与抑郁症中主观认知障碍与客观认知障碍之间差异相关的临床特征。
Clinical characteristics associated with the discrepancy between subjective and objective cognitive impairment in depression.
机构信息
Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet Dep. 6233, Blegdamsvej 9, DK-2100, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, DK-1353, Copenhagen, Denmark.
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
出版信息
J Affect Disord. 2019 Mar 1;246:763-774. doi: 10.1016/j.jad.2018.12.105. Epub 2018 Dec 27.
BACKGROUND
Patients with unipolar disorder (UD) commonly experience cognitive dysfunction during symptomatic and remitted phases. However, it is not necessarily the patients with the greatest subjective complaints, who display the largest objectively-measured deficits on neuropsychological tests.
OBJECTIVE
This report investigated the demographic and clinical factors associated with the discrepancy between subjective and objective measures of cognition in two separate depressed patient populations in Denmark and New Zealand, respectively, using a new methodology.
METHODS
Data from 137 depressed patients and 103 healthy controls including neuropsychological test scores, self-reported cognitive difficulties, and ratings of mood were pooled from two studies conducted in Copenhagen, Denmark, and Christchurch, New Zealand, respectively. Cognitive discrepancy scores were calculated using a novel methodology, with positive values indicating disproportionately more subjective than objective difficulties (i.e., "sensitivity") and negative values indicating more objective than subjective impairments (i.e., "stoicism").
RESULTS
In the Danish partially remitted patient sample, greater 'sensitivity' was associated with more subsyndromal depression severity (standardized Beta (std. β )= 0.4, p < 0.01)), illness duration (std. β = 0.4, p < 0.01), and younger age (std. β = 0.6, p < 0.001). This association was replicated in the New Zealand sample of more symptomatic patients (p-values ≤ 0.05).
LIMITATIONS
The cross-sectional design hampered causal inferences. We had obtained different measures of objective and subjective cognition from the two studies.
CONCLUSIONS
Patients with more depressive symptoms and younger age overreported cognitive impairments across all illness states. The use of an objective cognition screener thus seems particularly relevant for these patients to assess whether subjective complaints are accompanied by measurable cognitive deficits.
背景
单相障碍（UD）患者在症状期和缓解期通常会出现认知功能障碍。然而，在神经心理学测试中，表现出最大客观测量缺陷的患者不一定是主观抱怨最大的患者。
目的
本报告使用新的方法学，分别研究了丹麦和新西兰两个独立的抑郁患者群体中与认知的主观和客观测量之间差异相关的人口统计学和临床因素。
方法
来自丹麦哥本哈根和新西兰克赖斯特彻奇的两项研究的数据，包括神经心理学测试分数、自我报告的认知困难和情绪评分，共纳入 137 名抑郁患者和 103 名健康对照者。使用一种新的方法学计算认知差异评分，正值表示主观困难比客观困难更不成比例（即“敏感性”），负值表示客观损害比主观损害更多（即“坚忍”）。
结果
在丹麦部分缓解的患者样本中，更大的“敏感性”与更多的亚综合征抑郁严重程度（标准化β（std.β）=0.4，p<0.01）、更长的病程（std.β=0.4，p<0.01）和更年轻的年龄（std.β=0.6，p<0.001）相关。在新西兰更有症状的患者样本中也复制了这种关联（p 值≤0.05）。
局限性
横断面设计阻碍了因果推断。我们从两项研究中获得了不同的客观和主观认知测量。
结论
在所有疾病状态下，有更多抑郁症状和更年轻的患者会过度报告认知障碍。因此，对于这些患者，使用客观认知筛查器来评估主观抱怨是否伴有可测量的认知缺陷似乎特别重要。
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