Study on Influencing Factors of Cognitive Impairment in Late-life Depression Patients
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摘要:
目的 探究老年抑郁障碍患者认知损害的影响因素。 方法 入组2018年1月至2022年9月昆明医科大学第一附属医院精神科住院部老年期抑郁症患者119例,采用蒙特利尔认知评估量表评估认知功能,建立回归模型,分析比较认知损害的影响因素。 结果 年龄对认知总分、视觉空间能力和执行功能、语言功能的影响,差异有统计学意义(P < 0.05);焦虑的程度对认知总分、视觉空间能力和执行功能、注意力和工作记忆力的影响,差异有统计学意义(P < 0.05);血脂水平异常对认知总分、视觉空间能力和执行功能的影响,差异有统计学意义(P < 0.05);既往史对认知总分、语言功能的影响,差异有统计学意义(P < 0.05);性别、发病年龄、抑郁程度、ApoE基因、职业状态、有无精神病性症状均对个别认知功能的影响,差异有统计学意义(P < 0.05)。 结论 老年抑郁障碍患者存在明显的认知损害,其中年龄、焦虑程度,血脂水平异常、既往史等因素可能是中老年抑郁障碍患者认知损害的风险因素。 Abstract:Objective To explore the influencing factors of cognitive impairment in elderly patients with depressive disorder. Methods 119 elderly patients with depression were recruited in the 1st Affiliated Hospital of Kunming Medical University. MoCA was used to evaluate the cognitive function of the patients, and a regression model was established to analyze the influencing factors of cognitive impairment in elderly patients with depression. Results Age had a significant effect on the total score of cognition, visuospatial ability, executive function and language function (P < 0.05). The degree of anxiety had a significant effect on the total score of cognition, visuospatial ability, executive function, attention and working memory (P < 0.05). Dyslipidemia had a statistically significant effect on the total score of cognition, visuospatial ability and executive function (P < 0.05). The past medical history had a significant effect on the total score of cognition and language function (P < 0.05). The sex, onset time, degree of depression, ApoE gene, occupation status and psychotic symptoms had statistically significant effects on individual cognitive function (P < 0.05). Conclusion Patients with late-life depressive disorder have obvious cognitive impairment. Age, anxiety, dyslipidemia, and past medical history may be the risk factors for cognitive impairment in elderly patients with depressive disorder. -
Key words:
- Late-life depression /
- Cognitive impairment /
- ApoE gene
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表 1 参与者的一般人口学特征[M(P25, P75)/n(%)](n=119)
Table 1. Demographic information of participants[M(P25,P75)/n(%)](n=119)
变量 认知损伤组(n=57) 认知正常组(n=62) χ2/z/t P 年龄(岁) 71.00(65.00,74.50) 65.00(61.00,68.25) −3.78 <0.001*** 性别 0.86 0.353 男 14(24.60) 20(32.30) 女 43(75.40) 42(67.70) 病程(a) 5.00(0.75,10.50) 2.00(0.50,10.25) −0.92 0.358 发病时间(岁) 61.73±11.92 59.78±8.55 −1.03 0.306 ***P < 0.001。 表 2 认知正常组和认知损伤组的各项认知功能得分比较情况 [M(P25, P75),分]( n=119)
Table 2. Comparisons of the cognitive function scores between the cognitive normal group and cognitive impairment group [M(P25,P75),points]( n=119)
认知功能 认知损伤组(n=57) 认知正常组(n=62) z P 视觉空间能力和执行功能 3.00(2.00,3.00) 4.00(3.75,5.00) −7.32 <0.001*** 注意力和工作记忆力 5.00(4.00,5.00) 6.00(5.00,6.00) −5.91 0.006** 语言功能 4.00(4.00,5.00) 5.00(5.00,6.00) −4.18 <0.001*** 延迟回忆能力 2.00(1.50,3.00) 3.00(3.00,3.25) −5.12 <0.001*** 定向力 4.00(4.00,5.00) 5.00(5.00,6.00) −5.20 <0.001*** 总分 20.00(18.00,21.00) 24.00(23.00,26.00) −9.44 <0.001*** **P < 0.01; ***P < 0.001。 表 3 认知总分及各项因子分影响因素的多元线性回归模型回归系数[β(sx),n=119]
