抑郁症首次发病患者认知功能的研究

The cognition function in first-episode patients with major depressive disorder

目的探讨抑郁症首次发病(以下简称首发)患者的认知功能特点及其影响因素。方法采用韦氏成人智力量表、韦氏记忆量表、威斯康星卡片分类测验(WCST)分别评定116例首发抑郁症患者(抑郁症组)和41名健康人(对照组)的认知状况,采用汉密尔顿抑郁量表(24项,HAMD)评定病情严重程度。对影响神经心理学测验成绩的临床症状进行逐步多元回归分析。结果(1)抑郁症组的长时记忆[(35.28±7.27)分]、短时记忆[(51.32±13.41)分]、记忆商数[(89.46±17.84)]、语言智商数[(110.96±13.72)]、操作智商数[101.90±15.98)]、智商数[(107.41±15.78)]均明显低于对照组[长时记忆(44.05±5.06)分,短时记忆(71.41±8.51)分,记忆商数(121.90±11.26),语言智商数(117.49±10.99),操作智商数(117.24±10.54),智商数[(118.98±10.95)],差异均有统计学意义(均P<0.01)。抑郁症组的WCST总测验数[(74.70±27.96)个]、持续错误数[(26.07±15.31)个]、随机错误数[(24.46±17.54)个]均明显高于对照组[WCST总测验数(60.15±23.05)个,持续错误数(17.56±11.44)个,随机错误数(17.73±14.27)个],差异有统计学意义(P<0.01或<0.05)。抑郁症组长时记忆成绩、短时记忆成绩和记忆商数低于对照组2个标准差。(2)逐步多元回归分析显示,抑郁症患者的长时记忆成绩及记忆商数与绝望感因子分均呈负相关(均P=0.00),短时记忆成绩和即刻记忆成绩与阻滞因子分均呈负相关(均P=0.00),语言智商与焦虑/躯体化因子分呈负相关(P=0.01),操作智商及智商与HAMD总分均呈负相关(均P=0.01),WCST总测验数和持续错误数与HAMD总分均呈正相关(P=0.01,P=0.02),随机错误数与阻滞因子分呈正相关(P=0.02)。结论首发抑郁症患者急性期的记忆、语言智商、操作智商和执行功能明显减退,临床症状严重程度影响认知功能的改变。

Objective To explore the cognitive function features and the related factors in the firstepisode patients with major depression. Methods 116 major depressed patients and 41 healthy controls were involved. The cognitive function was measured with a series of neuropsychological tests, and the depression severity assessed with the 24-item Hamilton Rating Scale for Depression （ HAMD ） . Results （ 1 ） In comparison with the controls, the depressed patients had lower scores of the long-term memory （ LTM ） ,short-term memory （STM） , memory quotient （MQ）, verbal quotient （VIQ）, practical quotient （PIQ） and IQ, and had higher scores of total trials, preservative errors and random errors in the Wisconsin Card Sorting Test （WCST）, （P 〈0.01 or P 〈0.05）. （2） Linger regression analysis showed that the LTM and MQ scores were negatively correlated to the HAMD hopelessness factor score （ P = 0.00 ）, the STM and Immediate memory score negatively correlated to retardation factor score （ P = 0. 00）, the VIQ negatively to anxiety somatization factor score （ P = 0. 01 ）, the PIQ and IQ scores negatively to the HAMD total score （ P =0.01, P =0. 01 ）, the WCST total trials and preservative errors were positively correlated to the HAMD total score （ P = 0. 01, P = 0. 02 ）, and the random errors positively to retardation factor score （ P = 0. 02 ） .Conclusion The first-episode major depressed patients have obvious impairments in memory, verbal capability, practical capability and execute function. The depression symptom severity has clear impact on the cognitive function.