School of Rehabilitation Science, McMaster University, Canada.
Health Research Methodology, McMaster University, Canada.
J Affect Disord. 2020 Nov 1;276:249-259. doi: 10.1016/j.jad.2020.07.036. Epub 2020 Jul 16.
Previous meta-analyses on neurocognitive test performances in depression have provided effect sizes for cognitive domains. Most domain effect sizes have medium to high variance heterogeneity. Restriction to each test performance could reduce variance and clarify differing test effect sizes. This systematic review and meta-analysis were done to 1. provide effect sizes for cognitive performances (test, subtest, or multiple measures within tests), and 2. investigate age as an effect modifier.
Inclusion criteria were: 1. active major depression episode (MD), 2. a control group, 3 reported means and standard deviations, 4. non-computerized tests previously studied at least 3 times. Meta-analyses were performed using Cochrane Review Manager. Age under versus over 45 was investigated as an effect moderator.
Twenty-seven studies met criteria. MD patients performed significantly poorer on 16 of 16 neurocognitive measures (random effects d = -0.47 to -0.92 across tests). Variance was heterogeneous for 11 of 16 measures. Differences between cognitive measures were largely absent based on overlapping 95% confidence intervals. Effect sizes did not differ under versus over 45 years.
Bias risk assessment showed limited control for subject selection, comparability of depressed and control groups, pre-morbid intelligence, drug treatment, and effort in testing.
The depression - cognition effect was in the moderate to large range regardless of test type. Variance heterogeneity was substantial despite exclusion of inactive depression and the absence of test pooling. The size of the depression - cognition effect was not a function of age.
先前对抑郁症患者神经认知测试表现的荟萃分析提供了认知领域的效应量。大多数领域的效应量具有中等到高度的方差异质性。限制每个测试表现可以减少方差并澄清不同的测试效应量。这项系统评价和荟萃分析旨在：1. 提供认知表现的效应量（测试、子测试或测试内的多个测量），2. 研究年龄作为效应修饰剂。
纳入标准为：1. 活跃的重度抑郁症发作（MD），2. 对照组，3. 报告平均值和标准差，4. 之前至少研究过 3 次的非计算机化测试。使用 Cochrane Review Manager 进行荟萃分析。将年龄小于或大于 45 岁作为效应修饰剂进行研究。
27 项研究符合标准。MD 患者在 16 项神经认知测试中的 16 项表现明显较差（各项测试的随机效应 d 值在-0.47 到-0.92 之间）。11 项测试中有 11 项的方差存在异质性。基于重叠的 95%置信区间，认知测试之间的差异基本不存在。45 岁以下和以上的患者，其效应量没有差异。
偏倚风险评估显示，在研究对象选择、抑郁组和对照组的可比性、发病前智力、药物治疗和测试努力方面的控制有限。
无论测试类型如何，抑郁与认知的效应都在中等至较大的范围内。尽管排除了不活跃的抑郁症和缺乏测试汇总，但方差异质性仍然很大。抑郁与认知的效应量与年龄无关。
