抑郁症、高血脂症以及共病患者的认知功能
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摘要
目的:探讨抑郁症、高血脂症及共病是否对患者的认知功能有影响。方法:选取年龄、性别、受教育程度相匹配的病情稳定的抑郁症患者51例(符合ICD-10抑郁发作和复发性抑郁障碍诊断标准)、高血脂症患者38例(符合中国成人血脂指南的诊断标准)、高血脂症共病抑郁症患者40例、正常对照56例。所有受试完成焦虑、抑郁症状严重程度评估和认知功能的测量。结果:高血脂共病抑郁症组和抑郁症组的蒙特利尔认知评估量表总分低于高血脂症组[(24±3),(24±4)vs.(26±3),均P<0.05],抑郁症组得分低于正常对照组(25±3),P<0.05;高血脂症共病抑郁症组的Stroop C改正数多于其他三组(均P<0.05);高血脂症组的逻辑记忆即刻和延迟总分高于其他三组(均P<0.05);高血脂症共病抑郁症组和抑郁症组的词语流畅性总词汇数量少于高血脂症组(均P<0.05);高血脂共病抑郁症组和抑郁症组的威斯康辛卡片分类正确数都分别少于高血脂症组、正常对照组(均P<0.05);高血脂症共病抑郁症组和抑郁症组的威斯康辛卡片分类持续错误数要显著多于高血脂症组、正常对照组(均P<0.05)。结论:抑郁症患者存在认知功能的下降,而高血脂症可能并不总是影响认知功能。
Objective: To compare the cognitive functions in patients with depressive disorder,hyperlipidemia disorder,and comorbid both of the disorders. Methods: A cross-sectional study was performed in age,gender and education year matched patients with depressive disorder( n = 51)( according to the ICD-10),hyperlipidemia( n =38)( according to the Chinese adult lipid guideline),comorbid both of the disorders( n = 40) and normal controls( n= 56) were recruited in this study. All subjects received a battery of neuropsychological tests to access the anxiety and depression symptoms and cognitive function. Results: The scores of MoCA were lower in the patients with comorbid both disorders and patients with depression than patients with hyperlipidemia [( 24 ± 3),( 24 ± 4) vs.( 26 ±3),Ps < 0. 05],and were lower in patients with depression than in normal controls( 25 ± 3),P < 0. 05. Stroop colortest amends numbers were higher in patients with comorbid disorder than in the other three groups( Ps < 0. 05). The scores of immediate and delayed logical memory were higher in patients with hyperlipidemia than in other three groups( Ps < 0. 05). The total number of words in verbal fluency test were lower in patients with comorbid disorders and patients with depression than in patients with hyperlipidemia( Ps < 0. 05). Wisconsin card sorting test category completes were lower in patients with comorbid disorders and patients with depression than in patients with hyperlipidemia and normal controls( Ps < 0. 05). The scores of persistent errors were higher in patients with comorbid disorders and patients with depression than in patients with hyperlipidemia and normal controls( Ps < 0. 05). Conclusion:In this study,patients with depressive disorder have impairment of cognitive function,while hyperlipidemia may probably do not impair cognitive function.
Objective: To compare the cognitive functions in patients with depressive disorder,hyperlipidemia disorder,and comorbid both of the disorders. Methods: A cross-sectional study was performed in age,gender and education year matched patients with depressive disorder( n = 51)( according to the ICD-10),hyperlipidemia( n =38)( according to the Chinese adult lipid guideline),comorbid both of the disorders( n = 40) and normal controls( n= 56) were recruited in this study. All subjects received a battery of neuropsychological tests to access the anxiety and depression symptoms and cognitive function. Results: The scores of MoCA were lower in the patients with comorbid both disorders and patients with depression than patients with hyperlipidemia [( 24 ± 3),( 24 ± 4) vs.( 26 ±3),Ps < 0. 05],and were lower in patients with depression than in normal controls( 25 ± 3),P < 0. 05. Stroop colortest amends numbers were higher in patients with comorbid disorder than in the other three groups( Ps < 0. 05). The scores of immediate and delayed logical memory were higher in patients with hyperlipidemia than in other three groups( Ps < 0. 05). The total number of words in verbal fluency test were lower in patients with comorbid disorders and patients with depression than in patients with hyperlipidemia( Ps < 0. 05). Wisconsin card sorting test category completes were lower in patients with comorbid disorders and patients with depression than in patients with hyperlipidemia and normal controls( Ps < 0. 05). The scores of persistent errors were higher in patients with comorbid disorders and patients with depression than in patients with hyperlipidemia and normal controls( Ps < 0. 05). Conclusion:In this study,patients with depressive disorder have impairment of cognitive function,while hyperlipidemia may probably do not impair cognitive function.
