Support for the vascular depression hypothesis in late-life depression: results of a 2-site, prospective, antidepressant treatment trial.
Support for the vascular depression hypothesis in late-life depression: results of a 2-site, prospective, antidepressant treatment trial.
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DOI：
10.1001/archgenpsychiatry.2009.204
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发表时间：
2010-03
影响因子：
--
通讯作者：
Doraiswamy PM
中科院分区：
文献类型：
--
作者：
Sheline YI;Pieper CF;Barch DM;Welsh-Bohmer K;McKinstry RC;MacFall JR;D'Angelo G;Garcia KS;Gersing K;Wilkins C;Taylor W;Steffens DC;Krishnan RR;Doraiswamy PM
关于“血管性抑郁”的研究使用了两种方法，根据执行功能障碍或白色高信号（WMH）的严重程度对晚年抑郁（LLD）进行亚型划分。评估LLD患者神经心理学表现和WMH与临床反应的关系。2-现场前瞻性非随机对照试验。华盛顿大学和杜克大学的门诊诊所。217例年龄≥ 60岁的受试者符合DSM-IV重度抑郁症标准，评分≥ 20（MADRS），接受了血管风险因素（VRF）评分、神经心理学测试和MRI扫描;因认知障碍或重度医学疾病而被排除。进行Fazekas评分以分级WMH病变。舍曲林治疗12周，根据临床反应滴定。蒙哥马利-艾斯伯格抑郁评定量表（MADRS）评分随时间的变化。基线神经心理因素评分与基线Fazekas评分呈负相关。混合模型检查了预测变量随时间推移对MADRS评分的影响。基线情景记忆（p = 0.002）、语言（p = 0.007）、工作记忆（p = 0.01）、处理速度（p = 0.0001）、执行功能因子评分（p = 0.002）和分类Fazekas评分（p = 0.049）预测MADRS评分，控制年龄、教育、发病年龄和种族。除了工作记忆和Fazekas评分外，控制基线MADRS评分，这些因素仍然是MADRS评分降低的显著预测因素。33%的受试者达到缓解（MADRS ≤ 7）。缓解者与非缓解者在基线认知处理速度、执行功能、语言、情景记忆和VRF评分方面存在差异。综合神经心理功能和WMH严重程度预测MADRS评分前瞻性超过12周SSRI治疗过程中LLD。基线神经心理功能区分缓解者和非缓解者，并在比例风险模型中预测缓解时间。预测变量与VRF严重程度高度相关。这些数据支持血管性抑郁假说，并强调了基于神经心理功能和白色物质完整性的亚型联系的重要性。
Research on “vascular depression” has used two approaches to subtype late life depression (LLD) based on executive dysfunction or white matter hyperintensity (WMH) severity. Evaluate the relationship of neuropsychological performance and WMH to clinical response in LLD. 2-site prospective nonrandomized controlled trial. Outpatient clinics at Washington University and Duke University. 217 subjects age ≥ 60 met DSM-IV criteria for major depression, scored ≥ 20 (MADRS), received vascular risk factor (VRF) scores, neuropsychological testing and MRI scan; were excluded for cognitive impairment or severe medical disorders. Fazekas rating was conducted to grade WMH lesions. 12 weeks of sertraline treatment, titrated by clinical response. Montgomery-Asberg Depression Rating Scale (MADRS) score over time. Baseline neuropsychological factor scores correlated negatively with baseline Fazekas scores. A mixed model examined effects of predictor variables on MADRS scores over time. Baseline episodic memory (p = 0.002); language (p = 0.007); working memory (p = 0.01); processing speed (p = 0.0001); executive function factor scores (p = 0.002), and categorical Fazekas ratings (p = 0.049) predicted MADRS scores, controlling for age, education, age of onset and race. Controlling for baseline MADRS scores these factors remained significant predictors of decrease in MADRS scores except working memory and Fazekas ratings. 33% of subjects achieved remission (MADRS ≤ 7). Remitters differed from non-remitters in baseline cognitive processing speed, executive function, language, episodic memory and VRF scores. Comprehensive neuropsychological function and WMH severity predicted MADRS scores prospectively over a 12 week SSRI treatment course in LLD. Baseline neuropsychological function differentiated remitters from non-remitters and predicted time to remission in a proportional hazards model. Predictor variables correlated highly with VRF severity. These data support the vascular depression hypothesis and highlight the importance of linking subtypes based on neuropsychological function and white matter integrity.
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影响因子：
8.3
作者：
Jeerakathil, T;Wolf, PA;DeCarli, C
通讯作者：
DeCarli, C
影响因子：
17.7
作者：
Alexopoulos, George S.;Murphy, Christopher F.;Hoptman, Matthew J.
通讯作者：
Hoptman, Matthew J.
影响因子：
9.9
作者：
Guttmann, CRG;Jolesz, FA;Albert, MS
通讯作者：
Albert, MS
影响因子：
10.6
作者：
COFFEY, CE;FIGIEL, GS;WEINER, RD
通讯作者：
WEINER, RD
影响因子：
7.2
作者：
Firbank, MJ;Lloyd, AJ;O'Brien, JT
通讯作者：
O'Brien, JT