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    The Relationships between Depressive Symptoms, Inflammatory Cytokines, and Lower Extremity Function after Hip Fracture

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    Author
    Matheny, Maya E.
    Advisor
    Orwig, Denise L.
    Date
    2013
    Type
    dissertation
    
    Metadata
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    Abstract
    Background: Hip fractures are associated with alterations in physical, psychological, and immunologic functions in more than 1.6 million older adults who are affected annually. We aimed to examine the inter-relationships between these functional domains in a sample of older adult female hip fracture patients. Methods: Participants were community-dwelling women aged >65 years, admitted to one of three Baltimore-area hospitals with a new, non-pathological fracture of the proximal femur. At baseline, 2, 6 and 12 months post-fracture, depressive symptoms were assessed with the 15-item Geriatric Depression Scale (GDS). At 2, 6, and 12 months post-fracture, serum was analyzed for interleukin-6 (IL-6) and soluble tumor necrosis factor alpha receptor 1 (sTNF-αR1), and lower extremity performance was measured by the Lower Extremity Gain Scale (LEGS). Generalized estimating equations were used to model the longitudinal relationships between variables of interest. Results: Clinically significant levels of depressive symptoms were present in 12.5% of study participants at baseline. Persistently high depressive symptoms were significantly associated with lower sTNF-αR1 levels at 2 months (p=0.02) followed by an increase in sTNF-αR1 levels by 12 months (p<0.0001). Participants in the highest categories of IL-6 (≥5.14 pg/mL) and sTNF-αR1 (≥2421 pg/mL) had the highest GDS scores in the year post-fracture (p=0.09 for both). At 12 months post-fracture, the highest IL-6 and sTNF-αR1 categories had GDS scores that were on average 1.9 (95% confidence interval [CI]: 0.4, 3.4; p=0.01) and 1.4 (95% CI: -0.1, 3.0; p=0.07) points higher than the lowest category, respectively. Participants in the highest categories of IL-6 (≥3.69 pg/mL) and sTNF-αR1 (≥2210 pg/mL) had the lowest LEGS scores in the year post-fracture (p=0.03 for IL-6; p=0.23 for sTNF-αR1). At 2 months post-fracture, the highest IL-6 and sTNF-αR1 categories had LEGS scores that were on average 4.8 (95% CI: -8.1, -1.6; p=0.004) and 3.0 (95% CI: -6.3, 0.3; p=0.07) points lower than the lowest category, respectively. Conclusions: Results from this study support a role for inflammation in the pathophysiology of depressive symptoms after hip fracture. The magnitude and speed of recovery of lower extremity function may depend on the level of the pro-inflammatory cytokine response.
    Description
    University of Maryland, Baltimore. Epidemiology and Human Genetics. Ph.D. 2013
    Keyword
    Cytokines
    depressive symptoms
    functional recovery
    Hip Fractures
    Inflammation
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/2765
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    Theses and Dissertations All Schools
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