Department of Psychology, Queens College, City University of New York, Flushing, NY 11367, USA.
Am J Geriatr Psychiatry. 2009 Oct;17(10):881-8. doi: 10.1097/jgp.0b013e3181b4bf4a.
Selective Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed medications for geriatric depression. The association of late-life depression and cognitive impairment has been well documented. However, there have been few placebo-controlled trials examining the impact of SSRIs on cognitive functioning.
Prepost neuropsychological (NP) data collected as part of an 8-week, double-blind, placebo-controlled trial of citalopram in depressed patients aged 75 years and older were used to examine change in cognitive functioning.
University-affiliated outpatient psychiatry clinics.
One hundred seventy-four community-dwelling men and women aged 75 years or older with nonpsychotic unipolar depression.
NP assessments included mental status (Mini-Mental State Examination), psychomotor speed (Wechsler Adult Intelligence Scale-III Digit Symbol Subtest), reaction time (Choice Reaction Time), visual-spatial skill (Judgment of Line Orientation), executive functioning (Stroop Color/Word Test), and memory (Buschke Selective Reminding Test).
Differences in the pattern of change by treatment group depended on responder status. Citalopram nonresponders were the only group to decline on verbal learning and psychomotor speed. Citalopram responders showed significant improvement in visuospatial functioning, when compared with nonresponders in either condition, but their improvement was not greater than responders on placebo. Citalopram responders showed greater improvement on psychomotor speed than citalopram nonresponders, but their improvement was not greater than placebo responders or nonresponders.
Medication may have a deleterious effect on some aspects of cognition among patients aged 75 years and older who have not responded. This suggests that patients should not be maintained on a medication if they have not had an adequate response.
选择性 5-羟色胺再摄取抑制剂（SSRIs）是治疗老年抑郁症最常用的药物。晚年抑郁症与认知障碍的相关性已有充分的记录。然而，很少有安慰剂对照试验研究 SSRIs 对认知功能的影响。
在一项为期 8 周、双盲、安慰剂对照的西酞普兰治疗 75 岁及以上抑郁症患者的研究中，收集了神经心理学（NP）的前后测数据，用于检查认知功能的变化。
大学附属门诊精神病诊所。
174 名居住在社区的 75 岁及以上、非精神病性单相抑郁的男女。
NP 评估包括心理状态（简易精神状态检查）、运动速度（韦氏成人智力量表-III 数字符号替代测验）、反应时间（选择反应时间）、视觉空间技能（判断线定向）、执行功能（Stroop 颜色/单词测试）和记忆（Buschke 选择性提醒测试）。
治疗组的变化模式差异取决于应答者的状态。西酞普兰无应答者是唯一在词语学习和运动速度上下降的组。与任何条件下的无应答者相比，西酞普兰应答者的视觉空间功能有显著改善，但改善程度不及安慰剂组。与无应答者相比，西酞普兰应答者的运动速度改善更大，但改善程度不及安慰剂应答者或无应答者。
对于未应答的 75 岁及以上患者，药物可能对某些认知方面产生有害影响。这表明，如果患者没有得到充分的反应，就不应该维持药物治疗。
