王艳华钟笑梅吴章英李玲陈辛茹罗新妮李含秋陈建平宁玉萍

首次发作年龄对老年抑郁症患者认知功能的影响☆

王艳华*钟笑梅△吴章英△△李玲△△陈辛茹△罗新妮△李含秋△△陈建平△△△宁玉萍*

目的 比较早发型老年抑郁症及晚发型老年抑郁症认知功能的特点及血管风险因素，为阐明老年抑郁症认知功能障碍发生提供线索。方法 本研究通过选取本院门诊、住院老年抑郁症患者，包括早发型老年抑郁症29例，晚发型老年抑郁症27例，及社区招募正常对照组25例，收集人口学资料及进行总体认知评估、详细认知域及血管风险因素评估，分析早发型老年抑郁症与晚发型老年抑郁症认知功能特点及血管风险因素特点。结果 总体认知功能MMSE比较发现，晚发型老年抑郁症患者得分明显低于早发型老年抑郁症患者，差异有统计学意义（24.8±2.9，22.8±3.5，P=0.030）；早发型老年抑郁症组在符号数字转化测验、画钟测验及连线测验中得分优于晚发型老年抑郁症组，差异有统计学意义（29.8±10.5，22.9±11.8，P=0.028，3.6±0.8，2.9±1.3，P=0.006，60.4±20.6，74.7± 28.8，P=0.027）。晚发型老年抑郁症组血管风险因素评分高于早发型老年抑郁症组，差异有统计学意义（14.6±2.7，12.3±2.2，P=0.001）。结论 与早发型老年抑郁症相比，晚发型老年抑郁症认知损害更重，血管风险因素更高。

老年抑郁症 早发型抑郁症 晚发型抑郁症 认知功能 血管风险因素

【Abstract】Objective To investigate the cognitive characteristics and vascular risk factor between early onset depression and late onset depression in late life depression and provide a clue to elucidate the cause of cognitive impairment in late life depression.Method Fifty-six late life depression patients were recruited in our hospital，including 29 early onset depression patients and 27 late onset depression patients.25 controls were recruited from Guangzhou community.Cognitive evaluation were conducted in all the patients and controls，including MMSE，memory，attention，language，visuospatial abilities，executive function and Framingham vascular risk assessment，and analyze the cognitive and vascular risk between the patients.Result There were statistically significant differences in overall cognitive assessment MMSE（24.8± 2.9，22.8±3.5，P=0.030），symbol digit modalities test（SDMT）（29.8±10.5，22.9±11.8，P=0.028），clock drawing test（CDT）（3.6±0.8，2.9±1.3，P=0.006）and trail making test（TMT）（60.4±20.6，74.7±28.8，P=0.027）between late onset depression and early onset depression.In addition，the score of vascular risk assessment was significant between late onset depression and early onset depression（14.6±2.7，12.3±2.2，P=0.001）.Conclusion Compare with early onset depression，late onset depression has much severe cognitive impairments and increased vascular risk factors.

【Key words】Late life depression Early onset depression Late onset depression Cognitive function Vascular risk

老年抑郁症是一组异质性疾病，指发生在老年期（＞60岁）这一特定人群的抑郁症，包括早发型抑郁症（early onset depression，EOD）在老年期复发或持续至老年期，以及老年期首次发作的晚发型老年抑郁症（late onset depression，LOD）［1］。……