Cognitive outcome following tricyclic and electroconvulsive treatment of major depression in the elderly.
Cognitive outcome following tricyclic and electroconvulsive treatment of major depression in the elderly.
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DOI：
10.1176/ajp.148.10.1336
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发表时间：
1991-10
期刊：
影响因子：
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通讯作者：
A. Stoudemire;C. Hill;R. Morris;D. Martino-Saltzman;H. Markwalter;B. Lewison
中科院分区：
文献类型：
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作者：
A. Stoudemire;C. Hill;R. Morris;D. Martino-Saltzman;H. Markwalter;B. Lewison
目的：本研究旨在确定三环类药物和电休克治疗后的情感和认知结果的老年精神病患者符合诊断标准的抑郁症，其中一些人有正常的认知功能，其中一些人在治疗前认知受损。方法采用Mattis痴呆评定量表对符合抑郁症诊断标准的患者进行评估，并对汉密尔顿抑郁评定量表评分≥ 17分的患者进行结构化诊断访谈。然后，患者以非随机方式接受三环类抗抑郁药或ECT治疗（随后接受三环类维持治疗）。大多数接受ECT治疗的患者以前对三环类药物没有反应。在6个月内重复进行随访心理测量测试。结果在治疗前认知功能正常的患者中，认知功能基本稳定。在治疗前有认知障碍的患者中，包括接受ECT治疗的患者在内，相当多的患者表现出认知能力的改善。虽然大多数患者的情感和认知状态均得到改善，但仍确定了某些治疗难治性亚组。结论数据表明，大量老年患者（包括接受ECT的老年患者）在治疗后，与抑郁症相关的认知功能障碍可能会改善。然而，复发率可能相对较高，残留症状可能持续存在，这强调了需要为这一人群提供最佳的初始和长期抗抑郁策略。
OBJECTIVE This study sought to ascertain the affective and cognitive outcome after tricyclic and electroconvulsive treatment of elderly medical-psychiatric patients meeting diagnostic criteria for major depression, some of whom had normal cognitive functioning and some of whom were cognitively impaired before treatment. METHOD Patients who met criteria for major depression on the basis of a structured diagnostic interview and who scored 17 or more on the Hamilton Rating Scale for Depression were evaluated with the Mattis Dementia Rating Scale. The patients were then treated in a nonrandom manner with either tricyclic antidepressants or ECT (followed by tricyclic maintenance therapy). The majority of the patients treated with ECT had not responded previously to tricyclics. Follow-up psychometric testing was repeated in 6 months. RESULTS Among the patients with normal pretreatment cognitive functioning, cognition was generally stable. Among the patients with pretreatment cognitive impairment, a substantial number--including those receiving ECT--demonstrated improvement in cognition. While the majority of patients improved with respect to both their affective and cognitive states, certain treatment-refractory subgroups were nevertheless identified. CONCLUSIONS The data suggest that cognitive dysfunction associated with depression may improve after treatment in a substantial number of elderly patients, including those receiving ECT. Relapse rates, however, may be relatively high, and residual symptoms may persist, which emphasizes the need for optimal initial and long-term antidepressant strategies for this population.