Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
University of Exeter, Exeter, UK.
Int J Geriatr Psychiatry. 2019 Jan;34(1):38-46. doi: 10.1002/gps.4979. Epub 2018 Sep 27.
Depressive disorder is commonly associated with impaired cognitive function; however, it is unclear whether the age of onset of the first episode of depression, current depression severity, or historical severity of depressive episodes are associated with cognitive performance.
This study examined baseline cross-sectional data from the ongoing online PROTECT study. A total of 7344 participants, 50 years or older, with a history of depression and no diagnosis of dementia were divided into three groups according to age of onset of their first depressive episode: early-onset, midlife-onset, and late-onset. Performance on measures of visuospatial episodic memory, executive function, verbal working, and visual working memory were evaluated. Demographic and clinical characteristics such as age, education, and severity of symptoms during their worst previous depressive episode and current depression severity were included in multivariate regression models.
The late-onset depression group scored significantly lower on the verbal reasoning task than the early-onset group while there were no significant differences found on the other tasks. Midlife-onset depression participants performed better in the visual episodic memory task, but worse on the verbal reasoning task, than early-onset depression participants. Current depression severity was negatively correlated with all four cognitive domains, while historical severity score was found to be significantly associated with cognitive performance on the verbal reasoning and spatial working memory tasks.
The most important indicator of cognitive performance in depression appears to be current, rather than historic depression severity; however, late-onset depression may be associated with more executive impairment than an early-onset depression.
抑郁障碍通常与认知功能受损有关；然而，目前尚不清楚首发抑郁的发病年龄、当前抑郁严重程度或既往抑郁发作的严重程度是否与认知表现相关。
本研究分析了正在进行的在线 PROTECT 研究的基线横断面数据。共有 7344 名年龄在 50 岁及以上、有抑郁病史且无痴呆诊断的参与者，根据首发抑郁发作的发病年龄分为三组：早发性、中年发病和晚发性。评估了他们在视空间情景记忆、执行功能、言语工作记忆和视觉工作记忆方面的表现。在多变量回归模型中，纳入了人口统计学和临床特征，如年龄、教育程度以及既往最严重抑郁发作期间和当前抑郁严重程度的症状严重程度。
晚发性抑郁组在言语推理任务上的得分明显低于早发性抑郁组，而在其他任务上则没有显著差异。中年发病的抑郁参与者在视觉情景记忆任务上的表现优于早发性抑郁参与者，而在言语推理任务上的表现则较差。当前抑郁严重程度与所有四个认知领域呈负相关，而既往严重程度评分与言语推理和空间工作记忆任务的认知表现显著相关。
在抑郁中，认知表现的最重要指标似乎是当前而不是既往的抑郁严重程度；然而，与早发性抑郁相比，晚发性抑郁可能与更多的执行功能障碍相关。
