Duke-UNC Brain Imaging and Analysis Center, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA.
Am J Geriatr Psychiatry. 2012 Aug;20(8):653-63. doi: 10.1097/JGP.0b013e31823e2cc7.
Persistent cognitive impairment (PCI) after remission of depressive symptoms is a major adverse outcome of late-life depression (LLD). The purpose of this study was to examine neural substrates associated with PCI in LLD.
Longitudinal study.
Outpatient depression treatment study at Duke University.
Twenty-three patients with LLD completed a 2-year follow-up study, and were in a remitted or partially remitted state at Year 2.
At first entry to the study (Year 0), all participants had a functional magnetic resonance imaging scan while performing an emotional oddball task. For the purpose of this report, the primary functional magnetic resonance imaging outcome was brain activation during target detection, which is a measure of executive function. The Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery was used to assess cognitive status yearly, and the Montgomery-Åsberg Depression Rating Scale was used to assess severity of depression at Year 0 and every 6 months thereafter for 2 years. We investigated changes in brain activation at Year 0 associated with PCI over 2 years.
Patients with PCI at the 2-year follow-up date had significantly decreased activation at Year 0 in the dorsal anterior cingulate cortex, hippocampus, inferior frontal cortex, and insula compared to non-PCI patients.
Our results suggest individuals who have LLD with PCI have decreased activation in the similar neural networks associated with the development of Alzheimer disease among nondepressed individuals. Measuring neural activity in these regions in individuals with LLD may help identify patients at-risk for cognitive impairment.
抑郁症状缓解后持续性认知障碍（PCI）是老年期抑郁症（LLD）的主要不良后果。本研究旨在探讨与 LLD 中 PCI 相关的神经基础。
纵向研究。
杜克大学的门诊抑郁症治疗研究。
23 名 LLD 患者完成了为期 2 年的随访研究，在第 2 年时处于缓解或部分缓解状态。
在研究开始时（第 0 年），所有参与者在执行情绪意外任务时进行了功能磁共振成像扫描。就本报告而言，主要的功能磁共振成像结果是目标检测时的大脑激活，这是执行功能的一种衡量标准。使用 Alzheimer 病神经心理学登记研究联合会的神经心理学成套测验来每年评估认知状况，并用 Montgomery-Åsberg 抑郁评定量表在第 0 年和之后每 6 个月评估 2 年的抑郁严重程度。我们调查了与 2 年 PCI 相关的第 0 年大脑激活变化。
在 2 年随访日期出现 PCI 的患者在第 0 年的背侧前扣带皮层、海马体、下额叶皮层和岛叶的激活明显低于非 PCI 患者。
我们的结果表明，有 PCI 的 LLD 患者在与非抑郁个体中阿尔茨海默病发展相关的相似神经网络中的激活减少。在 LLD 个体中测量这些区域的神经活动可能有助于识别有认知障碍风险的患者。
