Bogner Hillary R, Bruce Martha L, Reynolds Charles F, Mulsant Benoit H, Cary Mark S, Morales Knashawn, Alexopoulos George S
Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA 19104, USA.
Int J Geriatr Psychiatry. 2007 Sep;22(9):922-9. doi: 10.1002/gps.1767.
To describe the influence of domains of cognition on remission and response of depression in an intervention trial among older primary care patients.
Twenty primary care practices were randomly assigned to Usual Care or to an Intervention consisting of a depression care manager offering algorithm-based care for depression. In all, 599 adults 60 years and older with a depression diagnosis were included in these analyses. Depression severity and remission of depression were assessed by the 24-item Hamilton Depression Rating Scale. The Mini-Mental State Examination (MMSE) was our global measure of cognitive function. Verbal memory was assessed with the memory subscale of the Dementia Rating Scale. Attention was measured with the digit span from the Weschler Adult Intelligence Test. Response inhibition, one of the executive functions, was assessed with the Stroop Color-Word test.
The intervention was associated with improved remission and response rates regardless of cognitive impairment. Response inhibition as measured by the Stroop Color-Word test appeared to significantly modify the intervention versus usual care difference in remission and response at 4 months. Patients in the poorest performance quartile at baseline on the Stroop Color-Word test in the Intervention Condition were more likely to achieve remission of depression at 4 months than comparable patients in Usual Care [odds ratio (OR) = 17.76, 95% Confidence Interval (CI), 3.06, 103.1].
Depressed older adults in primary care with executive dysfunction have low remission and response rates when receiving usual care but benefit from depression care management.
在一项针对老年初级保健患者的干预试验中，描述认知领域对抑郁症缓解及反应的影响。
20家初级保健机构被随机分配至常规护理组或干预组，干预组由一名抑郁症护理经理提供基于算法的抑郁症护理。总计599名年龄在60岁及以上且被诊断为抑郁症的成年人纳入了这些分析。抑郁症严重程度及缓解情况通过24项汉密尔顿抑郁量表进行评估。简易精神状态检查表（MMSE）是我们对认知功能的整体测量方法。言语记忆通过痴呆评定量表的记忆分量表进行评估。注意力通过韦氏成人智力量表的数字广度进行测量。执行功能之一的反应抑制通过斯特鲁普颜色-文字测试进行评估。
无论有无认知障碍，干预均与缓解率及反应率的改善相关。通过斯特鲁普颜色-文字测试测量的反应抑制似乎在4个月时显著改变了干预组与常规护理组在缓解及反应方面的差异。在干预组中，基线时斯特鲁普颜色-文字测试表现最差的四分位数患者在4个月时比常规护理组的可比患者更有可能实现抑郁症缓解[优势比（OR）= 17.76，95%置信区间（CI），3.06，103.1]。
患有执行功能障碍的初级保健中抑郁的老年人在接受常规护理时缓解率及反应率较低，但可从抑郁症护理管理中获益。
