Department of Psychiatry, University of Toronto, Ontario, Canada.
Department of Psychiatry, University Hospital Galway, Ireland.
Can J Psychiatry. 2021 Sep;66(9):798-806. doi: 10.1177/0706743720974823. Epub 2020 Dec 23.
Major depressive disorder (MDD) is associated with impairments in both cognition and functioning. However, whether cognitive deficits significantly contribute to impaired psychosocial and occupational functioning, independent of other depressive symptoms, is not well established. We examined the relationship between cognitive performance and functioning in depressed patients before and after antidepressant treatment using secondary data from the first Canadian Biomarker Integration Network in Depression-1 study.
Cognition was assessed at baseline in unmedicated, depressed participants with MDD ( = 207) using the Central Nervous System Vital Signs computerized battery, psychosocial functioning with the Sheehan Disability Scale (SDS), and occupational functioning with the Lam Employment Absence and Productivity Scale (LEAPS). Cognition ( = 181), SDS ( = 175), and LEAPS ( = 118) were reassessed after participants received 8 weeks of open-label escitalopram monotherapy. A series of linear regressions were conducted to determine (1) whether cognitive functioning was associated with psychosocial and occupational functioning prior to treatment, after adjusting for overall depressive symptom severity and (2) whether changes in cognitive functioning after an 8-week treatment phase were associated with changes in psychosocial and occupational functioning, after adjusting for changes in overall symptom severity.
Baseline global cognitive functioning, after adjusting for depression symptom severity and demographic variables, was associated with the SDS work/study subscale (β = -0.17; = 0.03) and LEAPS productivity subscale (β = -0.17; = 0.05), but not SDS total (β = 0.19; = 0.12) or LEAPS total (β = 0.41; = 0.17) scores. Although LEAPS and SDS scores showed significant improvements after 8 weeks of treatment ( < 0.001), there were no significant associations between changes in cognitive domain scores and functional improvements.
Cognition was associated with occupational functioning at baseline, but changes in cognition were not associated with psychosocial or occupational functional improvements following escitalopram treatment. We recommend the use of more comprehensive functional assessments to determine the impact of cognitive change on functional outcomes in future research.
重度抑郁症（MDD）与认知和功能障碍均有关。但是，认知缺陷是否会显著导致社会心理和职业功能受损，而与其他抑郁症状无关，尚不清楚。我们使用加拿大抑郁症生物标志物整合网络 1 研究的二次数据，在抗抑郁药治疗前后检查了抑郁患者的认知表现与功能之间的关系。
在未接受药物治疗的 MDD 抑郁患者中（=207），在基线时使用中枢神经系统生命体征计算机化电池评估认知功能，使用 Sheehan 残疾量表（SDS）评估社会心理功能，使用 Lam 就业缺勤和生产力量表（LEAPS）评估职业功能。在患者接受 8 周的开放性依地普仑单药治疗后，对认知（=181）、SDS（=175）和 LEAPS（=118）进行了重新评估。进行了一系列线性回归，以确定（1）在治疗前，在调整总体抑郁症状严重程度后，认知功能是否与社会心理和职业功能相关，以及（2）在调整总体症状严重程度变化后，在 8 周治疗阶段后认知功能的变化是否与社会心理和职业功能的变化相关。
在调整抑郁症状严重程度和人口统计学变量后，基线的整体认知功能与 SDS 工作/学习分量表（β=-0.17；=0.03）和 LEAPS 生产力分量表（β=-0.17；=0.05）相关，但与 SDS 总分（β=0.19；=0.12）或 LEAPS 总分（β=0.41；=0.17）无关。尽管 LEAPS 和 SDS 评分在 8 周治疗后有显著改善（<0.001），但认知域评分的变化与功能改善之间没有显著关联。
认知在基线时与职业功能相关，但依地普仑治疗后认知的变化与社会心理或职业功能的改善无关。我们建议在未来的研究中使用更全面的功能评估来确定认知变化对功能结果的影响。
