淡漠是脑小血管病(cerebral small vessel disease,CSVD)常见的神经精神症状,可导致患者生活质量下降,致残率增加、自杀率升高以及照顾者负担加重。然而,CSVD伴淡漠的诊治未被充分认识并且被严重低估。本文对CSVD伴淡漠的概念、流行病...淡漠是脑小血管病(cerebral small vessel disease,CSVD)常见的神经精神症状,可导致患者生活质量下降,致残率增加、自杀率升高以及照顾者负担加重。然而,CSVD伴淡漠的诊治未被充分认识并且被严重低估。本文对CSVD伴淡漠的概念、流行病学特征、神经影像机制、评估与诊断、与抑郁和认知功能的关系、治疗等进行综述。已有研究显示CSVD伴淡漠的发生机制可能涉及前额叶-基底神经节环路的白质纤维损害以及脑网络功能障碍;CSVD伴淡漠参与介导认知功能损害,而不是由抑郁介导,且淡漠可能增加痴呆的发生风险;多巴胺类药物及神经调控技术在CSVD伴淡漠的治疗中具备前景。展开更多
Background Depression related cognitive deficits are frequently considered as simple epiphenomena of the disorder. However, whether or not the depression might directly bring about cognitive deficits is still under in...Background Depression related cognitive deficits are frequently considered as simple epiphenomena of the disorder. However, whether or not the depression might directly bring about cognitive deficits is still under investigation. This study was to investigate the distinctpattern of cognitive deficits in patients with depression by comparing the cognitive function before and after anti-depressive drug therapy. Me^ods Sixty cases of patients, first-time diagnosed with depression, were assessed by 17-item Hamilton Rating Scale for Depression （HAMD17scale）The memory ability was tested by quantitatively clinical memory scale, while the attention ability by modified Ruff 2＆7 Selective Attention Test. Forty-two healthy volunteers were recruited as controls. The depressive patients were treated with Venlafaxine （75-300 mg/d）, Fluoxetine （20-40 mg/d）, Paroxetine （20-40 rag/d）, and Sertraline （50-150 mg/d）. After 12 weeks treatment, patients were tested again by HAMD17scale, quantitatively clinical memory scale, and modified Ruff 2＆7 selective attention test to assess the effect of anti-depressive drugs on cognitive deficits. Results The memory quotient （MQ） was significantly lowered in depressive patients. The selection speed was also significantly decreased and the number of missing and error hits increased in the depression group as compared to control. However, there was no significant difference in clinical memory scale and Ruff 2＆7 selective attention test between mild-to-moderate and severe depression group. Importantly, after anti-depressive drug therapy, the HAMD17 scale scores in depressive patients were significantly decreased, but the MQ, directional memory （DM）, free recall （FR）, associative learning （AL）, and face recognition were comparable with those before the treatment. Furthermore, the selection speed and the number of missing and error hits were also not significantly different after anti-depressive drugs treatment. Conclusions Depressive patients suffer from short-term memory deficits, and attention extent, stability and rearrangement deficiency. Even though anti-depressive drugs sufficiently relieve the cardinal presentation of depression, they could not successfully alleviate the accompanying cognitive deficits. This might indicate a distinct pattern of cognitive deficits in patients with depression.展开更多
文摘淡漠是脑小血管病(cerebral small vessel disease,CSVD)常见的神经精神症状,可导致患者生活质量下降,致残率增加、自杀率升高以及照顾者负担加重。然而,CSVD伴淡漠的诊治未被充分认识并且被严重低估。本文对CSVD伴淡漠的概念、流行病学特征、神经影像机制、评估与诊断、与抑郁和认知功能的关系、治疗等进行综述。已有研究显示CSVD伴淡漠的发生机制可能涉及前额叶-基底神经节环路的白质纤维损害以及脑网络功能障碍;CSVD伴淡漠参与介导认知功能损害,而不是由抑郁介导,且淡漠可能增加痴呆的发生风险;多巴胺类药物及神经调控技术在CSVD伴淡漠的治疗中具备前景。
基金This work was supported by a grant from the National Natura Science Foundation of China （No. 81000533）. Conflict of interest： None.
文摘Background Depression related cognitive deficits are frequently considered as simple epiphenomena of the disorder. However, whether or not the depression might directly bring about cognitive deficits is still under investigation. This study was to investigate the distinctpattern of cognitive deficits in patients with depression by comparing the cognitive function before and after anti-depressive drug therapy. Me^ods Sixty cases of patients, first-time diagnosed with depression, were assessed by 17-item Hamilton Rating Scale for Depression （HAMD17scale）The memory ability was tested by quantitatively clinical memory scale, while the attention ability by modified Ruff 2＆7 Selective Attention Test. Forty-two healthy volunteers were recruited as controls. The depressive patients were treated with Venlafaxine （75-300 mg/d）, Fluoxetine （20-40 mg/d）, Paroxetine （20-40 rag/d）, and Sertraline （50-150 mg/d）. After 12 weeks treatment, patients were tested again by HAMD17scale, quantitatively clinical memory scale, and modified Ruff 2＆7 selective attention test to assess the effect of anti-depressive drugs on cognitive deficits. Results The memory quotient （MQ） was significantly lowered in depressive patients. The selection speed was also significantly decreased and the number of missing and error hits increased in the depression group as compared to control. However, there was no significant difference in clinical memory scale and Ruff 2＆7 selective attention test between mild-to-moderate and severe depression group. Importantly, after anti-depressive drug therapy, the HAMD17 scale scores in depressive patients were significantly decreased, but the MQ, directional memory （DM）, free recall （FR）, associative learning （AL）, and face recognition were comparable with those before the treatment. Furthermore, the selection speed and the number of missing and error hits were also not significantly different after anti-depressive drugs treatment. Conclusions Depressive patients suffer from short-term memory deficits, and attention extent, stability and rearrangement deficiency. Even though anti-depressive drugs sufficiently relieve the cardinal presentation of depression, they could not successfully alleviate the accompanying cognitive deficits. This might indicate a distinct pattern of cognitive deficits in patients with depression.
