Stoudemire A, Hill C D, Morris R, Martino-Saltzman D, Markwalter H, Lewison B
Medical-Psychiatric Unit, Emory University Hospital, Atlanta, GA.
Am J Psychiatry. 1991 Oct;148(10):1336-40. doi: 10.1176/ajp.148.10.1336.
This study sought to ascertain the affective and cognitive outcome after tricyclic and electroconvulsive treatment of elderly medical-psychiatric patients meeting diagnostic criteria for major depression, some of whom had normal cognitive functioning and some of whom were cognitively impaired before treatment.
Patients who met criteria for major depression on the basis of a structured diagnostic interview and who scored 17 or more on the Hamilton Rating Scale for Depression were evaluated with the Mattis Dementia Rating Scale. The patients were then treated in a nonrandom manner with either tricyclic antidepressants or ECT (followed by tricyclic maintenance therapy). The majority of the patients treated with ECT had not responded previously to tricyclics. Follow-up psychometric testing was repeated in 6 months.
Among the patients with normal pretreatment cognitive functioning, cognition was generally stable. Among the patients with pretreatment cognitive impairment, a substantial number--including those receiving ECT--demonstrated improvement in cognition. While the majority of patients improved with respect to both their affective and cognitive states, certain treatment-refractory subgroups were nevertheless identified.
The data suggest that cognitive dysfunction associated with depression may improve after treatment in a substantial number of elderly patients, including those receiving ECT. Relapse rates, however, may be relatively high, and residual symptoms may persist, which emphasizes the need for optimal initial and long-term antidepressant strategies for this population.
本研究旨在确定符合重度抑郁症诊断标准的老年医学 - 精神病患者在接受三环类药物治疗和电休克治疗后的情感和认知结果，其中一些患者治疗前认知功能正常，另一些患者治疗前存在认知障碍。
基于结构化诊断访谈符合重度抑郁症标准且汉密尔顿抑郁量表评分达到或超过17分的患者，使用马蒂斯痴呆评定量表进行评估。然后，患者以非随机方式接受三环类抗抑郁药或电休克治疗（随后进行三环类维持治疗）。大多数接受电休克治疗的患者此前对三环类药物无反应。6个月后重复进行随访心理测量测试。
在治疗前认知功能正常的患者中，认知功能总体稳定。在治疗前存在认知障碍的患者中，相当一部分患者——包括接受电休克治疗的患者——认知功能有所改善。虽然大多数患者在情感和认知状态方面均有改善，但仍确定了某些治疗抵抗亚组。
数据表明，包括接受电休克治疗的患者在内，大量老年患者在治疗后与抑郁症相关的认知功能障碍可能会改善。然而，复发率可能相对较高，残留症状可能持续存在，这强调了针对该人群制定最佳初始和长期抗抑郁策略的必要性。
