The effects of memory, attention, and executive dysfunction on outcomes of depression in a primary care intervention trial: the PROSPECT study
The effects of memory, attention, and executive dysfunction on outcomes of depression in a primary care intervention trial: the PROSPECT study
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DOI：
10.1002/gps.1767
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发表时间：
2007-09-01
影响因子：
4
通讯作者：
Alexopoulos, George S.
中科院分区：
文献类型：
--
作者：
Bogner, Hillary R.;Bruce, Martha L.;Alexopoulos, George S.
目的描述老年初级保健患者干预试验中认知领域对抑郁缓解和反应的影响。方法20个初级保健实践被随机分配到常规护理或由提供基于算法的抑郁症护理的抑郁症护理经理组成的干预组。这些分析总共包括599名60岁及以上被诊断为抑郁症的成年人。采用24项汉密尔顿抑郁量表评定抑郁严重程度和缓解情况。简易智力状态检查(MMSE)是我们对认知功能的全球测量。用痴呆评定量表中的记忆分量表评定言语记忆。注意力是用韦施勒成人智力测试中的数字广度来衡量的。反应抑制是执行功能之一，采用Stroop颜色词测验进行评定。结果无论有无认知障碍，干预均可提高缓解率和缓解率。由Stroop颜色词测试测量的反应抑制似乎显著改变了4个月时干预与常规护理在缓解和反应方面的差异。在干预条件下，在Stroop颜色词测试中表现最差的四分位数的患者在4个月时比普通护理中的可比患者更有可能在4个月后抑郁得到缓解[优势比(OR)=17.76，95%可信区间(CI)，3.06,103.1]。结论在初级保健中有执行功能障碍的老年抑郁症患者在接受常规护理时缓解率和应答率较低，但从抑郁症护理管理中受益。版权所有(C)2007 John Wiley&Sons，Ltd.
Objective To describe the influence of domains of cognition on remission and response of depression in an intervention trial among older primary care patients. Methods Twenty primary care practices were randomly assigned to Usual Care or to an Intervention consisting of a depression care manager offering algorithm-based care for depression. In all, 599 adults 60 years and older with a depression diagnosis were included in these analyses. Depression severity and remission of depression were assessed by the 24-item Hamilton Depression Rating Scale. The Mini-Mental State Examination (MMSE) was our global measure of cognitive function. Verbal memory was assessed with the memory, subscale of the Dementia Rating Scale. Attention was measured with the digit span from the Weschler Adult Intelligence Test. Response inhibition, one of the executive functions, was assessed with the Stroop Color-Word test. Results The intervention was associated with improved remission and response rates regardless of cognitive impairment. Response inhibition as measured by the Stroop Color-Word test appeared to significantly modify the intervention versus usual care difference in remission and response at 4 months. Patients in the poorest performance quartile at baseline on the Stroop Color-Word test in the Intervention Condition were more likely to achieve remission of depression at 4 months than comparable patients in Usual Care [odds ratio (OR)= 17.76, 95% Confidence Interval (CI), 3.06, 103.1]. Conclusions Depressed older adults in primary care with executive dysfunction have low remission and response rates when receiving usual care but benefit from depression care management. Copyright (c) 2007 John Wiley & Sons, Ltd.