Ahern Elayne, White Jessica, Slattery Eadaoin
School of Psychology, Dublin City University, Glasnevin, Dublin 9, Ireland.
Department of Psychology, University of Limerick, Castletroy, Limerick, V94 T9PX, Ireland.
Neuropsychol Rev. 2025 Mar;35(1):1-34. doi: 10.1007/s11065-023-09629-9. Epub 2024 Feb 5.
Major depressive disorder (MDD) is associated with significant cognitive deficits during the acute and remitted stages. The aim of this systematic review and meta-analysis was to examine the course of cognitive function whilst considering demographic, treatment, or clinical features of MDD that could moderate the extent of cognitive change. Databases were searched to identify studies that reported on cognitive function in MDD with a ≥12-week test-retest interval. Relevant studies were pooled using random effects modelling to generate an inverse-variance, weighted, mean effect size estimate (Hedges' g) of cognitive change for each cognitive variable and for an overall composite cognitive domain. Of 6898 records, 99 eligible studies were identified from which 69 were meta-analysed, consisting of 4639 MDD patients (age = 40.25 years, female = 64.62%) across 44 cognitive variables. In over 95% of cognitive variables, improvements were either of non-significant, negligible, or of a small magnitude, and when compared to matched healthy controls, the possibility of practice effects could not be precluded. Depressive symptom improvement and the number of previous depressive episodes moderated the extent of cognitive change, demonstrating state- and scar-like features for one-quarter of the cognitive domains. Further longitudinal studies are required to elucidate the MDD cognitive trajectory from initial onset. Findings nonetheless suggest that following pharmacological and non-pharmacological treatment, cognitive change in MDD is typically small, but the capacity for change may be less with episode recurrence. Targeting cognition early in the course of illness may facilitate better prognosis and support a more complete functional recovery.
重度抑郁症（MDD）在急性期和缓解期均与显著的认知缺陷相关。本系统评价和荟萃分析的目的是研究认知功能的变化过程，同时考虑可能影响认知变化程度的MDD的人口统计学、治疗或临床特征。检索数据库以识别报告MDD认知功能且重测间隔≥12周的研究。使用随机效应模型汇总相关研究，以生成每个认知变量和总体综合认知领域认知变化的逆方差加权平均效应量估计值（Hedges' g）。在6898条记录中，识别出99项符合条件的研究，其中69项进行了荟萃分析，包括4639例MDD患者（年龄=40.25岁，女性=64.62%），涉及44个认知变量。在超过95%的认知变量中，改善要么不显著、可忽略不计，要么幅度较小，与匹配的健康对照相比，不能排除练习效应的可能性。抑郁症状改善和既往抑郁发作次数影响了认知变化程度，在四分之一的认知领域显示出状态样和疤痕样特征。需要进一步的纵向研究来阐明MDD从发病初期开始的认知轨迹。尽管如此，研究结果表明，经过药物和非药物治疗后，MDD的认知变化通常较小，但随着发作复发，变化能力可能会降低。在疾病过程早期针对认知进行干预可能有助于改善预后并支持更完全的功能恢复。
