Story Tyler J, Potter Guy G, Attix Deborah K, Welsh-Bohmer Kathleen A, Steffens David C
Division of Neurology, Duke University Medical Center, Durham, NC 27710, USA.
Am J Geriatr Psychiatry. 2008 Sep;16(9):752-9. doi: 10.1097/JGP.0b013e31817e739a. Epub 2008 Aug 12.
Depression is often associated with neurocognitive deficits in older adults, particularly in the domains of information processing speed, episodic memory, and executive functions. Greater neurocognitive dysfunction while depressed is associated with a less effective treatment response; however, questions remain about the specific variables that characterize patients showing low treatment response and persistent cognitive deficiencies.
The authors examined neurocognitive variables that differentiated patients who showed robust versus weak responses to antidepressant therapy.
The baseline sample included 110 women and 67 men, with a mean age of 69.1 years (SD = 6.9) and mean education of 14 years (SD = 3.3).
Patients enrolled in a treatment study completed both a structured diagnostic assessment for depression and neuropsychological testing at study entry and 1-year follow-up.
Clinicians rated patient depression using the Montgomery-Asberg Depression Rating Scale. Neuropsychological assessments consisted of prose recall and percent retention (Wechsler Memory Scale -III Logical Memory), word-list recall, attention and visuomotor processing speed (Trail Making A, Symbol Digit Modalities Test), and mental flexibility (Trail Making B).
Patients underwent treatment for depression following the guidelines of the Duke Somatic Treatment Algorithm for Geriatric Depression approach.
Individuals who demonstrated the greatest improvement in mood symptoms at follow-up exhibited better prose recall and faster processing speed at baseline than individuals who demonstrated weaker treatment responses. These differences remained after controlling for depression severity at both time-points.
The current results suggest that better pretreatment cognitive function, particularly in verbal memory, is associated with a greater treatment response in late-life depression.
抑郁症常与老年人的神经认知缺陷相关，尤其是在信息处理速度、情景记忆和执行功能方面。抑郁时更严重的神经认知功能障碍与治疗反应效果较差有关；然而，对于表现出低治疗反应和持续认知缺陷的患者的具体特征变量仍存在疑问。
作者研究了区分对抗抑郁治疗反应强烈与微弱的患者的神经认知变量。
基线样本包括110名女性和67名男性，平均年龄69.1岁（标准差=6.9），平均受教育年限14年（标准差=3.3）。
参加治疗研究的患者在研究开始时和1年随访时完成了抑郁症的结构化诊断评估和神经心理学测试。
临床医生使用蒙哥马利-阿斯伯格抑郁评定量表对患者的抑郁程度进行评分。神经心理学评估包括散文回忆和保留率（韦氏记忆量表第三版逻辑记忆）、单词列表回忆、注意力和视觉运动处理速度（连线测验A、符号数字模式测验）以及心理灵活性（连线测验B）。
患者按照杜克老年抑郁症躯体治疗算法指南接受抑郁症治疗。
在随访中情绪症状改善最大的个体在基线时表现出比治疗反应较弱的个体更好的散文回忆和更快的处理速度。在控制了两个时间点的抑郁严重程度后，这些差异仍然存在。
目前的结果表明，更好的治疗前认知功能，尤其是言语记忆方面，与老年抑郁症患者更大的治疗反应相关。
