Empirical evidence for discrete neurocognitive subgroups in patients with non-psychotic major depressive disorder: clinical implications
Empirical evidence for discrete neurocognitive subgroups in patients with non-psychotic major depressive disorder: clinical implications
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DOI：
10.1017/s003329171800034x
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发表时间：
2018-12-01
影响因子：
6.9
通讯作者：
Nakagome, Kazuyuki
中科院分区：
文献类型：
--
作者：
Pu, Shenghong;Noda, Takamasa;Nakagome, Kazuyuki
背景资料。严重抑郁障碍(MDD)的神经心理缺陷存在于不同的认知领域。然而，神经心理异常的一致性和特异性还没有建立起来。采用简明精神分裂症认知评定量表对170例非精神病性MDD患者的认知功能进行评估，并与42例精神分裂症患者进行比较，作为判断认知功能障碍严重程度的参考。采用系统聚类法分析MDD患者是否存在离散的神经认知亚群。然后，我们在几个临床因素和社会功能方面对这些亚组进行了比较。发现了三个不同的神经认知亚组：(1)轻度损害亚组，表现接近正常表现，运动速度轻度障碍；(2)选择性损害亚组，表现出保留的工作记忆和执行功能，但在言语记忆、运动速度、语言流畅性和注意力/信息处理速度方面存在中到重度缺陷；(3)总体损害亚组，所有神经认知领域都有中到重度缺陷，与精神分裂症的缺陷相当。整体损害亚组以病前智商(IQ)较低为特征。此外，两组在病前智商(p=0.003)、抗抑郁药物剂量(p=0.043)、抗精神病药物剂量(p=0.013)或抗焦虑药物剂量(p<；0.001)方面均有显著差异。这些结果表明，在具有独特特征的非精神病性MDD中存在多个神经认知亚群，其中一个亚群表现出与精神分裂症类似的缺陷。本研究的结果可能有助于指导未来使用不同的治疗方法来针对这些致残症状的努力。
Background. Neuropsychological deficits are present across various cognitive domains in major depressive disorder (MDD). However, a consistent and specific profile of neuropsychological abnormalities has not yet been established.Methods. We assessed cognition in 170 patients with non-psychotic MDD using the Brief Assessment of Cognition in Schizophrenia and the scores were compared with those of 42 patients with schizophrenia as a reference for severity of cognitive impairment. Hierarchical cluster analysis was conducted to determine whether there are discrete neurocognitive subgroups in MDD. We then compared the subgroups in terms of several clinical factors and social functioning.Results. Three distinct neurocognitive subgroups were found: (1) a mild impairment subgroup with near-normative performance and mild dysfunction in motor speed; (2) a selective impairment subgroup, which exhibited preserved working memory and executive function, but moderate to severe deficits in verbal memory, motor speed, verbal fluency, and attention/information processing speed; and (3) a global impairment subgroup with moderate to severe deficits across all neurocognitive domains, comparable with deficits in schizophrenia. The global impairment subgroup was characterized by lower pre-morbid intelligence quotient (IQ). Moreover, a significant difference between groups was observed in premorbid IQ (p = 0.003), antidepressant dose (p = 0.043), antipsychotic dose (p = 0.013), or anxiolytic dose (p < 0.001).Conclusions. These results suggest the presence of multiple neurocognitive subgroups in non-psychotic MDD with unique profiles, one of which exhibits deficits comparable to those of schizophrenia. The results of the present study may help guide future efforts to target these disabling symptoms using different treatments.