Sheline Yvette I, Pieper Carl F, Barch Deanna M, Welsh-Bohmer Kathleen, McKinstry Robert C, MacFall James R, D'Angelo Gina, Garcia Keith S, Gersing Kenneth, Wilkins Consuelo, Taylor Warren, Steffens David C, Krishnan Ranga R, Doraiswamy P Murali
Department of Psychiatry, Washington University School of Medicine, 660 S Euclid, Box 8134, St Louis, MO 63110, USA.
Arch Gen Psychiatry. 2010 Mar;67(3):277-85. doi: 10.1001/archgenpsychiatry.2009.204.
Research on vascular depression has used 2 approaches to subtype late-life depression, based on executive dysfunction or white matter hyperintensity severity.
To evaluate the relationship of neuropsychological performance and white matter hyperintensity with clinical response in late-life depression.
Two-site, prospective, nonrandomized controlled trial.
Outpatient clinics at Washington University and Duke University.
A total of 217 subjects aged 60 years or older met DSM-IV criteria for major depression, scored 20 or more on the Montgomery-Asberg Depression Rating Scale (MADRS), and received vascular risk factor scores, neuropsychological testing, and magnetic resonance imaging; they were excluded for cognitive impairment or severe medical disorders. Fazekas rating was conducted to grade white matter hyperintensity lesions. Intervention Twelve weeks of sertraline treatment, titrated by clinical response. Main Outcome Measure Participants' MADRS scores over time.
Baseline neuropsychological factor scores correlated negatively with baseline Fazekas scores. A mixed model examined effects of predictor variables on MADRS scores over time. Baseline episodic memory (P = .002), language (P = .007), working memory (P = .01), processing speed (P < .001), executive function factor scores (P = .002), and categorical Fazekas ratings (P = .05) predicted MADRS scores, controlling for age, education, age of onset, and race. Controlling for baseline MADRS scores, these factors remained significant predictors of decrease in MADRS scores, except for working memory and Fazekas ratings. Thirty-three percent of subjects achieved remission (MADRS < or =7). Remitters differed from nonremitters in baseline cognitive processing speed, executive function, language, episodic memory, and vascular risk factor scores.
Comprehensive neuropsychological function and white matter hyperintensity severity predicted MADRS scores prospectively over a 12-week treatment course with selective serotonin reuptake inhibitors in late-life depression. Baseline neuropsychological function differentiated remitters from nonremitters and predicted time to remission in a proportional hazards model. Predictor variables correlated highly with vascular risk factor severity. These data support the vascular depression hypothesis and highlight the importance of linking subtypes based on neuropsychological function and white matter integrity.
clinicaltrials.gov Identifier: NCT00045773.
血管性抑郁症的研究基于执行功能障碍或白质高信号严重程度，采用两种方法对老年期抑郁症进行亚型分类。
评估老年期抑郁症患者神经心理表现和白质高信号与临床反应之间的关系。
双中心、前瞻性、非随机对照试验。
华盛顿大学和杜克大学的门诊诊所。
共有217名60岁及以上的受试者符合DSM-IV重度抑郁症标准，蒙哥马利-阿斯伯格抑郁量表（MADRS）得分20分或更高，并接受了血管危险因素评分、神经心理测试和磁共振成像检查；因认知障碍或严重躯体疾病而被排除。采用 Fazekas 分级对白质高信号病变进行分级。干预：舍曲林治疗12周，根据临床反应进行滴定。主要结局指标：参与者随时间变化的MADRS评分。
基线神经心理因素评分与基线 Fazekas 评分呈负相关。采用混合模型检验预测变量对随时间变化的MADRS评分的影响。在控制年龄、教育程度、发病年龄和种族后，基线情景记忆（P = 0.002）、语言（P = 0.007）、工作记忆（P = 0.01）、处理速度（P < 0.001）、执行功能因子评分（P = 0.002）和分类 Fazekas 分级（P = 0.05）可预测MADRS评分。在控制基线MADRS评分后，除工作记忆和 Fazekas 分级外，这些因素仍然是MADRS评分降低的显著预测因素。33% 的受试者达到缓解（MADRS≤7）。缓解者与未缓解者在基线认知处理速度、执行功能、语言、情景记忆和血管危险因素评分方面存在差异。
在老年期抑郁症患者中，综合神经心理功能和白质高信号严重程度在12周的选择性5-羟色胺再摄取抑制剂治疗过程中可前瞻性预测MADRS评分。在比例风险模型中，基线神经心理功能可区分缓解者与未缓解者，并预测缓解时间。预测变量与血管危险因素严重程度高度相关。这些数据支持血管性抑郁症假说，并强调了基于神经心理功能和白质完整性对亚型进行关联的重要性。
clinicaltrials.gov标识符：NCT00045773。
