腹膜透析患者的抑郁与认知功能障碍：一项多中心横断面研究。

Depression and Cognitive Impairment in Peritoneal Dialysis: A Multicenter Cross-sectional Study.

机构信息

Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Institute of Nephrology, Peking University, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health, Beijing, China; Key Laboratory of Renal Disease, Ministry of Education, Beijing, China.

出版信息

Am J Kidney Dis. 2016 Jan;67(1):111-8. doi: 10.1053/j.ajkd.2015.06.025. Epub 2015 Aug 6.

DOI:10.1053/j.ajkd.2015.06.025

PMID:26255306

Abstract

BACKGROUND

Depression and cognitive impairment have been identified as independent risk factors for mortality in peritoneal dialysis (PD) patients. The relationship between depression and global and specific cognitive functions in PD patients was investigated in this study.

STUDY DESIGN

Multicenter cross-sectional study.

SETTING & PARTICIPANTS: 458 clinically stable patients, drawn from 5 PD units, who performed PD for at least 3 months were enrolled.

PREDICTOR

Depression, defined as depression severity index score > 0.5 using the Zung Self-rating Depression Scale.

OUTCOMES

Global and specific cognitive impairment. Global cognitive function was measured using the Modified Mini-Mental State Examination (3MS), Trail-Making Test forms A and B for executive function, and subtests of the Battery for the Assessment of Neuropsychological Status for immediate and delayed memory, visuospatial skills, and language ability.

RESULTS

Prevalences of depression and cognitive impairment evaluated by the 3MS were 52% and 28.4%, respectively. Patients with mild or moderate/severe depression had higher prevalences of general cognitive impairment, executive dysfunction, and impaired immediate and delayed memory. After adjusting for demographics, comorbid conditions, and clinical parameters, depression scores were independently associated with lower 3MS scores, lower immediate and delayed memory and language ability scores, and longer completion times of Trails A and B. Even mild depression was independently associated with higher risk for cognitive impairment, executive dysfunction, and impaired immediate and delayed memory after multivariable adjustments.

LIMITATIONS

The causal relationship between depression and cognitive impairment could not be determined, and the potential copathogenesis behind depression and cognitive impairment was not fully investigated.

CONCLUSIONS

Even mild depression is closely associated with global and specific cognitive impairment in PD patients.

摘要

背景

抑郁和认知障碍已被确定为腹膜透析（PD）患者死亡的独立危险因素。本研究旨在探讨 PD 患者中抑郁与整体和特定认知功能的关系。

研究设计

多中心横断面研究。

地点和参与者

纳入了来自 5 个 PD 单位的 458 名临床稳定的患者，他们接受 PD 治疗至少 3 个月。

预测因子

使用zung 自评抑郁量表，抑郁定义为抑郁严重程度指数评分>0.5。

结局

整体和特定认知障碍。整体认知功能采用修正后的简易精神状态检查（3MS）进行评估，执行功能采用连线测试 A 和 B，即刻和延迟记忆、视空间技能和语言能力的神经心理状态评估量表的子测验进行评估。

结果

3MS 评估的抑郁和认知障碍的患病率分别为 52%和 28.4%。轻度或中重度/重度抑郁患者的总体认知障碍、执行功能障碍和即刻及延迟记忆受损的患病率更高。在调整人口统计学、合并症和临床参数后，抑郁评分与 3MS 评分较低、即刻和延迟记忆及语言能力评分较低以及 Trails A 和 B 完成时间较长独立相关。即使是轻度抑郁，在多变量调整后，也与认知障碍、执行功能障碍和即刻及延迟记忆受损的风险增加独立相关。