Course of cognitive impairment following attempted suicide in older adults.
Course of cognitive impairment following attempted suicide in older adults.
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DOI：
10.1002/gps.4365
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发表时间：
2016-06
影响因子：
4
通讯作者：
Szanto K
中科院分区：
文献类型：
--
作者：
Gujral S;Ogbagaber S;Dombrovski AY;Butters MA;Karp JF;Szanto K
认知障碍与晚年自杀行为有关。在没有纵向数据的情况下，不清楚这些是抑郁状态的暂时性特征还是稳定性损害。我们纵向研究了患有抑郁症和有自杀未遂病史的老年人的认知损害过程。我们调查了198名抑郁症老年人(60岁)、91名自杀未遂者、39名有自杀意念的抑郁症个体(Ideator)和68名非自杀抑郁症成年人在四个时间点的两年时间内认知障碍的持久性。我们使用线性混合效应模型，使用简易智力状态检查(MMSE)、马蒂斯痴呆症评定量表(DRS)和高管访谈(EXIT)来检验两年来认知下降轨迹的组差异。在两年的时间里，自杀未遂者在简明精神状态量表上的表现明显比自杀意念者和非自杀抑郁的老年人差(平均差异：意想者：−0.88，p=0.02；非自杀抑郁：−1.52，p<；0.01)，而在退出和DRS上，自杀未遂者的表现明显比非自杀抑郁老年人差(平均差异：退出：−1.75，p=0.01；在drs：3.04，p<；0.01；在MMSE：1.15，p<；0.01)。自杀未遂者的认知功能障碍部分得到缓解，如群体*时间交互作用(p=0.039)，而不是退出(p=0.58)或简明精神状态量表(p=0.08)。晚年自杀行为中的认知障碍似乎既涉及稳定因素，也涉及与状态相关的因素。
Cognitive impairment has been associated with late-life suicidal behavior. Without longitudinal data it is unclear whether these are transient features of a depressive state or stable impairments. We examined longitudinally the course of cognitive impairment in older adults with depression and a history of suicide attempt. We investigated the persistence of cognitive impairment over time in 198 depressed older adults (age >60); 91 suicide attempters, 39 depressed individuals with suicidal ideation (ideators), and 68 non-suicidal depressed adults assessed over a 2-year period at four time points. We used linear mixed effects modeling to examine group differences in trajectories of cognitive decline over 2 years, using the Mini-Mental State Exam (MMSE), Mattis Dementia Rating Scale (DRS), and Executive Interview (EXIT). Over the 2-year period, suicide attempters performed significantly worse than both suicide ideators and nonsuicidal depressed older adults on the MMSE (mean difference: from ideators: −0.88, p = 0.02; from nonsuicidal depressed: −1.52, p < 0.01), while on the EXIT and DRS, suicide attempters performed significantly worse than non-suicidal depressed older adults (mean difference: in EXIT: −1.75, p=0.01; in DRS: 3.04, p < 0.01; in MMSE: 1.15, p < 0.01). Cognitive impairment in suicide attempters partly resolved, as indicated by a group*time interaction on the DRS (p= 0.039), but not the EXIT (p= 0.58) or the MMSE (p= 0.08). Cognitive impairment in late-life suicidal behavior appears to involve both a stable and a state-related component.