Nicholas J Ainsworth, Hanadi Oughli, Helen Lavretsky, Daniel M Blumberger, Patrick J Brown, Meryl A Butters, Jordan F Karp, Emily Lenard, Eric J Lenze, Mary Pat McAndrews, J Philip Miller, Bruce G Pollock, Charles F Reynolds, Benoit H Mulsant
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引用次数: 0
Abstract
Objective: Major depressive disorder in older adults (late-life depression; LLD) is frequently associated with cognitive impairment, and some deficits (e.g., executive function) have been associated with a higher level of treatment resistance. However, the cognitive profile of treatment-resistant LLD (TR-LLD) has not been characterized. We hypothesized that patients with TR-LLD would show deficits in cognitive function, especially executive function, and that executive function deficits would predict poorer response to pharmacotherapy.
Design: Secondary analysis of baseline cognitive data from OPTIMUM, a multicenter RCT evaluating pharmacotherapy strategies for TR-LLD.
Setting: Five outpatient academic medical centers (4 US, 1 Canada).
Participants: About 369 participants aged 60 and older from the OPTIMUM study.
Measurements: Baseline scores on individual tasks and composite scores from the NIH Toolbox-Cognition Battery were transformed into demographically-adjusted T-scores and compared to published norms. Impairments in the set shifting and inhibitory control tasks were investigated as predictors of depressive symptom change following treatment using ANCOVA models.
Results: Participants had low performance on tasks evaluating inhibitory control, processing speed, verbal/nonverbal memory, and the fluid composite, but normative performance on working memory and set shifting. Participants had high estimated premorbid IQ (superior Performance on oral reading recognition). Age and physical comorbidity negatively associated with processing speed. Impairments in set shifting predicted less improvement in depressive symptoms; impairments in inhibitory control did not.
Conclusions: Participants with TR-LLD presented with broad cognitive deficits relative to healthy norms. Given poorer outcomes following standard pharmacotherapy associated with impaired set shifting, future research needs to identify alternative treatment strategies.
目的：老年人重度抑郁障碍（晚年抑郁症；LLD）经常伴有认知功能障碍，而某些功能障碍（如执行功能）与较高程度的治疗耐药性有关。然而，治疗耐受性晚期抑郁症（TR-LLD）的认知特征尚未得到描述。我们假设，TR-LLD 患者会出现认知功能障碍，尤其是执行功能障碍，而执行功能障碍将预示患者对药物治疗的反应较差：OPTIMUM是一项评估TR-LLD药物治疗策略的多中心RCT，我们对OPTIMUM的基线认知数据进行了二次分析：五个门诊学术医疗中心（4个美国，1个加拿大）：OPTIMUM研究中约369名60岁及以上的参与者：美国国立卫生研究院（NIH）工具箱-认知测试中单项任务的基线分数和综合分数被转换成经过人口统计学调整的 T 分数，并与已公布的标准值进行比较。通过方差分析模型，研究了集转移和抑制控制任务中的障碍对治疗后抑郁症状变化的预测作用：结果：受试者在评价抑制控制、处理速度、言语/非言语记忆和流体综合能力的任务中表现较差，但在工作记忆和集合转换任务中表现正常。参与者的估计病前智商较高（在口头阅读识别方面表现优异）。年龄和身体合并症与处理速度呈负相关。集合移动能力的损伤预示着抑郁症状的改善程度较低；抑制控制能力的损伤则没有预示着抑郁症状的改善程度：结论：与健康标准相比，TR-LLD 患者存在广泛的认知缺陷。结论：TR-LLD患者的认知能力相对于健康人而言存在广泛的缺陷。鉴于标准药物治疗后的效果较差，且集合移动能力受损，未来的研究需要确定其他治疗策略。
期刊介绍：
The American Journal of Geriatric Psychiatry is the leading source of information in the rapidly evolving field of geriatric psychiatry. This esteemed journal features peer-reviewed articles covering topics such as the diagnosis and classification of psychiatric disorders in older adults, epidemiological and biological correlates of mental health in the elderly, and psychopharmacology and other somatic treatments. Published twelve times a year, the journal serves as an authoritative resource for professionals in the field.
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