Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Am J Geriatr Psychiatry. 2018 Jan;26(1):100-106. doi: 10.1016/j.jagp.2017.06.012. Epub 2017 Jun 16.
Cognitive impairment associated with late-life depression can persist after remission of mood symptoms. Apathy, a common symptom of late-life depression, often leads to worse clinical outcomes. We examined if severity of apathy mediates cognitive difficulties in a cohort of older adults with major depression.
One hundred thirty-eight older adults with depression (54.4% female; mean [SD] age: 69.7 [7.4] years; mean [SD] education:15.6 [2.7] years) were recruited to participate in a treatment study, and only baseline data were analyzed. All participants received a comprehensive evaluation of depression, apathy, and cognition. We examined whether apathy mediated the relationship between depression and cognition, focusing our attention on memory and cognitive control. We then explored whether the mediation effects differed across women and men.
Increased apathy was significantly associated with worse depression and lower performance in the cognitive control domain but not in memory. Higher depressive scores were significantly associated with worse cognitive control but not memory. Mediation analyses revealed a significant indirect effect on cognitive control by depression through increased apathy scores with the mediator accounting for 21% of the total effect. Stratifying by sex, we found that women exhibited a significant indirect effect, with the mediator accounting for 47% of the total effect, whereas there was no mediation by apathy in men.
The findings imply that increased apathy mediates the relationship between cognition and depression. The identification of mediating effects may inform future treatment strategies and preventive interventions that can focus on decreasing apathy to improve cognition in late-life depression.
与晚年抑郁症相关的认知障碍在情绪症状缓解后仍可能持续存在。淡漠是晚年抑郁症的常见症状，往往导致更差的临床结局。我们研究了在一组患有重度抑郁症的老年患者中，淡漠的严重程度是否会影响认知困难。
招募了 138 名老年抑郁症患者（54.4%为女性；平均[标准差]年龄：69.7[7.4]岁；平均[标准差]受教育年限：15.6[2.7]年）参与一项治疗研究，仅分析基线数据。所有参与者均接受了抑郁、淡漠和认知的全面评估。我们研究了淡漠是否介导了抑郁和认知之间的关系，特别关注了记忆和认知控制。然后，我们探讨了这些中介效应是否在女性和男性中存在差异。
淡漠程度增加与抑郁程度加重和认知控制领域的表现下降显著相关，但与记忆无关。抑郁评分越高，认知控制越差，但与记忆无关。中介分析显示，抑郁通过增加淡漠评分对认知控制存在显著的间接影响，其中中介因素占总效应的 21%。按性别分层，我们发现女性存在显著的间接效应，中介因素占总效应的 47%，而男性则没有通过淡漠的中介作用。
这些发现表明，淡漠程度增加会影响认知和抑郁之间的关系。中介效应的识别可能为未来的治疗策略和预防干预提供信息，这些策略和干预可以集中精力通过降低淡漠来改善晚年抑郁症患者的认知。
