Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.
Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2024 Nov;9(11):1199-1210. doi: 10.1016/j.bpsc.2024.07.009. Epub 2024 Jul 23.
Late-life depression (LLD) is associated with cognitive impairment, but substantial heterogeneity exists among patients. Data on the extent of cognitive impairments are inconclusive, particularly in patients with treatment-resistant depression (TRD). We investigated the cognitive profiles of patients with treatment-resistant versus nonresistant LLD and aimed to identify distinct cognitive subgroups. We also examined whether cognitive subgroups responded differentially to treatment with bilateral repetitive transcranial magnetic stimulation (rTMS).
A total of 165 patients with LLD were divided into treatment-resistant and nonresistant groups and compared with healthy control participants on measures of executive function, information processing speed, verbal learning, and memory. Cluster analysis identified subgroups based on cognitive scores. Demographic and clinical variables, as well as outcomes with bilateral rTMS, were compared between cognitive subgroups.
Patients with LLD, particularly TRD, exhibited significantly worse cognitive performance than healthy controls. A 3-cluster solution was found, including cognitively intact (n = 89), cognitively diminished (n = 29), and impaired memory (n = 47) subgroups. Both the cognitively diminished and impaired memory subgroups had more anxiety symptoms and a higher proportion of patients with TRD than the cognitively intact group, although the latter difference did not survive multiple comparison correction. No significant differences were observed in outcomes to rTMS treatment.
Patients with LLD exhibited impairments across cognitive domains, which were more pronounced in TRD. Three cognitive subgroups responded similarly to rTMS treatment, indicating its effectiveness across cognitive profiles, especially when medications are not tolerated. Future research should examine the relationships among cognitive subgroups, cognitive decline, and neurodegeneration.
老年期抑郁症（LLD）与认知障碍有关，但患者之间存在很大的异质性。关于认知障碍程度的数据尚无定论，尤其是在治疗抵抗性抑郁症（TRD）患者中。我们调查了治疗抵抗性与非抵抗性 LLD 患者的认知特征，并旨在确定不同的认知亚组。我们还检查了认知亚组是否对双侧重复经颅磁刺激（rTMS）治疗有不同的反应。
共有 165 名 LLD 患者分为治疗抵抗组和非抵抗组，并与健康对照组进行了执行功能、信息处理速度、言语学习和记忆的比较。聚类分析根据认知评分确定亚组。比较认知亚组之间的人口统计学和临床变量以及双侧 rTMS 的结果。
LLD 患者，尤其是 TRD 患者，认知表现明显差于健康对照组。发现了 3 个聚类解决方案，包括认知完整（n=89）、认知减退（n=29）和记忆受损（n=47）亚组。与认知完整组相比，认知减退和记忆受损亚组的焦虑症状更多，且 TRD 患者的比例更高，尽管后者的差异在多次比较校正后未被发现。rTMS 治疗的结果没有观察到显著差异。
LLD 患者表现出认知领域的障碍，在 TRD 中更为明显。三个认知亚组对 rTMS 治疗的反应相似，表明其对认知特征的有效性，尤其是在不能耐受药物治疗时。未来的研究应检查认知亚组、认知衰退和神经退行性变之间的关系。
