Correlation between Electroencephalogram Alterations and Frontal Cognitive Impairment in Esophageal Cancer Patients Complicated with Depression

Background：Some esophageal cancer patients complicated with depression exhibit cognitive impairments.Frontal electroencephalogram （EEG） may be used as a reliable biomarker for prefrontal-mediated cognitive functions.This study was to investigate alterations of EEG and frontal cognitive impairment in esophageal cancer patients complicated with depression and to assess their correlation.Methods：Sixty-five esophageal cancer patients with depression （study group） and 62 healthy controls （control group） were included in this study.The study group were assigned into psychotic depressed （PD,n =32） and nonpsychotic depressed （NPD,n =33） subgroups based on complication with psychotic symptoms （Brief Psychiatric Rating Scale [BPRS] 〉35）.EEG examination,Beck self-rating depression scale,and BPRS were used to assess clinical symptoms.Chi-square test,two independent sample t-test,one-way analysis of variance,and Kruskal-Wallis test were utilized to compare the variables between two groups.EEG abnormalities and scores of frontal cognitive function test were analyzed by partial correlation analysis in the PD and NPD subgroups.Results：Compared with control group,the study group displayed greater scores either in the Stroop test （19.89 ± 2.05 vs.24.12 ± 2.19,P =0.006） or Color Trails Test （CTT;11.92 ± 1.01 vs.15.02 ± 1.63,P =0.008）,and reduced score （35.05 ± 2.01 vs.32.11 ± 2.38,P =0.007） in the verbal fluency test （VFT）.Compared to NPD subgroup,PD subgroup exhibited increased scores in Stroop test （22.89 ± 2.07 vs.25.38 ± 2.32,P =0.009） and CTT （13.16 ± 1.71 vs.15.82 ± 1.13,P =0.008）.Moreover,increased scores in Stroop test and CTT as well as scores in VFT were associated with the severity of depression.The study group had an abnormal frontal EEG,such as α forward,α asymmetry,α moderation,and increased 0 activity relative to control group.Similarly,compared with NPD subgroup,PD subgroup displayed α forward,α asymmetry,and α moderation.The correlation test revealed that α forward and α asymmetry were negatively associated with VFT score,but positively correlated with the scores of CTT and the Stroop test in PD subgroup.In addition,α asymmetry in NPD subgroup was positively related to CTT scores.Conclusion：This study indicated that frontal cognitive impairment in esophageal cancer patients complicated with depression is associated with EEG alterations.

Treatment of depression using sleep electroencephalogram modulated repetitive transcranial magnetic stimulation

Background As a treatment of depression, the efficacy of conventional repetitive transcranial magnetic stimulation （rTMS） is limited, and symptoms recurrence is easy to occur after the treatment. This study aimed to examine the efficacy and safety of sleep electroencephalogram modulated repetitive rTMS （SEM-rTMS） in the treatment of depression. Methods After 7 days without psychoactive medication, 164 patients with clinically defined depression were randomly divided into 3 groups： SEM-rTMS group （n=-57）, conventional rTMS （C-rTMS, n=55） group and sham-rTMS group （n=-52）. Every patient was treated with the corresponding method for 30 minutes everyday for 10 days. Before and after scores on the 24-item Hamilton rating scale for depression （HAMD-24） and the clinical outcome on the 10th day of therapy for all subjects were analyzed. Results Twenty-two cases in the SEM-rTMS group obtained improved mood as compared to 6 in the C-rTMS group and 2 in the sham-rTMS group （X2=15.89, P=0.0004）. After completion of the rTMS phase of the protocol, a （51±5）% reduction of HAMD-24 scores from the baseline in the SEM-rTMS group was found compared with a （34±4）% in the C-rTMS group （q=26.09, P=-0.001） and a （14±3）% in sham-rTMS group （q=57.53, P=0.000）. The 88% total effective rate in the SEM-rTMS group was significantly higher than 68% in the C-rTMS group and 20% in the sham-rTMS group （χ2=12.01, P=0.0025）. No significant side effects were noted. Conclusion SEM-rTMS is an effective and safe way for treating depression with repetitive transcranial magnetic stimulation （ChiCTR-TRC-00000438）.