Cognitive Improvement Following Treatment in Late-Life Depression: Relationship to Vascular Risk and Age of Onset
Cognitive Improvement Following Treatment in Late-Life Depression: Relationship to Vascular Risk and Age of Onset
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DOI：
10.1097/jgp.0b013e318246b6cb
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发表时间：
2012-08-01
影响因子：
7.2
通讯作者：
Sheline, Yvette I.
中科院分区：
文献类型：
--
作者：
Barch, Deanna M.;D'Angelo, Gina;Sheline, Yvette I.
目的：验证血管负荷程度和/或发病年龄可能影响老年抑郁症治疗过程中认知改善程度的假设。设计：舍曲林治疗12周前后的认知测量。地点：大学医学中心（华盛顿大学和杜克大学）。参与者：166名晚年抑郁症患者。干预：舍曲林治疗。测量值：认知任务分为五个领域（语言，处理速度，工作记忆，情节记忆和执行功能）。我们使用中风风险特征测量来测量血管风险。我们使用Fazekas标准测量T2基白色高信号。结果如下：在舍曲林治疗期间，老年抑郁症患者的情景记忆和执行功能均得到显著改善。重要的是，年龄较大、血管风险评分较高和基线简易精神状态检查评分较低预测工作记忆的变化较小。此外，年龄较大，发病年龄晚，血管风险评分较高，预测执行功能的变化较小。结论：这些结果具有重要的临床意义，因为它们表明，定期评估老年抑郁症患者的血管风险是必要的，作为治疗计划和预测预后的一个组成部分，无论是抑郁症本身的过程还是在以后的生活中经常伴随抑郁症的认知障碍。(Am J Geriatr Psychiatry 2012; 20：682-690）
Objectives: To test the hypothesis that the degree of vascular burden and/or age of onset may influence the degree to which cognition can improve during the course of treatment in late-life depression. Design: Measurement of cognition both before and following 12 weeks of treatment with sertraline. Setting: University medical centers (Washington University and Duke University). Participants: One hundred sixty-six individuals with late-life depression. Intervention: Sertraline treatment. Measurements: The cognitive tasks were grouped into five domains (language, processing speed, working memory, episodic memory, and executive function). We measured vascular risk using the Framingham Stroke Risk Profile measure. We measured T2-based white matter hyperintensities using the Fazekas criteria. Results: Both episodic memory and executive function demonstrated significant improvement among adults with late-life depression during treatment with sertraline. Importantly, older age, higher vascular risk scores, and lower baseline Mini-Mental State Examination scores predicted less change in working memory. Furthermore, older age, later age of onset, and higher vascular risk scores predicted less change in executive function. Conclusions: These results have important clinical implications in that they suggest that a regular assessment of vascular risk in older adults with depression is necessary as a component of treatment planning and in predicting prognosis, both for the course of the depression itself and for the cognitive impairments that often accompany depression in later life. (Am J Geriatr Psychiatry 2012; 20:682-690)