Persistence of cognitive impairment in geriatric patients following antidepressant treatment: a randomized, double-blind clinical trial with nortriptyline and paroxetine
Persistence of cognitive impairment in geriatric patients following antidepressant treatment: a randomized, double-blind clinical trial with nortriptyline and paroxetine
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DOI：
10.1016/s0022-3956(02)00085-7
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发表时间：
2003-03-01
影响因子：
4.8
通讯作者：
Reynolds, CF
中科院分区：
文献类型：
--
作者：
Nebes, RD;Pollock, BG;Reynolds, CF
认知功能障碍在患有严重抑郁症的老年人中很常见。然而，随着抑郁症的成功治疗，这种功能障碍在多大程度上是可逆的仍不确定。本研究考察了SSRI(帕罗西汀)或三环类抗抑郁药(去甲替林)治疗(随机双盲设计)对老年抑郁症患者认知功能的影响。将患者的表现与一组年龄和教育程度相似的正常对照组进行比较。在为期12周的试验过程中，患者和对照组接受了五次工作记忆、信息处理速度、情景记忆和注意力的测量。在基线上，患者在所有认知指标上的表现都比老年对照组差。虽然患者在治疗过程中的表现确实有所改善，但这种改善的幅度并不超过老年对照组仅通过练习就能产生的改善幅度。同样的结果模式在意向治疗分析和应答者分析中都很明显。因此，没有证据表明抑郁症患者的认知表现在抗抑郁药物治疗后恢复正常。患者发病时的年龄和他们的认知功能基线水平都不影响他们在12周试验中表现改善的幅度。帕罗西汀和去甲替林在与治疗相关的认知改变方面没有差异。目前的结果表明，认知功能障碍在老年抑郁症患者中持续存在，即使他们的情绪障碍对抗抑郁药物有反应。(C)2003爱思唯尔科学有限公司。保留所有权利。
Cognitive dysfunction is common in Older persons suffering from a major depression. However, the degree to which this dysfunction is reversible with successful treatment of the depression remains uncertain. The present study examined the effects that treatment (randomized double-blind design) with either an SSRI (paroxetine) or a tricyclic antidepressant (nortriptyline) had on cognition in older depressed patients. The patients' performance was compared to that of a group of normal controls of similar age and education. Patients and controls were administered measures of working memory, information-processing speed, episodic memory and attention five times over the course of a 12 week trial. At baseline, the patients performed more poorly than the elderly controls on all cognitive measures. While the patients' performance did improve over the course of their treatment, the magnitude of this improvement did not exceed that produced in the elderly controls by practice alone. The same pattern of results was evident in both intent-to-treat and responder analyses. Thus, there was no evidence that the depressed patients' cognitive performance normalized after response to antidepressant therapy. Neither the patients' age at onset nor their baseline level of cognitive functioning influenced the amount by which their performance improved over the 12 week trial. There was no difference between paroxetine and nortriptyline in the amount of cognitive change associated with treatment. The present results suggest that cognitive dysfunction persists in older depressed patients even after their mood disorder has responded to antidepressant medications. (C) 2003 Elsevier Science Ltd. All rights reserved.