Carrière Isabelle, Norton Joanna, Farré Amandine, Wyart Marilyn, Tzourio Christophe, Noize Pernelle, Pérès Karine, Fourrier-Réglat Annie, Ritchie Karen, Ancelin Marie Laure
Inserm U1061, Neuropsychiatry: epidemiological and clinical research, 39 avenue Charles Flahault, BP 34493, 34093, Montpellier cedex 05, France.
Univ. Montpellier, U1061, Montpellier, France.
BMC Med. 2017 Apr 19;15(1):81. doi: 10.1186/s12916-017-0847-z.
Cognitive impairment is very common in late-life depression, principally affecting executive skills and information processing speed. The aim of the study was to examine the effect of antidepressant treatment on cognitive performances over a 10-year period.
The community-based cohort included 7381 participants aged 65 years and above. Five cognitive domains (verbal fluency, psychomotor speed, executive function, visuospatial skills and global cognition) were assessed up to five times over 10 years of follow-up. Treatment groups included participants under a specific antidepressant class at both baseline and the first follow-up and their follow-up cognitive data were considered until the last consecutive follow-up with a report of antidepressant use of the same class. Linear mixed models were used to compare baseline cognitive performance and cognitive decline over time according to antidepressant treatment. The models were adjusted for multiple confounders including residual depressive symptoms assessed by the Center for Epidemiologic Studies-Depression scale.
At baseline, 4.0% of participants were taking antidepressants. Compared to non-users, tricyclic antidepressant users had lower baseline performances in verbal fluency, visual memory and psychomotor speed, and selective serotonin reuptake inhibitor users in verbal fluency and psychomotor speed. For the two other cognitive abilities, executive function and global cognition, no significant differences were found at baseline irrespective of the antidepressant class. Regarding changes over time, no significant differences were observed in comparison with non-users whatever the cognitive domain, except for a slight additional improvement over the follow-up in verbal fluency skills for tricyclic antidepressant users.
In this large elderly general population cohort, we found no evidence for an association between antidepressant use and post-treatment cognitive decline over 10 years of follow-up in various cognitive domains.
认知障碍在老年抑郁症中非常常见，主要影响执行技能和信息处理速度。本研究的目的是考察抗抑郁治疗在10年期间对认知表现的影响。
该基于社区的队列研究纳入了7381名65岁及以上的参与者。在长达10年的随访期间，对五个认知领域（语言流畅性、精神运动速度、执行功能、视觉空间技能和整体认知）进行了多达五次评估。治疗组包括在基线和首次随访时使用特定抗抑郁药物类别的参与者，其随访认知数据在最后一次连续随访且报告使用同一类抗抑郁药物时进行考量。使用线性混合模型根据抗抑郁治疗比较基线认知表现和随时间的认知衰退。模型针对多个混杂因素进行了调整，包括通过流行病学研究中心抑郁量表评估的残余抑郁症状。
在基线时，4.0%的参与者正在服用抗抑郁药物。与未使用者相比，三环类抗抑郁药物使用者在语言流畅性、视觉记忆和精神运动速度方面的基线表现较低，而选择性5-羟色胺再摄取抑制剂使用者在语言流畅性和精神运动速度方面较低。对于另外两项认知能力，即执行功能和整体认知，无论抗抑郁药物类别如何，在基线时均未发现显著差异。关于随时间的变化，与未使用者相比，无论认知领域如何均未观察到显著差异，但三环类抗抑郁药物使用者在随访期间语言流畅性技能略有额外改善。
在这个大型老年普通人群队列中，我们没有发现证据表明在长达10年的随访中，使用抗抑郁药物与各认知领域治疗后的认知衰退之间存在关联。
