Sertraline treatment of elderly patients with depression and cognitive impairment
Sertraline treatment of elderly patients with depression and cognitive impairment
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DOI：
10.1002/gps.802
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发表时间：
2003-02-01
影响因子：
4
通讯作者：
Sackeim, HA
中科院分区：
文献类型：
--
作者：
Devanand, DP;Pelton, DH;Sackeim, HA
背景抗抑郁药治疗老年抑郁症合并认知功能障碍非痴呆(DEP-MCI)的疗效和副作用尚不清楚，抗抑郁药治疗能否改善患者的认知功能尚不清楚。方法对39例老年DEP-MCI患者，每日服用舍曲林200 mg，连续12周，观察抑郁和认知功能障碍的变化。抑郁症的诊断亚型与反应无关。WAIS-R数字符号变化百分率得分的方差分析显示，对应答者身份(F=5.59，p<；0.03)有显著影响，年龄(F=0.24，p<；0.64)和教育(F=1.64，p<；0.22)不是显著的协变量。从试验前到试验后，应答者的WAIS-R数字符号变化百分率得分有所提高(平均值为-10%SD24)，而无应答者的得分下降(平均值为14%SD18；t=2.60，p<；0.02)。其他神经心理指标与反应无关。HRSD评分的百分比变化与多项认知测量的百分比变化呈显著负相关。结论DEP-MCI患者对舍曲林治疗的临床反应中等。当响应者与非响应者进行比较时，认知改善仅限于注意力和执行功能的一种衡量标准。总体而言，抗抑郁药物治疗几乎没有改善认知能力。这一发现间接表明，DEP-MCI患者在治疗抑郁症后认知能力缺乏改善，可能与随访期间达到痴呆症诊断标准的风险增加有关。版权所有(C)2003 John Wiley Sons，Ltd.
Background There is little information on the efficacy and side effects of antidepressant treatment in elderly patients with combined depression and cognitive impairment without dementia (DEP-MCI), and it is unclear if cognitive performance improves with antidepressant response in these patients.Methods In 39 elderly DEP-MCI patients, changes in depression and cognitive impairment were evaluated with open sertraline treatment up to 200 mg/day for 12 weeks.Results Of the 26 completers, 17 were responders and nine were non-responders. Diagnostic subtype of depression was unrelated to response. ANCOVA on WAIS-R digit symbol percent change scores revealed a significant effect for responder status (F = 5.59, p < 0.03), and age (F = 0.24, p < 0.64) and education (F = 1.64, p < 0.22) were not significant covariates. From pre-trial to post-trial, responders improved in WAIS-R digit symbol percent change scores (Mean - 10% SD 24) while non-responders declined (Mean 14% SD 18; t = 2.60, p < 0.02). Other neuropsychological measures were unrelated to response. Percent change in HRSD scores showed significant inverse correlations with percent change in several cognitive measures.Conclusions DEP-MCI patients showed moderate clinical response to sertraline treatment. When responders were compared to non-responders, cognitive improvement was limited to one measure of attention and executive function. Overall, there was little cognitive improvement with antidepressant treatment. The findings indirectly suggest that lack of improvement in cognition following treatment of depression in DEP-MCI patients may be associated with increased risk of meeting diagnostic criteria for dementia during follow-up. Copyright (C) 2003 John Wiley Sons, Ltd.