【摘要】：目的探討首發(fā)老年抑郁癥患者抑郁癥狀與認知功能損害之間的關(guān)系，并進一步分析其認知功能損害的特點。 方法共入選首發(fā)老年抑郁癥伴有認知功能損害患者30例(A組）和不伴認知功能損害患者34例（B組），，無抑郁的輕度認知功能損害者31例（C組），正常老年人31例（D組），均隨訪12個月后進行比較分析。在基線、12個月時進行老年抑郁量表(The Geriatric DepressionScale,GDS)、簡易智能狀態(tài)檢查（Mini-Mental State Examination,MMSE）、數(shù)字廣度、連線測驗A、B（Trail making test,TMT-A、TMT-B)評定，并檢測基線時apoE基因型。對老年抑郁癥患者用選擇性五羥色胺回吸收抑制劑(selective serotonin reuptake inhibitor, SSRI)進行治療。采用SPSS17.0統(tǒng)計軟件，運用t檢驗、卡方檢驗、方差分析、相關(guān)分析等對資料進行分析。P＜0.05為有統(tǒng)計學(xué)意義。 結(jié)果 1. A、B兩組患者經(jīng)SSRI抗抑郁治療，12個月時A組GDS評分高于B組（P 0.01）；A組MMSE升高，但低于B組（P 0.01），高于C組（P 0.01）。B組12個月時MMSE評分無明顯變化（P0.05），GDS評分有顯著下降（P 0.01）。 2. A組12個月時MMSE評分與GDS評分存在負相關(guān)，而B組MMSE評分與年齡負相關(guān)。 3.四組間ApoEε4基因的表達無統(tǒng)計學(xué)差異（P0.05）。A組12個月時MMSE與攜帶ApoEε4基因相關(guān)。C組MMSE與攜帶ApoEε4基因相關(guān)。B組和D組12個月時MMSE與年齡呈負相關(guān)，與ApoEε4基因不相關(guān)。 4.12個月時A組順背、倒背、總數(shù)均高于基線時，差異有統(tǒng)計學(xué)意義（P0.01）；B組倒背、總數(shù)均高于基線時，差異有統(tǒng)計學(xué)意義（P0.01）；C組總數(shù)高于基線時（P0.05）。基線時、12個月時A組順背、倒背、總數(shù)均低于B組和D組，差異有統(tǒng)計學(xué)意義（P0.01）�；�時A組順背、倒背、總數(shù)與C組相仿（P0.05）;但12個月時均高于C組（P0.01）。 5.12個月時A組和B組TMT-A、TMT-B時間均高于基線時，差異有統(tǒng)計學(xué)意義（P0.01）。A組TMT-A測驗時間與B組相仿（P0.05）；而TMT-B測驗時間高于B組（P0.01）。A、B兩組TMT-A、TMT-B時間均低于C組（P0.01）。 結(jié)論 1.伴認知功能損害的老年抑郁癥患者對抗抑郁治療反應(yīng)比不伴認知功能損害患者差；抗抑郁治療對老年抑郁癥伴發(fā)的認知功能損害有改善作用。 2.抑郁可能是認知功能損害的危險因素，兩者共病時影響各自的轉(zhuǎn)歸。 3. ApoEε4基因是認知功能損害的危險因素。老年抑郁癥患者認知功能持續(xù)損害與攜帶ApoEε4基因相關(guān)。 4.老年抑郁癥患者的認知功能損害與MCI有區(qū)別，數(shù)字廣度和TMT-A、TMT-B在辨別兩者認知功能損害上有一定的輔助識別作用。
[Abstract]:Objective to investigate the relationship between depressive symptoms and cognitive impairment in first-episode elderly patients with depression, and to further analyze the characteristics of cognitive impairment. Methods A total of 30 patients with first-episode elderly depression with cognitive impairment (group A), 34 patients without cognitive impairment (group B) and 31 patients with mild cognitive impairment without depression (group C) were enrolled in this study. 31 cases of normal elderly (group D) were followed up for 12 months. The geriatric depression scale (The Geriatric DepressionScale,GDS), simple mental state test (Mini-Mental State Examination,MMSE), digital breadth, connectivity test A, B (Trail making test,TMT-A,TMT-B) were performed at baseline, 12 months. The apoE genotype was detected at baseline. Elderly patients with depression were treated with selective serotonin reabsorption inhibitor (selective serotonin reuptake inhibitor, SSRI). The data were analyzed by SPSS17.0 statistical software, t test, chi square test, variance analysis and correlation analysis. Result 1. A, the GDS score of group A was higher than that of group B at 12 months after antidepressant treatment with SSRI in group B (P < 0.01), and the score of GDS in group A was higher than that in group B (P < 0.01). The MMSE of group A was higher than that of group B (P 0.01), and that of group C was higher than that of group C (P < 0.01). There was no significant change in MMSE score in group A at 12 months (P < 0.05). The), GDS score of group A was significantly lower than that of group B (P < 0.01). two銆

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