老年抑郁症患者抗抑郁药治疗期间认知与抑郁症状的变化及其与ApoEε4等位基因的关系(英文)

Relationship of changes in cognitive and depressive symptoms during antidepressant treatment of individuals with geriatric depression and their relationship to the APOE epsilon 4 allele

背景老年抑郁症伴有的认知损害可能不随抗抑郁治疗而好转,可能会进展为痴呆。目的探讨老年抑郁症患者抗抑郁治疗前后认知和抑郁症状变化的关系及其与ApoEε4等位基因的关联。方法检测64例首发老年抑郁症患者和31名非抑郁老年人的ApoEε4等位基因。抑郁症患者接受标准化的选择性5-羟色胺再摄取抑制剂(Selective Serotonin Reuptake Inhibitors,SSRIs)治疗,在基线和治疗12个月后分别对研究对象进行老年抑郁量表(The Geriatric Depression Scale,GDS)、简易智能状态检查(Mini-Mental State Examination,MMSE)、数字广度测验(digit span task)和连线测验A,B(Trail making test,TMT-A,TMT-B)的测评。结果与对照组比较,治疗前老年抑郁症组患者的认知功能较差,其中31(48%)例符合轻度认知功能损害(mild cognitive impairment,MCI)的标准。治疗后,无论共病MCI与否,抑郁症患者的认知和抑郁症状均有改善,但伴MCI者残留症状更多。基线时认知症状的严重程度与抑郁症状的严重程度不存在相关性,但在12个月随访时二者存在正相关。患者中有14%(9/64)携带ApoEε4等位基因,而对照中仅有3%(1/31)携带APOEε4等位基因(Fisher精确检验,p=0.158)。与未携带ApoEε4等位基因的抑郁症患者相比,携带此等位基因的抑郁症患者治疗前、后均有较严重的认知症状,但仅某些方面的差异具有统计学意义。结论老年抑郁症患者普遍存在认知损害。经标准的SSRI治疗后,患者的抑郁和认知症状均有所改善,但共病MCI的患者治疗后残留更多的抑郁和认知症状。老年抑郁症患者中携带ApoEε4等位基因与较严重的认知损害有关,可能与抗抑郁剂治疗认知症状疗效欠佳有关。

Background： Co-occurring cognitive impairment in geriatric depression may not improve with antidepressant treatment and it may progress to dementia. Aim： Assess the relationship between changes in cognitive and depressive symptoms among patients with geriatric depression and their association with the APOE epsilon 4 allele before and after antidepressant treatment. Methods： The presence of the APOE epsilon 4 allele was assessed in 64 incident cases of geriatric depression and 32 elderly individuals without depression and the Geriatric Depression Scale （GDS）, Mini-Mental State Examination （MMSE）, digit span test, and Trail Making Tests A and B （TMT-A, TMT-B） were administered to these subjects at baseline and 12 months after baseline, during which time the depressed group received standardized treatment with selective serotonin reuptake inhibitors （SSRIs）. Results： Prior to treatment patients with geriatric depression had significantly worse cognitive functioning than control subjects and 31 （48%） met criteria for mild cognitive impairment （MCI）. After treatment depressed patients with and without comorbid MCI both had significant improvements in their depressive and cognitive symptoms, but those with MCI had more residual symptoms. The severity of cognitive symptoms was not associated with the severity of depressive symptoms at baseline, but they were positively correlated at the 12-month follow-up. The APOE epsilon 4 allele was identified in 14% （9/64） of the patients and in 3% （1/31） of the controls （Fisher＇s Exact Test, p=0.158）. Compared to depressed patients without the allele, depressed patients with the allele had more severe cognitive deficits both before and after treatment, though only some of these differences were statistically significant. Conclusions： There is substantial cognitive impairment in elderly individuals with geriatric depression. Both the depressive and cognitive symptoms improve with standard SSRI treatment, but individuals with comorbid MCI have more residual depressive and cognitive symptoms after treatment. The APOE epsilon 4 allele is associated with greater cognitive impairment in geriatric depressed patients and may be associated with less responsiveness of cognitive symptoms to antidepressant treatment.