Vascular Depression in African Americans: Phenomenology, treatment, and course of

非裔美国人的血管抑郁症：现象学、治疗和病程

基本信息

批准号：
8101115
负责人：
JOEL R. SNEED
金额：
$ 19.04万
依托单位：
QUEENS COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-07-01 至 2013-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8101115
关键词：
Acute Address African American Age Anisotropy Antidepressive Agents Blood Vessels Build-it Cardiovascular Diseases Cause of Death Cerebrovascular Disorders Clinical Clinical Trials Color Communities Data Depressive Syndromes Development Disease Elderly Epidemic Feasibility Studies Functional disorder Funding Goals Hypertension Imaging Techniques Impaired cognition Impairment Ischemia Leadership Lesion Magnetic Resonance Imaging Major Depressive Disorder Medical Mental Depression Mental Health Mental disorders Mentored Patient-Oriented Research Career Development Award Modeling National Institute of Mental Health Neuropsychological Tests Obesity Participant Patients Pattern Phase Population Pre-Post Tests Process Prospective Studies Psyche structure Public Health Public Hospitals Recruitment Activity Relapse Research Research Personnel Risk Risk Factors Sampling Stroke Testing United States United States National Institutes of Health Vascular Dementia base brain behavior cognitive function diabetes risk economic implication executive function follow-up high risk inner city innovation interest meetings public health relevance response social implication treatment response vascular depression white matter

项目摘要

DESCRIPTION (provided by applicant): The vascular depression hypothesis proposes that "cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes". African Americans (AAs) have among the highest rates of vascular risk factors in the United States, including hypertension, which is among the highest in the world. AAs also have higher rates of ischemia diseases such as cardiovascular disease, stroke, and vascular dementia. Indeed, vascular dementia has been deemed a "silent epidemic" among older adult African Americans. The proposed study is based on the hypothesis that because of these high rates AAs are at high risk for vascular depression. However, this association has yet to be tested as AAs are underrepresented in mental research in general and clinical trials in particular despite mandates from the NIH that have existed for decades. The goal of this proposal is to establish the feasibility of conducting mental health research in an inner-city, public hospital serving the needs of a primarily African American population. It builds on the community-academic partnership Dr. Sneed and Singh (PIs) have developed over the past four years as part of Dr. Sneed's K23 award. We propose to 1) recruit twenty AAs (age >=50) per year with major depression for a one year study involving acute antidepressant treatment, repeat neuropsychological testing, and pre-post structural MRI; 2) demonstrate an 80% retention rate in the acute treatment phase; and 3) demonstrate a 75% retention rate among patients completing the acute treatment phase at 1-year follow-up. The community-academic partnership, focus on a high risk population, and incorporation of advanced imaging techniques represents an innovative next step in the study of vascular depression. The pilot data generated by this feasibility study will support a subsequent R01 examining acute treatment response, relapse rates, and progression of cognitive impairment and white matter lesion burden in AAs with vascular depression. Furthermore, this proposal meets each of NIMH's strategic objectives: 1) develops an integrative understanding of brain- behavior processes underlying vascular depression; 2) characterizes the developmental trajectory to determine when, where, and how to intervene; 3) develops a community- academic partnership; and 4) meets the needs of an underserved and understudied population in an inner city, public hospital setting; and ultimately (if funded), promotes the public health impact of NIMH-sponsored research. PUBLIC HEALTH RELEVANCE: African Americans have the highest rates of hypertension in the world, and not surprisingly, higher rates of cardiovascular disease, stroke, and vascular dementia. Given that the number of African American older adults is expected to increase fivefold by 2050, the social and economic implications of being at high risk for vascular depression could be staggering. Building on a community-academic partnership model, the proposed study addresses this important public health need by establishing the feasibility of conducting mental research in an inner-city, public hospital setting.

描述（由申请人提供）：血管抑郁假设提出“脑血管疾病可能易感，沉淀或永久存在一些老年抑郁综合症”。非裔美国人（AAS）在美国的血管危险因素率最高，包括高血压，这是世界上最高的高血压。 AA还具有较高的缺血性疾病，例如心血管疾病，中风和血管性痴呆。确实，血管性痴呆被认为是老年非裔美国人的“沉默流行病”。拟议的研究基于以下假设：由于这些高率，AAS具有血管抑郁症的高风险。但是，尽管NIH已有数十年的任务，但该关联尚未在一般的心理研究和临床试验中尤其是临床试验的人数不足。该提案的目的是建立在城市内部公立医院进行心理健康研究的可行性，以满足非裔美国人人口的需求。它建立在Sneed博士和Singh（PIS）的社区学术伙伴关系基础上，作为Sneed博士K23奖的一部分，它在过去的四年中发展了。我们提议1）每年招募二十AA（年龄> = 50），重度抑郁症进行一年的研究，涉及急性抗抑郁药治疗，重复神经心理学测试和前结构MRI； 2）在急性治疗阶段证明保留率为80％； 3）证明在1年随访的急性治疗阶段完成急性治疗阶段的患者中保留率为75％。社区学术伙伴关系，专注于高风险人群，并纳入先进的成像技术，代表了血管抑郁症研究的创新下一步。这项可行性研究产生的试点数据将支持随后的R01检查急性治疗反应，复发率以及认知障碍和白质病变负担的急性治疗反应，并在血管抑郁症的AAS中进行。此外，该提案符合NIMH的每个战略目标：1）对血管抑郁症基础的脑行为过程的综合理解； 2）表征发展轨迹以确定何时，何地和如何干预； 3）建立社区学术伙伴关系； 4）满足在城市内部公立医院环境中服务不足和研究不足的人口的需求；最终（如果资助）促进了NIMH赞助研究的公共卫生影响。公共卫生相关性：非洲裔美国人的高血压率最高，毫不奇怪，心血管疾病，中风和血管性痴呆症的发生率更高。鉴于预计到2050年，非洲裔美国老年人的数量将增加五倍，因此血管抑郁症的高风险的社会和经济影响可能会令人震惊。拟议的研究以社区学术伙伴关系模型为基础，通过在市中心，公立医院环境中进行心理研究的可行性来解决这一重要的公共卫生需求。