Ott Caroline Vintergaard, Vinberg Maj, Kessing Lars V, Miskowiak Kamilla W
Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet Dep. 6233, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Eur Neuropsychopharmacol. 2016 Aug;26(8):1264-73. doi: 10.1016/j.euroneuro.2016.05.009. Epub 2016 Jun 24.
This is a secondary data analysis from our erythropoietin (EPO) trials. We examine (I) whether EPO improves speed of complex cognitive processing across bipolar and unipolar disorder, (II) if objective and subjective baseline cognitive impairment increases patients׳ chances of treatment-efficacy and (III) if cognitive improvement correlates with better subjective cognitive function, quality of life and socio-occupational capacity. Patients with unipolar or bipolar disorder were randomized to eight weekly EPO (N=40) or saline (N=39) infusions. Cognition, mood, quality of life and socio-occupational capacity were assessed at baseline (week 1), after treatment completion (week 9) and at follow-up (week 14). We used repeated measures analysis of covariance to investigate the effect of EPO on speed of complex cognitive processing. With logistic regression, we examined whether baseline cognitive impairment predicted treatment-efficacy. Pearson correlations were used to assess associations between objective and subjective cognition, quality of life and socio-occupational capacity. EPO improved speed of complex cognitive processing across affective disorders at weeks 9 and 14 (p≤0.05). In EPO-treated patients, baseline cognitive impairment increased the odds of treatment-efficacy on cognition at weeks 9 and 14 by a factor 9.7 (95% CI:1.2-81.1) and 9.9 (95% CI:1.1-88.4), respectively (p≤0.04). Subjective cognitive complaints did not affect chances of treatment-efficacy (p≥0.45). EPO-associated cognitive improvement correlated with reduced cognitive complaints but not with quality of life or socio-occupational function. As the analyses were performed post-hoc, findings are only hypothesis-generating. In conclusion, pro-cognitive effects of EPO occurred across affective disorders. Neuropsychological screening for cognitive dysfunction may be warranted in future cognition trials.
这是一项对我们的促红细胞生成素（EPO）试验进行的二次数据分析。我们研究了：（I）EPO是否能提高双相情感障碍和单相情感障碍患者复杂认知加工的速度；（II）客观和主观的基线认知障碍是否会增加患者治疗有效的几率；以及（III）认知改善是否与更好的主观认知功能、生活质量和社会职业能力相关。单相或双相情感障碍患者被随机分为接受八周每周一次的EPO输注组（N = 40）或生理盐水输注组（N = 39）。在基线期（第1周）、治疗结束后（第9周）和随访期（第14周）评估认知、情绪、生活质量和社会职业能力。我们使用重复测量协方差分析来研究EPO对复杂认知加工速度的影响。通过逻辑回归，我们检验了基线认知障碍是否能预测治疗效果。使用Pearson相关性分析来评估客观与主观认知、生活质量和社会职业能力之间的关联。在第9周和第14周时，EPO提高了情感障碍患者复杂认知加工的速度（p≤0.05）。在接受EPO治疗的患者中，基线认知障碍使第9周和第14周认知治疗有效的几率分别增加了9.7倍（95%置信区间：1.2 - 81.1）和9.9倍（95%置信区间：1.1 - 88.4）（p≤0.04）。主观认知主诉并不影响治疗有效的几率（p≥0.45）。与EPO相关的认知改善与认知主诉减少相关，但与生活质量或社会职业功能无关。由于这些分析是事后进行的，研究结果仅用于生成假设。总之，EPO在情感障碍中产生了促认知作用。在未来的认知试验中，可能有必要对认知功能障碍进行神经心理学筛查。
