重度抑郁症认知功能障碍的神经心理学评估：系统性回顾和元回归分析》（A Systematic Review and Meta-Analysis with Meta-Regression.

IF 16.3 1区医学 Q1 PSYCHIATRY

Psychotherapy and Psychosomatics Pub Date : 2024-01-01 Epub Date: 2024-01-25 DOI:10.1159/000535665

Taeho Greg Rhee, Sung Ryul Shim, Kevin J Manning, Howard A Tennen, Tyler S Kaster, Giacomo d'Andrea, Brent P Forester, Andrew A Nierenberg, Roger S McIntyre, David C Steffens

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引用次数: 0

摘要

简介认知功能障碍或缺陷在重度抑郁障碍（MDD）患者中很常见。本研究对重度抑郁症患者认知功能障碍的多个领域进行了系统回顾和荟萃分析：方法：对 PubMed/MEDLINE、PsycINFO、Cochrane Library、Embase、Web of Science 和 Google Scholar 进行了检索，检索时间从开始到 2023 年 5 月 17 日，没有语言限制。符合以下纳入标准的研究均被纳入：(1) 使用标准化诊断标准确诊为 MDD 的患者；(2) 健康对照组（即无 MDD 的对照组）；(3) 使用剑桥神经心理学测试自动化电池（CANTAB）对认知障碍进行神经心理学评估；(4) 有足够数据可量化标准化效应大小的报告。赫奇斯 g 标准化平均差 (SMD) 及相应的 95% 置信区间 (CI) 用于量化 MDD 认知障碍的效应大小。SMD采用固定效应或随机效应模型进行估算：共有 33 项研究纳入了 2,596 名受试者（MDD 患者为 1,337 人，健康对照组为 1,259 人）。与健康对照组相比，MDD 患者存在中度认知缺陷（SMD，-0.39 [95% CI，-0.47 至 -0.31]）。在亚组分析中，与健康对照组相比，耐药抑郁症患者（SMD，-0.56 [95% CI，-0.78 至 -0.34]）和老年多发性抑郁症患者（SMD，-0.51 [95% CI，-0.66 至 -0.36]）的认知缺陷更大。在未服药的 MDD 患者中，效应大小较小（SMD，-0.19 [95% CI，-0.37 至 -0.00]），我们在儿童中未发现任何统计学差异。除反应时间外，我们在所有领域都发现了认知缺陷。未发现发表偏倚：由于 MDD 患者的认知障碍可能会在缓解期持续存在，或增加主要神经退行性疾病的风险，因此在治疗 MDD 患者时，除了缓解抑郁症状外，还应将缓解认知障碍作为一个重要目标。

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Neuropsychological Assessments of Cognitive Impairment in Major Depressive Disorder: A Systematic Review and Meta-Analysis with Meta-Regression.

Introduction: Cognitive dysfunction or deficits are common in patients with major depressive disorder (MDD). The current study systematically reviews and meta-analyzes multiple domains of cognitive impairment in patients with MDD.

Methods: PubMed/MEDLINE, PsycINFO, Cochrane Library, Embase, Web of Science, and Google Scholar were searched from inception through May 17, 2023, with no language limits. Studies with the following inclusion criteria were included: (1) patients with a diagnosis of MDD using standardized diagnostic criteria; (2) healthy controls (i.e., those without MDD); (3) neuropsychological assessments of cognitive impairment using Cambridge Neuropsychological Test Automated Battery (CANTAB); and (4) reports of sufficient data to quantify standardized effect sizes. Hedges' g standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were used to quantify effect sizes of cognitive impairments in MDD. SMDs were estimated using a fixed- or random-effects models.

Results: Overall, 33 studies consisting of 2,596 subjects (n = 1,337 for patients with MDD and n = 1,259 for healthy controls) were included. Patients with MDD, when compared to healthy controls, had moderate cognitive deficits (SMD, -0.39 [95% CI, -0.47 to -0.31]). In our subgroup analyses, patients with treatment-resistant depression (SMD, -0.56 [95% CI, -0.78 to -0.34]) and older adults with MDD (SMD, -0.51 [95% CI, -0.66 to -0.36]) had greater cognitive deficits than healthy controls. The effect size was small among unmedicated patients with MDD (SMD, -0.19 [95% CI, -0.37 to -0.00]), and we did not find any statistical difference among children. Cognitive deficits were consistently found in all domains, except the reaction time. No publication bias was reported.

Conclusion: Because cognitive impairment in MDD can persist in remission or increase the risk of major neurodegenerative disorders, remediation of cognitive impairment in addition to alleviation of depressive symptoms should be an important goal when treating patients with MDD.

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来源期刊

Psychotherapy and Psychosomatics 医学-精神病学

CiteScore

29.40

自引率

6.10%

发文量

期刊介绍： Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.