Mood Disorders Psychopharmacology Unit, University Health Network, Canada.
Mood Disorders Psychopharmacology Unit, University Health Network, Canada; University of Toronto, Canada.
Compr Psychiatry. 2019 Oct;94:152113. doi: 10.1016/j.comppsych.2019.07.006. Epub 2019 Jul 24.
It is well established that deficits in motivation, reward, and cognition are common during and in between syndromal episodes of depression as part of Major Depressive Disorder (MDD). Informed by evidence indicating functional and structural interconnectivity between cognitive and reward brain circuits, we preliminarily evaluate the association between measures of cognitive performance and reward/motivation.
This is a post-hoc analysis of a primary study (i.e. the THINC-it sensitivity to change study). Adults (18-65 years of age) meeting DSM-5 criteria for MDD, single-episode or recurrent confirmed by M.I.N.I. with moderate severity or greater (i.e. Montgomery Asberg Depression Rating Scale ≥20). All eligible subjects received vortioxetine 10-20 mg open-label for 8 weeks. The Effort Expenditure Reward Task (EEfRT) was the principal measure of motivation and reward. We directly compare the effects of cognitive measures and depressive symptoms on effort-based decision-making using the THINC-it composite score and MADRS total score.
Twenty-one participants with MDD (Mean age = 38.47, SD = 12.85) and 20 healthy volunteers (Mean age = 41.50, SD = 14.21) completed the optional EEfRT task. Amongst individuals with MDD, performance in processing speed, executive function (i.e. Trails B) and overall composite cognitive score was positively associated with the proportion of hard-task choices in the high reward condition (i.e. greater reward valuation). Across both groups, a greater probability (χ = 1.137) and magnitude of reward (χ = 0.045) was associated with increased effort (i.e. choosing the hard task more frequently). Using fully factored GEE models, we observed a positive association between performance on the Trails test (β = 2.223, SE = 0.928, p = 0.017) as well as the composite score (β = 0.978, SE = 0.0.459, p = 0.033), and greater effort for high rewards. In addition, it was observed that a positive association (i.e. greater effort for reward in higher probability) was observed with depressive symptoms and overall cognitive measures.
Herein, we observed that an association exists between overall cognitive function, notably processing speed and executive function and reward function. Specifically, a greater effort for hard task rewards (using the EEfRT task) was manifested in individuals exhibiting higher levels of cognitive performance in a well-characterized sample of MDD treated with Vortioxetine.
已有研究证实，在抑郁症发作期间和发作之间，动机、奖励和认知方面的缺陷是常见的，这是重度抑郁症（MDD）的一部分。鉴于证据表明认知和奖励大脑回路之间存在功能和结构的相互连通性，我们初步评估了认知表现与奖励/动机之间的关联。
这是一项主要研究（即 THINC-it 变化敏感性研究）的事后分析。符合 DSM-5 标准的 MDD 成人（18-65 岁），单次发作或复发，经 M.I.N.I. 确认，严重程度为中度或以上（即蒙哥马利抑郁评定量表[MADRS]≥20）。所有符合条件的患者接受为期 8 周的沃替西汀 10-20mg 开放标签治疗。努力支出奖励任务（EEfRT）是动机和奖励的主要测量方法。我们使用 THINC-it 综合评分和 MADRS 总分直接比较认知测量和抑郁症状对基于努力的决策的影响。
21 名 MDD 患者（平均年龄 38.47，标准差 12.85）和 20 名健康志愿者（平均年龄 41.50，标准差 14.21）完成了可选的 EEfRT 任务。在 MDD 患者中，处理速度、执行功能（即 Trails B）和整体认知综合评分的表现与高奖励条件下困难任务选择的比例呈正相关（即更大的奖励估值）。在两组中，更大的概率（χ=1.137）和奖励幅度（χ=0.045）与更大的努力（即更频繁地选择困难任务）相关。使用完全因子广义估计方程模型，我们观察到 Trails 测试的表现（β=2.223，SE=0.928，p=0.017）以及综合评分（β=0.978，SE=0.0.459，p=0.033）与高奖励时的更大努力之间存在正相关关系。此外，还观察到与抑郁症状和整体认知测量一样，与奖励的正相关（即更高的奖励需要更大的努力）。
在这里，我们观察到整体认知功能，特别是处理速度和执行功能与奖励功能之间存在关联。具体来说，在接受沃替西汀治疗的 MDD 特征明确的样本中，表现出更高认知水平的个体在使用 EEfRT 任务时表现出更高的努力，以获得更高难度任务的奖励。
