中重度晚发抑郁症患者的神经认知功能损害

摘要

目的:探讨晚发抑郁症患者的认知功能损害特征.方法:采用横断面研究,选取30例首次发病年龄≥60岁、符合疾病和有关健康问题的国际统计分类第十次修订本(ICD-10)“中、重度抑郁发作或复发”诊断标准的门诊及住院老年抑郁症患者为晚发抑郁症组,选取30例年龄、性别匹配的正常老年人作为正常对照组.使用威斯康星卡片分类测验(WCST)、Stroop字色干扰测验、词语流畅性测验(VFT),对两组间定势转移、注意抑制、工作记忆等神经认知特点进行比较,应用汉密顿抑郁量表(HAMD-17)评定晚发抑郁症的抑郁严重程度.结果:与正常对照组相比,晚发抑郁症组WCST的错误应答数、持续性应答数、持续性错误数、持续性错误百分数的得分较高[(61±23) vs.(41±25),(44±27) vs.(27±19),(36 ±20) vs.(23±16),(28±15) vs.(19±11),均P＜0.01],WCST的概念化水平应答百分数、Stroop一致组正确数、VFT的得分较低[(36±24) vs.(54±26),(19±3) vs.(20±2),(10±2) vs.(11±2),均P＜0.01].老年抑郁症组HAMD-17的阻滞因子与WCST的持续性应答数呈正相关(r=0.38,P＜0.05),与Stroop一致组正确数呈负相关(r=-0.41,P＜0.05),与VFT的分值呈负相关(r=-0.52,P＜0.01).结论:本研究提示中重度晚发抑郁症患者存在认知功能缺损,尤其是明显的执行功能损害.%Objective:To investigate the damaging traits of cognitive function in late-onset depression.Methods:In this cross-sectional study,30 elderly out-and in-patients whose first onset of major depression occurred at 60 years of age and older were included as the case group,and 30 age-and gender-matched normal elderly people were included as the controls.The diagnoses of moderate to severe depressive episode or recurrent depression were made according to the International Statistical Classification of Diseases and Related Health Problems,Tenth Revision (ICD-10) diagnostic criteria.The Wisconsin Card Sorting Test (WCST),Stroop Test and Verbal Fluency Test (VFT) were used to assess attentional set shifting,attentional inhibition and working memory.The severity of depression was evaluated with the Hamilton Depression Scale-17(HAMD-17).Results:The performance scores of errors,perseverative responses,perseverative errors,percent of perseverative errors in the WCST were significantly higher in the patient group then in the control group[(61 ± 23) vs.(41 ± 25),(44 ± 27) vs.(27± 19),(36 ± 20) vs.(23 ± 16),(28 ± 15) vs.(19 ± 11),P ＜ 0.01].The scores of conceptual level responses [(36±24) vs.(54 ±26)],the correct scores of consistent group in Stroop test[(19 ±3) vs.(20 ±2)] and the scores of VFT in WCST[(10 ±2) vs.(11 ±2)] were lower in the patient group than in the control group (Ps ＜0.01).The scores of perseverative responses in the WCST were positively correlated with retardation factor scores(r =0.38,P ＜ 0.05).The correct scores of consistent group in the Stroop test were negatively correlated with retardation factor scores(r =-0.41,P ＜ 0.05).The scores of VFT were negatively correlated with retardation factor scores(r =-0.52,P ＜ 0.01).Conclusion:There may be impairment of cognitive function in late-onset depression,especially severe executive dysfunction.