Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada.
Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC.
J Affect Disord. 2020 Sep 1;274:593-601. doi: 10.1016/j.jad.2020.05.101. Epub 2020 May 27.
Cognitive impairment is a well-recognized symptom of major depressive disorder; however, contributing factors are not fully characterized. The present study examined the neurocognitive profiles and predictors of cognitive impairment in patients with treatment-resistant depression (TRD).
Moderate to severely depressed TRD patients were compared to matched healthy volunteers (HV) in verbal learning and recall and executive functions. Based on cognitive scores, cluster analysis was performed to identify subsets within the TRD sample. Predictors of cognitive impairment were also investigated.
TRD patients showed worse performance in tests assessing verbal memory, executive attentional shifting, and inhibitory control. The cluster analysis revealed two groups: a cognitively impaired (CI) group that showed a generalized deficit across cognitive domains, and a relatively cognitively intact group that performed better than CI in all domains except attentional shifting. A logistic binomial regression of the two groups revealed three significant contributing risk factors for CI: 1) older age, 2) lower premorbid IQ, and 3) benzodiazepine use. Cognitive impairment and benzodiazepine use were associated with worse functioning.
Significant cognitive impairment is present in TRD and is associated with worse functioning. Age, lower premorbid IQ, and benzodiazepine use increased the likelihood of generalized cognitive impairment in TRD patients. The detrimental effect of benzodiazepine on cognitive impairment is independent of anxiety symptoms. Further research is needed to characterize the timeline of cognitive impairment in depression.
认知障碍是重度抑郁症的一种公认症状，但致病因素尚未完全明确。本研究旨在探讨治疗抵抗性抑郁症（TRD）患者的神经认知特征及其认知障碍的预测因素。
我们将中重度抑郁的 TRD 患者与匹配的健康志愿者（HV）进行了言语学习和记忆以及执行功能的比较。基于认知评分，对 TRD 样本进行了聚类分析，以确定认知障碍亚组。还研究了认知障碍的预测因素。
TRD 患者在评估言语记忆、执行注意转换和抑制控制的测试中表现较差。聚类分析显示出两组：一组是认知受损（CI）组，表现出认知领域的普遍缺陷，另一组是相对认知完整组，除了注意转换之外，在所有领域的表现都优于 CI 组。对两组的二项逻辑回归显示，CI 的三个显著风险因素为：1）年龄较大，2）较低的先赋智商，和 3）苯二氮䓬类药物的使用。认知障碍和苯二氮䓬类药物的使用与较差的功能有关。
TRD 患者存在明显的认知障碍，且与较差的功能有关。年龄较大、先赋智商较低和苯二氮䓬类药物的使用增加了 TRD 患者普遍认知障碍的可能性。苯二氮䓬类药物对认知障碍的不良影响与焦虑症状无关。需要进一步研究以描述抑郁患者认知障碍的时间进程。
