认知控制、与奖励相关的决策制定以及抗抑郁药治疗的老年抑郁症的结果
Cognitive control, reward-related decision making and outcomes of late-life depression treated with an antidepressant.
作者信息
Alexopoulos G S, Manning K, Kanellopoulos D, McGovern A, Seirup J K, Banerjee S, Gunning F
机构信息
Department of Psychiatry,Weill Cornell Medical College,White Plains,NY,USA.
Department of Psychiatry,University of Connecticut Health Center,Farmington,CT,USA.
出版信息
Psychol Med. 2015 Oct;45(14):3111-20. doi: 10.1017/S0033291715001075. Epub 2015 Jul 14.
BACKGROUND
Executive processes consist of at least two sets of functions: one concerned with cognitive control and the other with reward-related decision making. Abnormal performance in both sets occurs in late-life depression. This study tested the hypothesis that only abnormal performance in cognitive control tasks predicts poor outcomes of late-life depression treated with escitalopram.
METHOD
We studied older subjects with major depression (N = 53) and non-depressed subjects (N = 30). Executive functions were tested with the Iowa Gambling Test (IGT), Stroop Color-Word Test, Tower of London (ToL), and Dementia Rating Scale - Initiation/Perseveration domain (DRS-IP). After a 2-week placebo washout, depressed subjects received escitalopram (target daily dose: 20 mg) for 12 weeks.
RESULTS
There were no significant differences between depressed and non-depressed subjects on executive function tests. Hierarchical cluster analysis of depressed subjects identified a Cognitive Control cluster (abnormal Stroop, ToL, DRS-IP), a Reward-Related cluster (IGT), and an Executively Unimpaired cluster. Decline in depression was greater in the Executively Unimpaired (t = -2.09, df = 331, p = 0.0375) and the Reward-Related (t = -2.33, df = 331, p = 0.0202) clusters than the Cognitive Control cluster. The Executively Unimpaired cluster (t = 2.17, df = 331, p = 0.03) and the Reward-Related cluster (t = 2.03, df = 331, p = 0.0433) had a higher probability of remission than the Cognitive Control cluster.
CONCLUSIONS
Dysfunction of cognitive control functions, but not reward-related decision making, may influence the decline of symptoms and the probability of remission of late-life depression treated with escitalopram. If replicated, simple to administer cognitive control tests may be used to select depressed older patients at risk for poor outcomes to selective serotonin reuptake inhibitors who may require structured psychotherapy.
背景
执行过程至少由两组功能组成：一组与认知控制有关，另一组与奖赏相关的决策有关。这两组功能的异常表现均出现在老年抑郁症中。本研究检验了以下假设：只有认知控制任务中的异常表现才能预测艾司西酞普兰治疗的老年抑郁症的不良预后。
方法
我们研究了患有重度抑郁症的老年受试者（N = 53）和非抑郁症老年受试者（N = 30）。采用爱荷华赌博任务（IGT）、斯特鲁普色词测验、伦敦塔测验（ToL）和痴呆评定量表-启动/持续领域（DRS-IP）对执行功能进行测试。经过2周的安慰剂洗脱期后，抑郁症患者接受艾司西酞普兰（目标日剂量：20mg）治疗12周。
结果
抑郁症患者和非抑郁症患者在执行功能测试中无显著差异。对抑郁症患者进行分层聚类分析，确定了一个认知控制聚类（斯特鲁普、ToL、DRS-IP异常）、一个奖赏相关聚类（IGT）和一个执行功能未受损聚类。执行功能未受损聚类（t = -2.09，自由度 = 331，p = 0.0375）和奖赏相关聚类（t = -2.33，自由度 = 331，p = 0.0202）的抑郁症状改善程度大于认知控制聚类。执行功能未受损聚类（t = 2.17，自由度 = 331，p = 0.03）和奖赏相关聚类（t = 2.03，自由度 = 331，p = 0.0433）的缓解概率高于认知控制聚类。
结论
认知控制功能障碍而非奖赏相关决策功能障碍，可能会影响艾司西酞普兰治疗的老年抑郁症症状的改善和缓解概率。如果得到重复验证，简单易行的认知控制测试可用于筛选可能对选择性5-羟色胺再摄取抑制剂治疗效果不佳、可能需要结构化心理治疗的老年抑郁症患者。
Zotero 插件