Calderón J, Flores P, Babul M, Aguirre J M, Slachevsky A, Padilla O, Scoriels L, Henríquez C, Cárcamo C, Bravo-Zehnder M, González A, Massardo L
Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
Department of Neurological Sciences Oriente, Facultad de Medicina, Universidad de Chile, Chile.
Lupus. 2014 Sep;23(10):1042-53. doi: 10.1177/0961203314536247. Epub 2014 May 30.
Our aim was to assess the contribution of depression to cognitive impairment in patients with systemic lupus erythematosus (SLE).
Clinical features, education, age, and Hospital Anxiety and Depression Scale (HADS) were evaluated in 82 patients with SLE and 22 healthy controls, all Chilean women. The Cambridge Neuropsychological Test Automated Battery (CANTAB eclipseTM) assessing attention, spatial memory, and learning and executive function domains was applied. Cognitive deficit definition: a cut-off for definite impairment was defined as a score below -2 standard deviations in at least one outcome measure in two or more domains. ANCOVA with stepwise selection evaluated influences of health status (SLE or control), age, education, and HADS depression and anxiety scores on cognitive outcomes. To avoid overfitting, a shrinkage method was performed. Also, adjusted p-values for multiple comparisons were obtained.
Cognitive deficit affected 16 (20%) patients, and no controls (p=0.039). Median HADS depression score in SLE patients was 6 (range 0-19) and in controls was 0 (0-19), p<0.001). ANCOVA and shrinkage models showed that worse cognitive performance in sustained attention and spatial working memory tests was explained by the presence of SLE but not depression, whereas depression only affected a measure of executive function (I/ED Stages completed).
Depression has a limited role in cognitive impairment in SLE. Impairments in sustained attention and spatial working memory are distinctly influenced by yet-unknown disease-intrinsic factors.
我们的目的是评估抑郁症对系统性红斑狼疮（SLE）患者认知障碍的影响。
对82例SLE患者和22名健康对照者（均为智利女性）进行了临床特征、教育程度、年龄及医院焦虑抑郁量表（HADS）评估。应用剑桥神经心理测试自动成套系统（CANTAB eclipseTM）评估注意力、空间记忆、学习及执行功能领域。认知缺陷定义：明确损伤的临界值定义为在两个或更多领域中至少一项结果测量得分低于-2个标准差。采用逐步选择的协方差分析评估健康状况（SLE或对照）、年龄、教育程度以及HADS抑郁和焦虑得分对认知结果的影响。为避免过度拟合，采用了收缩方法。此外，还获得了多重比较的校正p值。
认知缺陷影响了16例（20%）患者，而对照组无此情况（p=0.039）。SLE患者的HADS抑郁评分中位数为6（范围0-19），对照组为0（0-19），p<0.001）。协方差分析和收缩模型表明，持续注意力和空间工作记忆测试中较差的认知表现可由SLE的存在来解释，而非抑郁症，而抑郁症仅影响执行功能的一项测量指标（完成的I/ED阶段）。
抑郁症在SLE患者的认知障碍中作用有限。持续注意力和空间工作记忆的损伤明显受未知的疾病内在因素影响。
