Tracy Joseph I, Lippincott Cynthia, Mahmood Tariq, Waldron Brigid, Kanauss Kevin, Glosser David, Sperling Michael R
Department of Neurology, Comprehensive Epilepsy Center, Thomas Jefferson University Hospital/Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
Epilepsia. 2007 Dec;48(12):2327-35. doi: 10.1111/j.1528-1167.2007.01254.x. Epub 2007 Aug 14.
The degree to which depression interacts with the cognitive deficits of epilepsy to alter cognitive skill and general functioning is unknown. Depression has significant negative effects on adaptive functioning including cognitive skills. Temporal lobe epilepsy (TLE) patients are known to possess cognitive dysfunction. Thus, TLE patients who are depressed may suffer a double burden of cognitive deficits.
We examined whether depressed patients show increased cognitive deficits relative to nondepressed TLE patients (n = 59). We then sought to determine if this effect varied for left versus right TLE patients utilizing preoperative depression and neuropsychological data. To accurately study the lateralization of any observed effects, we selected only patients with definitive evidence of unilateral pathology and seizure focus and utilized a two-year seizure-free postsurgical outcome to capture this.
The data suggested that cognitive performance was not related to depression, and that depression did not reliably mediate the cognitive presentation of either our left or right TL patients. The notion of a double burden on cognition did not receive support from our data. The data did produce the expected advantage on verbal memory measures for right TLE patients.
The reasons for the limited statistical effects are discussed and issues in unraveling the causal relationships between depression, cognition, and TLE are considered. We discussed the potential role depression may play in the cognitive skills of TLE patients, but the major implication is that depression and neurocognitive performance appear to bear a limited relationship in the context of TLE.
抑郁症与癫痫的认知缺陷相互作用以改变认知技能和总体功能的程度尚不清楚。抑郁症对包括认知技能在内的适应性功能有显著负面影响。已知颞叶癫痫（TLE）患者存在认知功能障碍。因此，患有抑郁症的TLE患者可能承受双重认知缺陷负担。
我们研究了与未患抑郁症的TLE患者（n = 59）相比，患抑郁症的患者是否表现出更多的认知缺陷。然后，我们试图利用术前抑郁症和神经心理学数据来确定这种影响在左侧与右侧TLE患者中是否有所不同。为了准确研究任何观察到的效应的脑叶定位，我们仅选择具有单侧病变和癫痫病灶的确切证据的患者，并利用术后两年无癫痫发作的结果来进行研究。
数据表明，认知表现与抑郁症无关，抑郁症也不能可靠地介导我们左侧或右侧TLE患者的认知表现。认知双重负担的概念未得到我们数据的支持。数据确实在右侧TLE患者的言语记忆测量中产生了预期的优势。
讨论了统计效应有限的原因，并考虑了在揭示抑郁症、认知和TLE之间因果关系时存在的问题。我们讨论了抑郁症可能在TLE患者认知技能中所起的潜在作用，但主要的结论是，在TLE背景下，抑郁症与神经认知表现之间的关系似乎有限。
