双相情感障碍和重度抑郁症患者的神经认知功能与精神科住院治疗及社会人口学状况的关联
Association of neurocognitive function with psychiatric hospitalization and socio-demographic conditions in individuals with bipolar and major depressive disorders.
作者信息
Sankar Anjali, Ziersen Simon C, Ozenne Brice, Beaman Emily E, Dam Vibeke H, Fisher Patrick M, Knudsen Gitte M, Kessing Lars V, Frokjaer Vibe, Miskowiak Kamilla W
机构信息
Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Neurocognition and Emotion in Affective Disorders (NEAD) Centre, Department of Psychology, University of Copenhagen, and Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.
出版信息
EClinicalMedicine. 2023 Mar 24;58:101927. doi: 10.1016/j.eclinm.2023.101927. eCollection 2023 Apr.
BACKGROUND
Neurocognitive impairments are associated with poor clinical and employment outcomes in individuals with affective disorders. However, little is known about their associations with long-term clinical outcomes such as psychiatric hospitalizations, and with socio-demographic indicators other than employment. In the largest longitudinal study of neurocognition in affective disorders to date, we investigate the role of neurocognitive impairments on psychiatric hospitalizations and socio-demographic conditions.
METHODS
The study included 518 individuals with bipolar or major depressive disorder. Neurocognitive assessments covered executive function and verbal memory domains. Longitudinal data on psychiatric hospitalization and socio-demographic conditions (employment, cohabitation, and marital status) for up to 11 years were obtained using National population-based registers. The primary and secondary outcomes were psychiatric hospitalizations (n = 398) and worsening of socio-demographic conditions (n = 518), in the follow-up period since study inclusion, respectively. Cox regression models were used to examine the association of neurocognition with future psychiatric hospitalizations and the worsening of socio-demographic conditions.
FINDINGS
Clinically significant impairment in verbal memory (z-score ≤ -1; defined by the ISBD Cognition Task Force), but not in executive function, was associated with a higher risk of future hospitalization, when adjusted for age, sex, hospitalization in the year preceding inclusion, depression severity, diagnosis, and type of clinical trial (HR = 1.84, 95% CI:1.05-3.25, p = 0.034; n = 398). The results remained significant even after accounting for illness duration. Neurocognitive impairments were not associated with the worsening of socio-demographic conditions (p ≥ 0.17; n = 518).
INTERPRETATION
Promoting neurocognitive function, especially verbal memory, may mitigate the risk of future psychiatric hospitalization in individuals with affective disorders.
FUNDING
Lundbeckfonden (R279-2018-1145).
背景
神经认知障碍与情感障碍患者不良的临床和就业结局相关。然而，对于它们与长期临床结局（如精神病住院治疗）以及除就业以外的社会人口统计学指标之间的关联，人们知之甚少。在迄今为止最大规模的情感障碍神经认知纵向研究中，我们调查了神经认知障碍在精神病住院治疗和社会人口统计学状况方面所起的作用。
方法
该研究纳入了518名双相情感障碍或重度抑郁症患者。神经认知评估涵盖执行功能和言语记忆领域。通过基于全国人口的登记系统获取了长达11年的精神病住院治疗和社会人口统计学状况（就业、同居和婚姻状况）的纵向数据。在自纳入研究后的随访期内，主要和次要结局分别为精神病住院治疗（n = 398）和社会人口统计学状况恶化（n = 518）。使用Cox回归模型来检验神经认知与未来精神病住院治疗以及社会人口统计学状况恶化之间的关联。
研究结果
在对年龄、性别、纳入研究前一年的住院治疗情况、抑郁严重程度、诊断和临床试验类型进行校正后，言语记忆方面具有临床意义的损害（z分数≤ -1；由国际双相障碍协会认知工作组定义），而非执行功能方面的损害，与未来住院治疗风险较高相关（风险比=1.84，95%置信区间：1.05 - 3.25，p = 0.034；n = 398）。即使在考虑疾病持续时间后，结果仍然显著。神经认知障碍与社会人口统计学状况恶化无关（p≥0.17；n = 518）。
解读
促进神经认知功能，尤其是言语记忆，可能会降低情感障碍患者未来精神病住院治疗的风险。
资助
伦德贝克基金会（R279 - 2018 - 1145）。
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