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沉思反刍预示着晚年抑郁症患者认知功能较低:多元多重回归分析

Brooding rumination predicts lower cognitive functioning in late-life depression: multivariate multiple regression analyses.

作者信息

Baker Kiara, Taylor Warren D, Szymkowicz Sarah M

机构信息

Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.

Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA.

出版信息

J Clin Exp Neuropsychol. 2025 Jun 19:1-14. doi: 10.1080/13803395.2025.2520356.

Abstract

INTRODUCTION

Late-life depression (LLD) is associated with cognitive deficits, particularly in memory and executive functions. Rumination, namely brooding, may also negatively impact cognition. Few studies have investigated multivariate relationships between depressive symptoms and different types of rumination on cognition in LLD, which was the focus of the current study. We also explored whether relationships differed by gender and depression age of onset.

METHOD

Cognition was measured via five cognitive composites (Attention/Working Memory, Processing Speed, Language, Episodic Recall, and Executive Functions). LLD who completed both the Montgomery Asberg Depression Rating Scale (MADRS) and Ruminative Responses Scale (RRS) was used in analyses ( = 91). RRS subscales included Brooding and Reflection rumination. Two separate bootstrapped multivariate multiple regressions examined whether MADRS, Brooding, or Reflection, and their respective interactions predicted cognitive performance after covariate adjustments and Bonferroni correction. Exploratory analyses using similar models but stratified by gender and depression age of onset were also conducted.

RESULTS

Only Brooding significantly predicted cognitive performance in the multivariate omnibus models ((7,78) = 3.52,  = 0.006). Follow-up univariate analyses showed significant relationships for Language ( = 0.005, BCa 95% CI [-0.09 to -0.02]) and Episodic Recall ( < 0.001, BCa 95% CI [-0.012 to -0.04]) domains, with higher Brooding associated with lower cognitive performances. Exploratory analyses demonstrated a significant multivariate effect of Brooding in both men and women; however, the only significant univariate effect was for Episodic Recall in women ( = 0.025, BCa 95% CI [-0.11 to 0.01]). Age of depression onset was not significant for any of the multivariate models.

CONCLUSION

Elevated Brooding (and not depressive symptoms, Reflection rumination, or their interactions) was associated with lower language and memory functions in LLD. This effect may be greater in women, particularly for memory. Interventions aimed at improving brooding rumination in LLD may also benefit cognitive performance.

摘要

引言

老年期抑郁症(LLD)与认知缺陷有关,尤其是在记忆和执行功能方面。沉思,即反复思考,也可能对认知产生负面影响。很少有研究调查LLD中抑郁症状与不同类型的沉思对认知的多变量关系,这是本研究的重点。我们还探讨了这些关系是否因性别和抑郁症发病年龄而异。

方法

通过五个认知综合指标(注意力/工作记忆、处理速度、语言、情景记忆和执行功能)来测量认知。分析中使用了同时完成蒙哥马利-艾斯伯格抑郁评定量表(MADRS)和沉思反应量表(RRS)的LLD患者(n = 91)。RRS分量表包括沉思和反思性沉思。两个独立的自抽样多变量多元回归分析,在进行协变量调整和邦费罗尼校正后,检验MADRS、沉思或反思性沉思及其各自的交互作用是否能预测认知表现。还使用类似模型但按性别和抑郁症发病年龄分层进行了探索性分析。

结果

在多变量综合模型中,只有沉思能显著预测认知表现(F(7,78) = 3.52,p = 0.006)。后续单变量分析显示,在语言(p = 0.005,BCa 95%置信区间[-0.09至-0.02])和情景记忆(p < 0.001,BCa 95%置信区间[-0.012至-0.04])领域存在显著关系,沉思程度越高,认知表现越低。探索性分析表明,沉思在男性和女性中都有显著的多变量效应;然而,唯一显著的单变量效应是在女性的情景记忆方面(p = 0.025,BCa 95%置信区间[-0.11至0.01])。抑郁症发病年龄在任何多变量模型中都不显著。

结论

沉思程度升高(而非抑郁症状、反思性沉思或它们之间的交互作用)与LLD患者较低的语言和记忆功能有关。这种影响在女性中可能更大,尤其是在记忆方面。针对改善LLD患者沉思性沉思的干预措施可能也有益于认知表现。

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