic Resonance Imaging; Major Depressive Disorder; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Methodology; Mood Disorders; Neuropsychological Tests; Patients; Population; Psychometrics; Public Health; Rate; Research; Research Personnel; Research Project Grants; Research Training; Risk Factors; Score; Selective Serotonin Reuptake Inhibitor; Sensitivity and Specificity; Series; Statistical Methods; Testing; Thinking; Training; Treatment outcome; Week; career; cerebrovascular; disease classification; executive function; geriatric depression; neuropsychiatry; neuropsychological; prototype; response; skills; treatment trial; vascular depression

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）：这是申请指导患者导向的研究职业发展奖（K23）。该提案的培训和研究部分为申请人提供了测试血管抑制结构的内部（结构）有效性和外部（并发和预测）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年神经精神疾病疾病分类学专家。为期 4 年的培训计划主要侧重于发展统计方法方面的专业知识，用于对诊断实体进行彻底的心理测量评估，以得出有效的诊断标准。由于晚年疾病的诊断标准可能不仅仅涵盖现象学，因此次要培训目标是培养识别 MRI 高强度以及神经心理学对抑郁症和痴呆症鉴别诊断的专业知识。这项为期四年的研究计划通过提出一系列连续研究来补充培训计划，这些研究可操作和测试血管性抑郁症的具体诊断标准。该研究计划有以下目标： 1. 通过对三种现有的晚年抑郁症应用潜在类别聚类分析，测试血管性抑郁症这一疾病分类实体的内部（构建）有效性，并确定最准确识别其发生的诊断标准数据集； 2. 根据目标 1 中建立的标准，将来自两项已完成的晚年抑郁症治疗试验的患者分类为血管性抑郁症或非血管性抑郁症（非血管性抑郁症），然后比较各组的血管性抑郁症构建的外部有效性。并发（基线现象学）和预测（短期治疗反应）有效性； 3. 在为期 8 周的艾司西酞普兰开放治疗试验中前瞻性测试疾病分类构建的外部有效性，并确定非裔美国人的血管抑郁发生率是否高于预期。总之，该提案首次尝试对所提出的诊断类别血管性抑郁症的内部和外部有效性进行系统的心理测量评估。该提案中应用的策略超越了以前主导 DSM 分类工作的专家共识的使用，这里验证的诊断标准可能包括 MRI 和神经心理学测试分数。因此，血管性抑郁症可以作为未来诊断分类的方法和内容的原型；也就是说，血管抑制的标准除了需要内部和外部有效性的证据外，还可能依赖于现象学和实验室测试的结合。该应用程序解决了一个主要的公共卫生问题，即老年人抑郁症的识别和治疗，老年人是人口增长最快的群体。它特别关注非裔美国老年人，他们的高血压发病率特别高，并且可能特别容易患血管性抑郁症。