Zuckerman Hannah, Pan Zihang, Park Caroline, Brietzke Elisa, Musial Natalie, Shariq Aisha S, Iacobucci Michelle, Yim Samantha J, Lui Leanna M W, Rong Carola, McIntyre Roger S
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
Front Psychiatry. 2018 Dec 4;9:655. doi: 10.3389/fpsyt.2018.00655. eCollection 2018.
Major Depressive Disorder (MDD) is a prevalent, chronic, disabling, and multidimensional mental disorder. Cognitive dysfunction represents a core diagnostic and symptomatic criterion of MDD, and is a principal determinant of functional non-recovery. Cognitive impairment has been observed to persist despite remission of mood symptoms, suggesting dissociability of mood and cognitive symptoms in MDD. Recurrent impairments in several domains including, but not limited to, executive function, learning and memory, processing speed, and attention and concentration, are associated with poor psychosocial and occupational outcomes. Attempts to restore premorbid functioning in individuals with MDD requires regular screenings and assessment of objective and subjective measures of cognition by clinicians. Easily accessible and cost-effective tools such as the THINC-integrated tool (THINC-it) are suitable for use in a busy clinical environment and appear to be promising for routine usage in clinical settings. However, antidepressant treatments targeting specific cognitive domains in MDD have been insufficiently studied. While select antidepressants, e.g., vortioxetine, have been demonstrated to have direct and independent pro-cognitive effects in adults with MDD, research on additional agents remains nascent. A comprehensive clinical approach to cognitive impairments in MDD is required. The current narrative review aims to delineate the importance and relevance of cognitive dysfunction as a symptomatic target for prevention and treatment in the phenomenology of MDD.
重度抑郁症（MDD）是一种常见、慢性、致残且具有多维度特征的精神障碍。认知功能障碍是MDD的核心诊断和症状标准，也是功能无法恢复的主要决定因素。尽管情绪症状有所缓解，但认知障碍仍会持续存在，这表明MDD中情绪和认知症状具有可分离性。包括但不限于执行功能、学习与记忆、处理速度以及注意力和专注力等多个领域的反复受损，与不良的心理社会和职业结局相关。要恢复MDD患者病前的功能，临床医生需要定期对认知的客观和主观指标进行筛查和评估。像THINC综合工具（THINC-it）这样易于获取且成本效益高的工具适用于繁忙的临床环境，并且在临床环境中的常规使用似乎很有前景。然而，针对MDD特定认知领域的抗抑郁治疗研究尚不充分。虽然某些抗抑郁药，如伏硫西汀，已被证明对患有MDD的成年人具有直接且独立的促认知作用，但对其他药物的研究仍处于初期阶段。需要一种针对MDD认知障碍的综合临床方法。当前的叙述性综述旨在阐明认知功能障碍作为MDD现象学中预防和治疗的症状靶点的重要性和相关性。
