Cognitive control, reward-related decision making and outcomes of late-life depression treated with an antidepressant.
Cognitive control, reward-related decision making and outcomes of late-life depression treated with an antidepressant.
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认知控制，与奖励相关的决策和抗抑郁药治疗的后期抑郁症的结果。
DOI：
10.1017/s0033291715001075
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发表时间：
2015-10
影响因子：
6.9
通讯作者：
Gunning F
中科院分区：
文献类型：
--
作者：
Alexopoulos GS;Manning K;Kanellopoulos D;McGovern A;Seirup JK;Banerjee S;Gunning F
执行过程至少包括两组功能：一组与认知控制有关，另一组与奖励相关的决策有关。这两种情况的异常表现都发生在晚年抑郁症中。本研究验证了只有认知控制任务中的异常表现才能预测艾司西酞普兰治疗晚期抑郁症的不良结局的假设。我们研究了患有重度抑郁症的老年受试者（N=53）和非抑郁症受试者（N=30）。采用爱荷华州赌博测试（IGT）、Stroop颜色/单词测试、伦敦塔和痴呆评定量表-起始/持续域（DRS-IP）测试执行功能。经过2周的安慰剂洗脱后，抑郁症受试者接受艾司西酞普兰（目标日剂量：20 mg）治疗12周。抑郁和非抑郁受试者之间的执行功能测试没有显着差异。抑郁症受试者的分层聚类分析确定了一个认知控制聚类（异常Stroop，Tower，DRS-IP），一个奖励相关聚类（IGT）和一个执行未受损聚类。与认知控制组相比，执行力未受损组（t=-2.09，df=331，p=0.0375）和奖励相关组（t=-2.33，df=331，p=0.0202）的抑郁下降幅度更大。执行未受损群集（t=2.17，df=331，p=0.03）和奖励相关群集（t=2.03，df=331，p=0.0433）比认知控制群集具有更高的缓解概率。认知控制功能障碍，而不是奖励相关的决策，可能会影响症状的下降和艾司西酞普兰治疗的晚年抑郁症的缓解概率。如果重复，简单的管理认知控制测试可以用来选择抑郁症老年患者的风险，为穷人的结果SSRIs谁可能需要结构化的心理治疗。
Executive processes consist of at least two sets of functions: one concerned with cognitive control and the other with reward-related decision making. Abnormal performance in both sets occurs in late-life depression. This study tested the hypothesis that only abnormal performance in cognitive control tasks predicts poor outcomes of late-life depression treated with escitalopram. We studied older subjects with major depression (N=53) and non-depressed subjects (N=30). Executive functions were tested with the Iowa Gambling Test (IGT), Stroop Color/Word test, Tower of London, and Dementia Rating Scale-Initiation/Perseveration Domain (DRS-IP). After a 2-week placebo washout, depressed subjects received escitalopram (target daily dose: 20 mg) for 12 weeks. There were no significant differences between depressed and non-depressed subjects on executive function tests. Hierarchical cluster analysis of depressed subjects identified a Cognitive Control Cluster (abnormal Stroop, Tower, DRS-IP), a Reward-Related Cluster (IGT), and an Executively Unimpaired Cluster. Decline in depression was greater in the Executively Unimpaired (t=−2.09, df=331, p=0.0375) and the Reward-Related Cluster (t=−2.33, df=331,p=0.0202) than the Cognitive Control Cluster. The Executively Unimpaired Cluster (t=2.17, df=331, p=0.03) and the Reward-Related Cluster (t=2.03, df=331, p=0.0433) had a higher probability of remission than the Cognitive Control Cluster. Dysfunction of cognitive control functions, but not reward-related decision making, may influence the decline of symptoms and the probability of remission of late-life depression treated with escitalopram. If replicated, simple to administer cognitive control tests may be used to select depressed older patients at risk for poor outcomes to SSRIs who may require structured psychotherapy.