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Predictors of Cognitive Improvement Following Treatment for Late-Life Depression
Journal of Geriatric Psychiatry and Neurology ( IF 2.6 ) Pub Date : 2020-03-25 , DOI: 10.1177/0891988720915515
Prabha Siddarth 1 , Cynthia M Funes 1, 2 , Kelsey T Laird 1 , Linda Ercoli 1 , Helen Lavretsky 1
Affiliation  

Objective:

Cognitive impairment is frequently comorbid with late-life depression (LLD) and often persists despite remission of mood symptoms with antidepressant treatment. Increasing understanding of factors that predict improvement of cognitive symptoms in LLD is useful to inform treatment recommendations.

Methods:

We used data from 2 randomized clinical trials of geriatric depression to examine the relationships between sociodemographic factors (resilience, quality of life) and clinical factors (age of depression onset, severity of depression, apathy) with subsequent cognitive outcomes. One hundred sixty-five older adults with major depression who had completed one of 2 clinical trials were included: (1) methylphenidate plus placebo, citalopram plus placebo, and citalopram plus methylphenidate or (2) citalopram combined with Tai Chi or health education. A comprehensive neuropsychiatric battery was administered; 2 measures of cognitive improvement were examined, one defined as an increase in general cognitive performance score of at least 1 standard deviation and the other 0.5 standard deviation pre–post treatment.

Results:

At posttreatment, 59% of participants had remitted, but less than a third of those who remitted showed cognitive improvement (29%). Cognitive improvement was observed in 18% of nonremitters. Lower baseline depression severity, greater social functioning, and depression onset prior to 60 years of age were significantly associated with cognitive improvement. None of the other measures, including baseline apathy, resilience, and depression remission status, were significantly associated with cognitive improvement.

Conclusions:

Lower severity of depression, earlier onset, and greater social functioning may predict improvement in cognitive functioning with treatment for depression in LLD.



中文翻译:

晚年抑郁症治疗后认知改善的预测因素

目标:

认知障碍通常与晚年抑郁症 (LLD) 并存,尽管通过抗抑郁药治疗缓解了情绪症状,但认知障碍常常持续存在。增加对预测 LLD 认知症状改善的因素的了解有助于提供治疗建议。

方法:

我们使用来自老年抑郁症的 2 项随机临床试验的数据来检查社会人口学因素(恢复力、生活质量)和临床因素(抑郁症发作的年龄、抑郁症的严重程度、冷漠)与随后的认知结果之间的关系。165 名已完成 2 项临床试验之一的重度抑郁症老年人被纳入:(1)哌醋甲酯加安慰剂、西酞普兰加安慰剂、西酞普兰加哌醋甲酯或(2)西酞普兰联合太极拳或健康教育。管理了一个全面的神经精神病学电池;检查了 2 项认知改善措施,一项定义为一般认知表现评分增加至少 1 个标准差,另一个定义为治疗后增加 0.5 个标准差。

结果:

在治疗后,59% 的参与者已经缓解,但只有不到三分之一的参与者表现出认知改善 (29%)。在 18% 的非汇款者中观察到认知改善。较低的基线抑郁严重程度、较高的社会功能和 60 岁之前的抑郁发作与认知改善显着相关。其他措施,包括基线冷漠、弹性和抑郁缓解状态,均与认知改善无显着相关。

结论:

抑郁症的严重程度较低、发病较早和社会功能较强,可能预示着 LLD 抑郁症治疗后认知功能的改善。

更新日期:2020-04-21
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