Reynolds C F, Kupfer D J, Houck P R, Hoch C C, Stack J A, Berman S R, Zimmer B
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA 15213.
Arch Gen Psychiatry. 1988 Mar;45(3):258-64. doi: 10.1001/archpsyc.1988.01800270076009.
Using electroencephalographic sleep data from a sample of 235 elderly subjects, discriminant function analyses of sleep alterations in depression and dementia were performed. Overall, 80% of patients were correctly classified using a backward discriminant function analysis, and 81% with a general stepwise discriminant function analysis. Four measures contributed to the separation of depressed and demented patients: rapid eye movement (REM) sleep latency (lower in depressives); REM sleep percent (higher in depressives); indeterminate non-REM sleep percent (higher in demented patients, reflecting greater loss of spindles and K complexes); and early morning awakening (more marked in depressives). When both discriminant functions were subjected to cross-validation in independent subsamples, both procedures correctly identified 78% of patients. The classification functions derived from nondemented depressed and nondepressed demented patients were applied to a mixed-symptom group (n = 42). Overall, 27 patients (64%) with either depressive pseudodementia or dementia with depressive features were correctly classified using the same four predictor variables. These findings suggest that sleep physiological alterations of depression and dementia reflect between-group differences in sleep continuity, sleep architecture, and REM sleep temporal distribution, and that the differences are statistically reliable, in both diagnostically pure and mixed clinical presentations. These findings are discussed in the context of current hypotheses of sleep regulation and its mechanisms.
利用来自235名老年受试者样本的脑电图睡眠数据，对抑郁症和痴呆症患者的睡眠改变进行了判别函数分析。总体而言，采用向后判别函数分析时，80%的患者被正确分类；采用一般逐步判别函数分析时，81%的患者被正确分类。有四项指标有助于区分抑郁症患者和痴呆症患者：快速眼动（REM）睡眠潜伏期（抑郁症患者较短）；REM睡眠百分比（抑郁症患者较高）；不确定的非REM睡眠百分比（痴呆症患者较高，反映纺锤波和K复合波的丧失更严重）；以及早醒（抑郁症患者更明显）。当在独立子样本中对这两种判别函数进行交叉验证时，两种方法都正确识别出了78%的患者。从无痴呆的抑郁症患者和无抑郁的痴呆症患者中得出的分类函数应用于一个混合症状组（n = 42）。总体而言，使用相同的四个预测变量，27名（64%）患有抑郁性假性痴呆或伴有抑郁特征的痴呆症患者被正确分类。这些发现表明，抑郁症和痴呆症的睡眠生理改变反映了两组在睡眠连续性、睡眠结构和REM睡眠时间分布方面的差异，并且这些差异在诊断上纯粹的和混合的临床表现中在统计学上都是可靠的。将结合当前关于睡眠调节及其机制的假说来讨论这些发现。
