Buysse D J, Reynolds C F, Kupfer D J, Houck P R, Hoch C C, Stack J A, Berman S R
Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213.
Arch Gen Psychiatry. 1988 Jun;45(6):568-75. doi: 10.1001/archpsyc.1988.01800300064008.
Twenty-six patients with mixed symptoms of depression and cognitive impairment were studied with serial clinical ratings and sleep electroencephalograms during a one-night sleep-deprivation procedure. A subgroup of these patients with depressive pseudodementia (n = 8) had less severe symptoms of dementia at baseline and showed significant improvements in both Hamilton Depression Rating Scale scores and Profile of Mood States tension scores following sleep deprivation, while another subgroup of patients having primary degenerative dementia with depression (n = 18) showed no change or worsening in Hamilton depression and Profile of Mood States tension ratings. Baseline sleep measures demonstrated significantly higher rapid eye movement (REM) percent and phasic REM activity/intensity in pseudodemented compared with demented patients. While both groups had increases in sleep efficiency, sleep maintenance, and slow-wave sleep following sleep deprivation, recovery night 2 was characterized by greater first REM period duration in depressive pseudodementia than in dementia. These differences in REM sleep rebound (using an REM period 1 cutoff of greater than or equal to 25 minutes) permitted correct identification of 88.5% of patients. Implications of these data for current theories regarding sleep, aging, and psychopathology are discussed.
对26名患有抑郁和认知障碍混合症状的患者在一夜睡眠剥夺过程中进行了系列临床评分和睡眠脑电图研究。这些患有抑郁性假性痴呆的患者亚组（n = 8）在基线时痴呆症状较轻，睡眠剥夺后汉密尔顿抑郁量表评分和情绪状态量表紧张评分均有显著改善，而另一组患有原发性退行性痴呆伴抑郁的患者（n = 18）在汉密尔顿抑郁量表和情绪状态量表紧张评分方面没有变化或恶化。基线睡眠测量显示，与痴呆患者相比，假性痴呆患者的快速眼动（REM）百分比和阶段性REM活动/强度显著更高。虽然两组在睡眠剥夺后睡眠效率、睡眠维持和慢波睡眠均有所增加，但在恢复的第2晚，抑郁性假性痴呆患者的首次REM期持续时间比痴呆患者更长。这些REM睡眠反弹的差异（使用大于或等于25分钟的REM期1临界值）能够正确识别88.5%的患者。本文讨论了这些数据对当前关于睡眠、衰老和精神病理学理论的意义。
