Bortolato Beatrice, Carvalho Andre F, McIntyre Roger S
Departments of Psychiatry and Pharmacology, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, Ontario, M5T 2S8, Canada.
CNS Neurol Disord Drug Targets. 2014;13(10):1804-18. doi: 10.2174/1871527313666141130203823.
Major depressive disorder (MDD) is a prevalent and recurring mental disorder often associated with high rates of non-recovery and substantial consequences on psychosocial outcome. Cognitive impairment is one of the most frequent residual symptoms of MDD. The persistence of cognitive impairment even in remitted phases of the disorder, notably in the domains of executive function and attention, suggests that it may serve as a mediational nexus between MDD and poor functional outcome, accounting for occupational and relational difficulties regardless of clinical improvement on depressive symptoms. The critical impact of cognitive deficits on psychosocial dysfunction invites clinicians to regularly screen and assess cognition across multiple domains, taking into account also clinical correlates of cognitive dysfunction in MDD. Despite the availability of several instruments for the screening and assessment of cognitive dysfunction, the lack of consensus guiding the choice of appropriate instruments increases the likelihood to underestimate cognitive dysfunction in MDD in clinical settings. On the other hand, the unsatisfactory effect of most antidepressant treatments on cognitive deficits for many individuals with MDD calls for the development of genuinely novel therapeutic agents with potential to target cognitive dysfunction. Notwithstanding the necessity of further investigations, this review indicates that neuropsychological deficits (e.g., impaired executive functions) are stable markers of MDD and underscores the need for the development of integrative and multi-modal strategies for the prevention and treatment of neuropsychological impairments in MDD.
重度抑郁症（MDD）是一种常见且复发性的精神障碍，常与高复发率以及对心理社会结局产生的重大后果相关。认知障碍是MDD最常见的残留症状之一。即使在该疾病的缓解期，认知障碍仍持续存在，尤其是在执行功能和注意力领域，这表明它可能是MDD与不良功能结局之间的中介联系，无论抑郁症状在临床上是否改善，都会导致职业和人际关系方面的困难。认知缺陷对心理社会功能障碍的关键影响促使临床医生定期对多个领域的认知进行筛查和评估，同时也要考虑MDD中认知功能障碍的临床相关因素。尽管有多种用于筛查和评估认知功能障碍的工具，但缺乏指导选择合适工具的共识增加了在临床环境中低估MDD认知功能障碍的可能性。另一方面，对于许多MDD患者而言，大多数抗抑郁治疗对认知缺陷的效果并不理想，这就需要开发真正有潜力针对认知功能障碍的新型治疗药物。尽管有必要进行进一步研究，但本综述表明，神经心理学缺陷（例如执行功能受损）是MDD的稳定标志物，并强调需要制定综合和多模式策略来预防和治疗MDD中的神经心理学损伤。
