老年抑郁症药物干预前后事件相关电位及交感神经皮肤反应

Control study on the cognitive and autonomic nerve function in the elderly depression patients before and after drug intervention

目的探讨老年抑郁症（GD）药物干预前后事件相关电位（ERPs）和交感神经皮肤反应（SSR）的变化。方法选择符合人选标准的GD患者（研究组）43例以及41例健康老年人（对照组），研究组予艾司西酞普兰治疗（10～20mg／d），治疗前与治疗8W后进行ERPs，SSR，汉密尔顿抑郁量表24项（HAMD），蒙特利尔认知评估量表（MoCA）和日常生活活动能力量表（ADL）测量。对照组于体检当天完成上述测量。结果研究组治疗前HAMD总分与对照组HAMD总分差异显著（P〈0．05）；ERPs（N2及P3潜伏期、P3波幅）及SSR（波幅和潜伏期）差异显著（P〈0．05）；MoCA量表评定总分及各分项目评分差异显著（P〈0．05）；ADL差异显著（P〈0．05）。研究组治疗前后比较：HAMD量表评分、ERPs及SSR差异显著（P〈0．05）；MoCA量表评定总分及注意、语言、抽象、命名、定向方面认知障碍有明显改善（P〈0．05），视空间及执行及延迟记忆无明显变化（P〉0.05）。ADL差异存在统计学意义（P〈0．05）。研究组治疗后HAMD总分与对照组无差异（P〉0．05）；无ERPs差异（P〉0．05）；SSR差异显著（P〈0．05）。MoCA量表评定总分及各分项目评分差异显著（P〈0．05）。ADL差异显著（P〈0．05）。研究组治疗前ERPs电位成分中N2、P3波潜伏期与SSR潜伏期之间，以及P3波幅和SSR波幅之间均表现正相关（r=0．342，0．472，P〈0．05），而P3波幅与SSR波潜伏期之间，以及N2、P3潜伏期与SSR波幅之间均表现负相关（r=-0．399，-0．422，P〈0．05）。结论GD患者存在ERPs和SSR异常，两者之间有相关性。药物治疗后随着临床症状的缓解，其ERPs及SSR可以得到部分改善。认知功能和自主神经功能损害的恢复可能迟于抑郁症状的改善。

Objective To explore the cognitive and autonomic nerve function of elderly geriatric depression （GD） before and after drug intervention. Methods 43 patients with GD were carried out cognitive potential P300, sympathetic skin response （ SSR）, Hamilton Depression Scale 24 （HAMD）, the Montreal Cognitive Assessment Scale （MoCA） and the activities of daily living scale （ADL） before and after treatment respectively. 41 healthy elderly people （control group） were investigated all of the above measurements on the day of physical examination. Results Compared with control group, HAMD total score and ADL score were significant higher in study group before treatment;ERP （N2 and P3 latency period, P3 amplitude） and SSR （amplitude and latency period） were significantly different （P 〈 0. 05 ） between control group and study group before treatment; MoCA total score and all factor scores （attention, visual-spatial and executive function, language, naming, orientation, delayed memory and abstract） were significant lower in study group before treatment than those of control group. There were significant differences in HAMD scale, ADL scale, ERP （ N2 and P3 latency period, P3 amplitude） and SSR （ amplitude and latency period） between before and after treatment in GD. Compared with before treatment, MoCA total score and factor scores （attention, language, naming, orientation and abstract） were significant higher after treatment, but there were no significant difference before and after treatment in visual-spatial and executive function and delayed memory. Compared with control group, there were no significant difference in study group after treatment in HAMD total score and ERP （N2 and P3 latency period, P3 amplitude） ;and there were significantly difference in SSR （amplitude and latency period） （P 〈 0. 05 ） between control and study group after treatment. There were significantly different between study group after treatment and control group in ADL score, MoCA total score and all factor scores （ attention, visualspatial and executive function, language, naming, orientation, delayed memory and abstract）. N2, P3 latency period were significantly positive related with SSR latency period, and the P3 amplitude was significantly positive related with SSR amplitude （ r = 0. 394 - 0. 472, P 〈 0. 01 ） in study group before treatment. The P3 amplitude was significantly negative related with SSR latency period, as well as N2, P3 latency period were all significantly negative related with SSR amplitude （ r = - 0. 399 ~ - 0. 422, P 〈 0.01 ） in study group before treatment. Conclusions There are cognitive function impairment and autonomic nervous system dysfunction in elderly patients with GD, but also there is a relevance between the two function impairments. After treatment with the drug, cognitive function and autonomic nervous function can be improved partly. Cognitive function and autonomic nerve recovery may be later than improvement of depression symptoms.