Table 3. Multiple linear regression models reporting coefficients (standard errors) for the influencing factors of the total score and each factor score of cognition[β(sx),n=119]
变量(对照组) 视觉空间能力和
执行功能注意力和
工作记忆力语言功能 延迟回忆能力 定向力 认知总分 发病时间(<60岁) ≥60岁 0.39(0.23) 0.15(0.18) −0.05(0.17) 0.16(0.21) −0.32(0.15)* 0.35(0.56) 性别(女) 男 0.03(0.24) −0.32(0.19) 0.43(0.18)* 0.13(0.22) −0.06(0.16) 0.21(0.58) 年龄 −0.07(0.02)*** −0.02(0.01) −0.05(0.01)*** −0.03(0.02) −0.02(0.01) −0.20(0.05)*** 焦虑程度(轻度,7~13分) 中度(14~20分) −0.44(0.39) −0.38(0.30) 0.15(0.29) −0.30(0.36) 0.00(0.26) −0.95(0.95) 重度(21~28分) −0.41(0.39) −0.54(0.31) 0.06(0.29) −0.28(0.36) −0.29(0.26) −1.45(0.96) 极重度(≥29分) −1.47(0.50)** −1.17(0.39)** 0.22(0.38) −0.31(0.46) −0.42(0.34) −3.15(1.23)* 抑郁程度(轻度,7~16分) 中度(17~23分) −0.27(0.29) 0.05(0.23) −0.23(0.22) −0.09(0.30) −0.22(0.19) −0.85(0.71) 重度(≥24分) −0.76(0.33)* 0.27(0.26) −0.11(0.25) −0.15(0.26) −0.15(0.22) −0.82(0.81) 有无精神病性症状(无) 有 −0.51(0.46) −0.37(0.36) −0.71(0.35)* 0.56(0.42) −0.85(0.31)** −1.91(1.14) 既往史(无) 高血压 −0.25(0.25) −0.00(0.19) 0.03(0.18) −0.42(0.23) 0.15(0.17) −0.48(0.61) 糖尿病 −0.32(0.50) 0.60(0.39) −1.17(0.38)** 0.25(0.46) −0.47(0.34) −1.30(1.24) 甲状腺疾病 −0.80(0.56) −0.83(0.44) 0.15(0.42) 0.36(0.51) 0.24(0.38) −0.89(1.37) 冠心病 −0.02(0.50) −0.13(0.39) −0.08(0.37) 0.04(0.46) 0.66(0.34) 0.95(1.23) 多种疾病共病(≥2) −0.39(0.27) −0.29(0.22) −0.42(0.21)* −0.27(0.25) 0.04(0.19) −1.33(0.67)* 脂代谢(正常) 高甘油三酯血症 −0.93(0.27)** −0.23(0.21) 0.13(0.21) −0.28(0.25) −0.14(0.19) −1.47(0.67)* 高胆固醇血症 −1.15(0.41)** −0.10(0.32) 0.26(0.31) −0.14(0.38) 0.12(0.28) −1.03(1.01) 低高密度脂蛋白血症(n=1) −0.75(1.04) −3.05(0.81)*** −0.46(0.78) −2.20(0.95)* 0.44(0.70) −6.03(2.55)* 混合型高脂血症 −0.07(0.58) 0.42(0.45) 0.57(0.43) −0.05(0.53) −0.43(0.39) 0.67(1.42) 受教育程度(文盲) 初等教育 −0.57(0.42) −0.57(0.33) −0.23(0.32) −0.26(0.39) −0.37(0.29) −2.00(1.04) 中等教育 0.15(0.41) 0.15(0.32) −0.16(0.30) 0.22(0.37) 0.07(0.27) 0.42(1.00) 高等教育 0.44(0.44) 0.04(0.34) −0.13(0.33) 0.28(0.40) 0.32(0.30) −0.06(1.08) 婚姻状态(已婚) 离异 0.80(0.46) 0.10(0.36) −0.40(0.34) 0.24(0.42) −014(0.31) 0.44(1.12) 丧偶 0.09(0.31) −0.47(0.24) 0.06(0.23) 0.47(0.28) 0.07(0.21) 0.25(0.76) 未婚 −0.98(1.04) −0.03(0.81) 1.24(0.78) 0.68(0.95) 0.92(0.70) 1.80(2.54) 职业状态(退休) 全职 0.20(0.28) 0.05(0.22) −0.06(0.21) −0.13(0.26) 0.24(0.19) 0.33(0.69) 兼职 1.24(0.51)* −0.32(0.40) −0.46(0.38) −0.09(0.46) −0.32(0.34) 0.04(1.24) 自雇 0.34(0.72) 0.06(0.57) −1.75(0.54)** 0.47(0.66) −0.31(0.49) −1.24(1.78) 无业 0.10(0.34) 0.21(0.26) −0.47(0.25) −0.04(0.31) −0.06(0.23) −0.26(0.83) ApoE亚型携带情况(ε3/ε3) ε2/ε2(n=0) − − − − − − ε2/ε3 0.19(0.27) 0.26(0.21) −0.49(0.20)* 0.53(0.24)* −0.07(0.18) 0.44(0.66) ε2/ε4(n=0) − − − − − − ε3/ε4 −0.28(0.23) −0.14(0.18) −0.13(0.17) 0.14(0.21) −0.23(0.16) −0.63(0.57) ε4/ε4 0.28(0.58) −0.07(0.45) −0.63(0.43) −0.11(0.53) −0.13(0.39) −0.68(1.41) *P < 0.05; **P < 0.01; ***P < 0.001。 -
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