Cognitive impairment and depression outcomes in the IMPACT study.
Cognitive impairment and depression outcomes in the IMPACT study.
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DOI：
10.1097/01.jgp.0000194646.65031.3f
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发表时间：
2006-05
期刊：
影响因子：
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通讯作者：
D. Steffens;M. Snowden;Ming‐Yu Fan;H. Hendrie;W. Katon;J. Unützer
中科院分区：
文献类型：
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作者：
D. Steffens;M. Snowden;Ming‐Yu Fan;H. Hendrie;W. Katon;J. Unützer
目前尚不清楚认知功能障碍是否会影响老年抑郁症的急性和长期治疗反应。此外，对于在抑郁症治疗过程中经历认知下降的老年人抑郁症的长期结果知之甚少。作者使用IMPACT试验的数据研究了这两个问题。样本包括IMPACT研究中的1，684名参与者，他们有基线和两年的随访数据。受试者被随机分配到一年的积极干预与抑郁症护理经理或常规护理。一年后，所有受试者接受另一年的常规护理。数据收集了两年。作者使用六项认知筛查来检查基线认知损害和认知下降对抑郁症结局的急性和长期影响。抑郁测量包括HSCL-20和无抑郁天数的估计。使用线性回归和重复测量分析确定结果。结果积极干预组的抑郁受试者在一年后有更好的抑郁结局，无论基线认知障碍如何。每个治疗组中认知功能受损受试者的结局与无认知功能受损受试者相似。与认知评分没有变化的受试者相比，认知评分在两年内下降的受试者的24个月抑郁结局更差。结论：认知功能障碍抑郁症患者在适当的急性期和持续期管理下可以显著改善抑郁症。经历持续认知下降的老年抑郁症患者可能有更高的抑郁症预后不良的风险，可能需要更仔细的临床监测和管理认知和情感症状。
INTRODUCTION It is unclear whether cognitive impairment affects acute and long-term treatment response in geriatric depression. In addition, little is known about the long-term outcome of depression among older individuals who experience cognitive decline during a course of treatment for depression. The authors examined both of these issues using data from the IMPACT trial. METHODS The sample consisted of 1,684 participants in the IMPACT study who had baseline and two-year follow-up data. Subjects were randomized to one year of active intervention with a depression care manager or usual care. After one year, all subjects had usual care for another year. Data were collected for two years. The authors used the Six-Item Cognitive Screener to examine acute and long-term effects on depression outcome of baseline cognitive impairment and of cognitive decline. Depression measures included the HSCL-20 and an estimation of depression-free days. Outcomes were determined using both linear regression and repeated-measures analyses. RESULTS Depressed subjects in the active intervention group had better depression outcomes at one year regardless of baseline cognitive impairment. Cognitively impaired subjects within each treatment group had similar outcomes to subjects without cognitive impairment. Subjects who experienced decline in cognitive score over two years had worse 24-month depression outcomes compared with subjects whose cognitive score did not change. CONCLUSIONS Cognitively impaired depressed patients can experience significant improvement in depression with appropriate acute and continuation-phase management. Older depressed adults experiencing ongoing cognitive decline may be at higher risk for poor depression outcomes and may require more careful clinical monitoring and management of both cognitive and affective symptoms.