Han Bowie, Page Evaren E, Stewart Lauren M, Deford Cassandra C, Scott James G, Schwartz Lauren H, Perdue Jedidiah J, Terrell Deirdra R, Vesely Sara K, George James N
Department of Biostatistics and Epidemiology, College of Public Health, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.
Department of Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma.
Am J Hematol. 2015 Aug;90(8):709-14. doi: 10.1002/ajh.24060. Epub 2015 May 28.
After recovery from an acute episode of acquired thrombotic thrombocytopenic purpura (TTP), patients often describe problems with memory, concentration, and endurance. We have previously reported the occurrence of depression and cognitive impairment in these patients. In this study, we describe the frequency, severity, and clinical course of depression and cognitive impairment. Fifty-two (85%) out of 61 eligible Oklahoma Registry patients who had recovered from TTP, documented by ADAMTS13 activity <10%, have had at least one (median, four) evaluation for depression over 11 years using the Beck Depression Inventory-II; 31 (59%) patients screened positive for depression at least once; in 15 (29%), the results suggested severe depression at least once. Nine of these 15 patients had a psychiatric interview, the definitive diagnostic evaluation; the diagnosis of major depressive disorder was established in eight (89%) patients. In 2014, cognitive ability was evaluated in 33 patients by the Montreal Cognitive Assessment and the Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Both tests detected significant cognitive impairment in the patients as a group. Fifteen out of the 33 patients had been evaluated by extensive cognitive tests in 2006. The 2014 RBANS results were significantly worse than the 2006 results for the overall score and two out of the five RBANS domains (immediate and delayed memory). Neither depression nor cognitive impairment was significantly associated with the occurrence of relapses or ADAMTS13 activity <10% during remission. These observations emphasize the importance of screening evaluations for depression and cognitive impairment after recovery from acquired TTP.
在获得性血栓性血小板减少性紫癜（TTP）急性发作恢复后，患者常描述存在记忆、注意力和耐力方面的问题。我们之前曾报道过这些患者中出现抑郁和认知障碍的情况。在本研究中，我们描述了抑郁和认知障碍的发生率、严重程度及临床病程。俄克拉荷马登记处61名符合条件的患者中，有52名（85%）已从TTP中康复，通过ADAMTS13活性<10%得以证实，在11年期间，他们使用贝克抑郁量表第二版至少接受过一次（中位数为四次）抑郁评估；31名（59%）患者至少有一次抑郁筛查呈阳性；15名（29%）患者的结果表明至少有一次为重度抑郁。这15名患者中有9名接受了精神病学访谈，即确定性诊断评估；其中8名（89%）患者被确诊为重度抑郁症。2014年，通过蒙特利尔认知评估和可重复神经心理状态评估量表（RBANS）对33名患者的认知能力进行了评估。两项测试均检测出该组患者存在明显的认知障碍。33名患者中有15名在2006年接受过全面的认知测试。2014年RBANS的总体评分及五个RBANS领域中的两个领域（即时和延迟记忆）的结果明显比2006年的结果更差。在缓解期，抑郁和认知障碍均与复发的发生或ADAMTS13活性<10%无显著关联。这些观察结果强调了在获得性TTP恢复后对抑郁和认知障碍进行筛查评估的重要性。
