Weill Cornell Medical College, Department of Psychiatry, Institute of Geriatric Psychiatry, White Plains, NY 10605, USA.
Am J Geriatr Psychiatry. 2011 Feb;19(2):115-22. doi: 10.1097/JGP.0b013e3181e751c4.
This study tested the hypothesis that use of semantic organizational strategy in approaching the Mattis Dementia Rating Scale (MDRS) complex verbal initiation/perseveration (CV I/P) task, a test of semantic fluency, is the function specifically associated with remission of late-life depression.
Seventy elders with major depression participated in a 12-week escitalopram treatment trial. Neuropsychologic performance was assessed at baseline after a 2-week drug washout period. Patients with a Hamilton Depression Rating Scale Score ≤7 for 2 consecutive weeks and who no longer met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria were considered to be remitted. Cox's proportional hazards survival analysis was used to examine the relationship between subtests of the I/P, other neuropsychologic domains, and remission rate. Participants' performance on the CV I/P subscale was coded for perseverations, and use of semantic strategy.
The relationship between the performance on the CV I/P subscale and remission rate was significant. No other subtest of the MDRS I/P evidenced this association. There was no significant relationship between speed, confrontation naming, verbal memory, or perseveration with remission rate. Remitters' use of verbal strategy was significantly greater than nonremitters.
Geriatric depressed patients who showed decrements in performance on a semantic fluency task showed poorer remission rates than those who showed adequate performance on this measure. Executive impairment in verbal strategy explained performance. This finding supports the concept that executive functioning exerts a "top down" effect on other basic cognitive processes, perhaps as a result of frontostriatal network dysfunction implicated in geriatric depression.
本研究检验了一个假设，即使用语义组织策略来处理 Mattis 痴呆评定量表（MDRS）复杂的词语启动/持续（CV I/P）任务，这是一种语义流畅性测试，与老年抑郁症的缓解有关。
70 名患有重度抑郁症的老年人参加了为期 12 周的依地普仑治疗试验。在 2 周的药物洗脱期后，在基线时进行神经心理学评估。连续 2 周汉密尔顿抑郁评定量表（HDRS）评分≤7 且不再符合《精神障碍诊断与统计手册》第 4 版标准的患者被认为是缓解的。Cox 比例风险生存分析用于检验 I/P 的子测试、其他神经心理学领域与缓解率之间的关系。参与者 CV I/P 子量表的表现被编码为持续和语义策略的使用。
CV I/P 子量表的表现与缓解率之间存在显著关系。MDRS I/P 的其他子测试均未显示出这种关联。速度、正面对抗命名、言语记忆或持续与缓解率之间没有显著关系。缓解者使用言语策略的比例明显高于非缓解者。
在语义流畅性任务中表现不佳的老年抑郁患者的缓解率低于在该测试中表现良好的患者。在言语策略方面的执行功能损伤解释了表现。这一发现支持了这样一种概念，即执行功能对其他基本认知过程施加了“自上而下”的影响，这可能是额叶纹状体网络功能障碍在老年抑郁症中的作用。
