A Meta-Analysis of Executive Dysfunction and Antidepressant Treatment Response in Late-Life Depression.
A Meta-Analysis of Executive Dysfunction and Antidepressant Treatment Response in Late-Life Depression.
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DOI：
10.1016/j.jagp.2015.05.010
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发表时间：
2016-01
期刊：
影响因子：
--
通讯作者：
Sneed JR
中科院分区：
文献类型：
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作者：
Pimontel MA;Rindskopf D;Rutherford BR;Brown PJ;Roose SP;Sneed JR
伴有执行功能障碍（艾德）的抑郁老年人可能对抗抑郁药治疗反应不佳。艾德是一个多方面的概念，不同的研究测量了艾德的不同方面，因此不清楚哪些方面预测不良反应。荟萃分析方法被用来确定艾德是否预测抗抑郁药治疗反应不良的晚年抑郁症，并确定哪些领域的执行功能是负责这种关系。进行Medline检索，以确定比较老年应答者和无应答者执行功能的系统治疗试验;仅纳入50岁及以上抑郁症门诊患者的系统治疗试验。根据最新的PRISMA指南，从8项研究中提取了25项执行功能指标。确定了六个领域：认知灵活性、计划和组织、反应抑制、选择性注意、语言流畅性和痴呆评定量表起始/持续综合评分（DRS I/P）。赫奇的g值是针对每一项执行功能的测量而计算的。一个三水平贝叶斯分层线性模型（HLM）被用来估计执行功能的每个领域的效果大小。计划和组织的影响与零有显著差异（贝叶斯HLM估计的领域效应大小：0.91; 95%CI：0.32-1.58），而认知灵活性，反应抑制，选择性注意，语言流畅性和DRS I/P综合评分没有。计划和组织领域与晚年抑郁症患者抗抑郁治疗反应不良有意义相关。这些研究结果表明，专注于计划和组织的治疗可能为抗抑郁药无应答者提供有效的增强策略。
Depressed older adults with executive dysfunction (ED) may respond poorly to antidepressant treatment. ED is a multifaceted construct and different studies have measured different aspects of ED, making it unclear which aspects predict poor response. Meta-analytic methods were used to determine whether ED predicts poor antidepressant treatment response in late-life depression and to determine which domains of executive functioning are responsible for this relationship. A Medline search was conducted to identify regimented treatment trials contrasting executive functioning between elderly responders and nonresponders; only regimented treatment trials for depressed outpatients aged 50 and older were included. Following the most recent PRISMA guidelines, 25 measures of executive functioning were extracted from eight studies. Six domains were identified: cognitive flexibility, planning and organization, response inhibition, selective attention, verbal fluency, and the Dementia Rating Scale Initiation/Perseveration composite score (DRS I/P). Hedge’s g was calculated for each measure of executive functioning. A three-level Bayesian hierarchical linear model (HLM) was used to estimate effect sizes for each domain of executive functioning. The effect of planning and organization was significantly different from zero (Bayesian HLM estimate of domain effect size: 0.91; 95% CI: 0.32–1.58), whereas cognitive flexibility, response inhibition, selective attention, verbal fluency, and the DRS I/P composite score were not. The domain of planning and organization is meaningfully associated with poor antidepressant treatment response in late-life depression. These findings suggest that therapies that focus on planning and organization may provide effective augmentation strategies for antidepressant nonresponders with late-life depression.