Cognitive Function in Heart Failure Is Associated With Nonsomatic Symptoms of Depression But Not Somatic Symptoms
Cognitive Function in Heart Failure Is Associated With Nonsomatic Symptoms of Depression But Not Somatic Symptoms
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DOI：
10.1097/jcn.0000000000000178
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发表时间：
2015-09-01
影响因子：
2
通讯作者：
Hughes, Joel W.
中科院分区：
文献类型：
--
作者：
Hawkins, Misty A. W.;Dolansky, Mary A.;Hughes, Joel W.
背景：心力衰竭（HF）患者认知障碍和抑郁症状的发生率很高。心衰患者的抑郁症状与严重的认知障碍有关；然而，尚不清楚特定的抑郁症状群是否比其他抑郁症状群对认知更有害。 目的：本研究的目的是确定躯体和/或非躯体抑郁症状群是否与心力衰竭患者的认知功能相关。方法：参与者为 326 名心力衰竭患者（40.5% 为女性，26.7% 非白人，年龄 68.6 +/- 9.7 岁）。使用医疗人群常用的抑郁问卷来测量抑郁症状：患者健康问卷 9。躯体和非躯体子量表分数是使用之前的因子分析结果创建的。神经心理电池测试了注意力、执行功能和记忆力。复合材料是使用年龄调整的标度分数的平均值创建的。对人口和临床因素进行回归调整。结果：回归显示，患者健康问卷 9 的总分与注意力（beta = -.14，P = .008）和执行功能（beta = -.17，P = .001）相关。单独分析时，非躯体症状分量表（P 值 >= .092）与注意力评分（β = -.15，P = .004）和记忆力（β = -.11，P = .044）相关。非躯体症状（β = -.18，P < .001）和躯体症状（β = -.11，P = .048）均与执行功能相关。当综合考虑时，只有非躯体症状群与注意力（beta = -.15，P = .020）和执行功能（beta = -.19，P = .003）相关。结论：总体抑郁症状严重程度与多个认知领域的表现较差相关，这主要是由抑郁症的非躯体症状驱动的。临床意义：这些发现表明可能需要明确筛查非躯体抑郁症状，并且可能需要了解非躯体抑郁症状的潜在机制。心衰患者抑郁与认知功能的关系不仅仅与睡眠或食欲障碍有关。因此，与针对抑郁情绪、快感缺失和其他非躯体症状的综合治疗相比，仅针对患者躯体症状（例如食欲不振或疲劳）的干预措施可能不会产生最大的认知益处。
Background:Patients with heart failure (HF) have high rates of cognitive impairment and depressive symptoms. Depressive symptoms have been associated with greater cognitive impairments in HF; however, it is not known whether particular clusters of depressive symptoms are more detrimental to cognition than others.Objective:The aim of this study was to identify whether somatic and/or nonsomatic depressive symptom clusters were associated with cognitive function in persons with HF.Methods:Participants were 326 HF patients (40.5% women, 26.7% non-white race-ethnicity, aged 68.6 +/- 9.7 years). Depressive symptoms were measured using a depression questionnaire commonly used in medical populations: the Patient Health Questionnaire-9. Somatic and nonsomatic subscale scores were created using previous factor analytic results. A neuropsychological battery tested attention, executive function, and memory. Composites were created using averages of age-adjusted scaled scores. Regressions adjusting for demographic and clinical factors were conducted.Results:Regressions revealed that Patient Health Questionnaire-9 total was associated with attention (beta = -.14, P = .008) and executive function (beta = -.17, P = .001). When analyzed separately, the nonsomatic subscale, but not the somatic symptoms subscale (P values >= .092), was associated with attention scores (beta = -.15, P = .004) and memory (beta = -.11, P = .044). Both nonsomatic (beta = -.18, P < .001) and somatic (beta = -.11, P = .048) symptoms were related to executive function. When included together, only the nonsomatic symptom cluster was associated with attention (beta = -.15, P = .020) and executive function (beta = -.19, P = .003).Conclusions:Greater overall depressive symptom severity was associated with poorer performance on multiple cognitive domains, an effect driven primarily by the nonsomatic symptoms of depression.Clinical Implications:These findings suggest that screening explicitly for nonsomatic depressive symptoms may be warranted and that the mechanisms underlying the depression-cognitive function relationship in HF are not solely related to sleep or appetite disturbance. Thus, interventions that target patients' somatic symptoms only (eg, poor appetite or fatigue) may not yield maximum cognitive benefit compared with a comprehensive treatment that targets depressed mood, anhedonia, and other nonsomatic symptoms.