Steffens David C, Snowden Mark, Fan Ming-Yu, Hendrie Hugh, Katon Wayne J, Unützer Jürgen
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
Am J Geriatr Psychiatry. 2006 May;14(5):401-9. doi: 10.1097/01.JGP.0000194646.65031.3f.
It is unclear whether cognitive impairment affects acute and long-term treatment response in geriatric depression. In addition, little is known about the long-term outcome of depression among older individuals who experience cognitive decline during a course of treatment for depression. The authors examined both of these issues using data from the IMPACT trial.
The sample consisted of 1,684 participants in the IMPACT study who had baseline and two-year follow-up data. Subjects were randomized to one year of active intervention with a depression care manager or usual care. After one year, all subjects had usual care for another year. Data were collected for two years. The authors used the Six-Item Cognitive Screener to examine acute and long-term effects on depression outcome of baseline cognitive impairment and of cognitive decline. Depression measures included the HSCL-20 and an estimation of depression-free days. Outcomes were determined using both linear regression and repeated-measures analyses.
Depressed subjects in the active intervention group had better depression outcomes at one year regardless of baseline cognitive impairment. Cognitively impaired subjects within each treatment group had similar outcomes to subjects without cognitive impairment. Subjects who experienced decline in cognitive score over two years had worse 24-month depression outcomes compared with subjects whose cognitive score did not change.
Cognitively impaired depressed patients can experience significant improvement in depression with appropriate acute and continuation-phase management. Older depressed adults experiencing ongoing cognitive decline may be at higher risk for poor depression outcomes and may require more careful clinical monitoring and management of both cognitive and affective symptoms.
认知障碍是否会影响老年抑郁症患者的急性和长期治疗反应尚不清楚。此外，对于在抑郁症治疗过程中出现认知衰退的老年人，其抑郁症的长期转归知之甚少。作者利用IMPACT试验的数据对这两个问题进行了研究。
样本包括IMPACT研究中的1684名参与者，他们有基线数据和两年的随访数据。受试者被随机分配接受抑郁症护理经理为期一年的积极干预或常规护理。一年后，所有受试者再接受一年的常规护理。数据收集了两年。作者使用六项认知筛查工具来研究基线认知障碍和认知衰退对抑郁症转归的急性和长期影响。抑郁症测量指标包括HSCL-20和无抑郁天数的估计。使用线性回归和重复测量分析来确定结果。
无论基线认知障碍如何，积极干预组中的抑郁症患者在一年时的抑郁症转归更好。每个治疗组中认知受损的受试者与无认知障碍的受试者有相似的转归。与认知分数未改变的受试者相比，在两年内认知分数下降的受试者24个月时的抑郁症转归更差。
通过适当的急性期和持续期管理，认知受损的抑郁症患者的抑郁症可得到显著改善。持续出现认知衰退的老年抑郁症患者抑郁症转归不良的风险可能更高，可能需要对认知和情感症状进行更仔细的临床监测和管理。
