He Jiali, Wu Yangyu, Zhong Shuming, Wang Ying, Lai Shunkai, Huang Dong, Zhang Jianzhao, Lu Xiaodan, Song Xiaodong, Zhong Qilin, Chen Pan, Jia Yanbin
Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou, China; Department of Psychology, Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou, China.
J Affect Disord. 2025 Jun 15;379:10-18. doi: 10.1016/j.jad.2025.02.081. Epub 2025 Feb 27.
Early-onset depression (EOD) and late-onset depression (LOD) are prevalent subtypes of major depressive disorder (MDD), but the clinical distinction between EOD and LOD remains blurred due to nonspecific symptoms and lack of biomarkers. This study aims to elucidate the characteristics in cognitive function and biochemical metabolism of EOD and LOD, and to identify biological factors influencing age of onset (AOO).
Seventy patients with MDD (40 with EOD and 30 with LOD) and sixty-eight age-matched healthy controls (HC) were included in this study. Participants were evaluated for clinical features, cognitive function, and serum trace elements levels. Proton magnetic resonance spectroscopy (H-MRS) was employed to quantify neurometabolites levels, including N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr).
Patients with LOD experienced more episodes and severe depressive symptoms than those with EOD (p = 0.025, p < 0.001). EOD patients performed significantly worse than LOD patients on social cognition (p = 0.005), while LOD patients performed worse than EOD patients on reasoning and problem solving (p = 0.005). Additionally, LOD patients displayed higher ceruloplasmin (Cp) levels compared to EOD patients (p = 0.004), but no difference was found in neurometabolic levels between EOD and LOD. Multiple linear regression indicated a positive correlation between serum Cp levels and AOO of depression (p < 0.001), while bilateral thalamic NAA/Cr showed a negative correlation with AOO (p = 0.012, p = 0.016).
Patients with EOD were characterized by social cognition impairments, while patients with LOD were marked by reasoning and problem-solving deficits. Serum Cp levels demonstrated an AOO-related effect and served as a positive predictor for the AOO of depression. Furthermore, a negative correlation has been established between bilateral thalamic NAA/Cr and the AOO of MDD.
The limited sample size and the challenge in distinguishing whether observed results are attributed to age or AOO effects.
早发性抑郁症（EOD）和晚发性抑郁症（LOD）是重度抑郁症（MDD）的常见亚型，但由于症状不具特异性且缺乏生物标志物，EOD和LOD之间的临床区别仍不明确。本研究旨在阐明EOD和LOD在认知功能和生化代谢方面的特征，并确定影响发病年龄（AOO）的生物学因素。
本研究纳入了70例MDD患者（40例EOD患者和30例LOD患者）以及68例年龄匹配的健康对照（HC）。对参与者进行了临床特征、认知功能和血清微量元素水平评估。采用质子磁共振波谱（H-MRS）定量神经代谢物水平，包括N-乙酰天门冬氨酸（NAA）、胆碱（Cho）和肌酸（Cr）。
与EOD患者相比，LOD患者经历的发作次数更多，抑郁症状更严重（p = 0.025，p < 0.001）。EOD患者在社会认知方面的表现明显比LOD患者差（p = 0.005），而LOD患者在推理和解决问题方面的表现比EOD患者差（p = 0.005）。此外，与EOD患者相比，LOD患者的铜蓝蛋白（Cp）水平更高（p = 0.004），但EOD和LOD之间的神经代谢水平没有差异。多元线性回归表明血清Cp水平与抑郁症的AOO呈正相关（p < 0.001），而双侧丘脑的NAA/Cr与AOO呈负相关（p = 0.012，p = 0.016）。
EOD患者的特征是社会认知受损，而LOD患者的特征是推理和解决问题能力缺陷。血清Cp水平显示出与AOO相关的效应，并可作为抑郁症AOO的阳性预测指标。此外，双侧丘脑的NAA/Cr与MDD的AOO之间已建立负相关。
样本量有限，且难以区分观察到的结果是归因于年龄还是AOO效应。