引文
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[17]陈勇,洪伟.血清总胆固醇及其低、高密度脂蛋白胆固醇的水平下降与抑郁症患者自杀行为的关系[J].四川精神卫生,2003,16(2):76-78.
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[20]刘艳丽,董春雪,周妍妍,等.血管性危险因素与阿尔茨海默病关系的研究进展[J].中国当代医药,2013,20(4):18-19.
[21]Xie C,Lund EG,Turley SD,et al.Quantitation of two pathways for cholesterol excretion from the brain in normal mice and mice with neurodegeneration[J].J Lipid Res,2003,44(9):1780-1789.
[22]肖玉娴.血管性痴呆与高血压、高血脂、高血糖的相关性[J].中国临床研究,2011,24(2):142-143.
[23]Elias PK,Elias MF,D'Agostino RB,et al.Serum cho-lesterol and cognitive performance in the Framingham Heart Study[J].Psychosom Med,200567(1):24-30.
[24]Mielke MM,Zandi PP,Sjogren M,et al.High totalcholesterol levels in late life associated with a reducedrisk of dementia[J].Neurology,2005,64(10):1689-1695.
[25]Evans RM,Emsley CL,Gao S,et al.Serum cholesterol,APOE genotype,and the risk of Alzheimer's disease:a population-based study of African Americans[J].Neurology,2000,54(1)240-242.
[2]Deniz C,Celik Y,Ozdemir Gultekin T,et al.Evaluation and followup of cognitive functions in patients with minor stroke and transient ischemic attack[J].Neuropsychiatr Dis Treat,2016,12:2039-2048.
[3]Alonso J,Vilagut G,Adroher ND,et al.Disability mediates the impact of common conditions on perceived health[J].PLoS One,2013,8(6):e65858.
[4]Kessler RC,Bromet EJ.The epidemiology of depression across cultures[J].Annu Rev Public Health,2013,34:119-138.
[5]温洪波,张振馨,牛富生,等.北京地区蒙特利尔认知量表的应用研究[J].中华内科杂志,2008,47(1):36-39.
[6]世界卫生组织.ICD-10精神与行为障碍分类临床描述与诊断要点[M].范肖东,汪向东,于欣,等,译.北京:人民卫生出版社,1993:140-143.
[7]张明园.精神科评定量表手册[M].长沙:湖南科学技术出版社,1998:121-126,133-137.
[8]Folstein MF,Folstein SE,McHugh PR."Mini-mental state".A practical method for grading the cognitive state of patients for the clinician[J].J Psychiatr Res,1975,12(3):189-198.
[9]Lezak MD,Howieson DB,Loring DW.Neuropsychological Assessment[M].New York:Oxford University Press,2004.
[10]Reitan RM,Wolfson D.The Halstead-Reitan Neuropsychological Test Battery[M].Tucson:Neuropsychological Press,1985.
[11]Tucha O,Mecklinger L,Laufkotter R,et al.Clustering and switching on verbal and figural fluency functions in adults with attention deficit hyperactivity disorder[J].Cogn Neuropsychiatry,2005,10(3):231-248.
[12]龚耀先.中国修订韦氏成人智力量表手册[M].长沙:湖南地图出版社,1992.
[13]Heaton RK,Chelune GL,Talley JL,et al.Wisconsin Card Sorting Test(WCST)(Manual revised and expanded)[M].Odessa,FL:Psychological Assessment Resources,1993.
[14]黄景玉,贾艳滨,钟舒明,等.抑郁症患者人格特征与认知功能的相关[J].广东医学,2016,37(17):2584-2587.
[15]吴桂萍,张虹,李蕊,等.年龄受教育程度和高甘油三酯血症对代谢综合征患者认知功能的影响[J].山西医药杂志,2010,39(6):503-504.
[16]周珊珊,李宁,刘维娟,等.总胆固醇水平对首发青年抑郁症患者认知功能的影响研究[J].国际检验医学杂志,2013,34(14):1828-1832.
[17]陈勇,洪伟.血清总胆固醇及其低、高密度脂蛋白胆固醇的水平下降与抑郁症患者自杀行为的关系[J].四川精神卫生,2003,16(2):76-78.
[18]Raffai RL,Weisgraber KH.Cholesterol:from heart attacks to Alzheimer's disease[J].J Lipid Res,2003,44(8):1423-1430.
[19]Ullrich C,Pirchl M,Humpel C.Hypercholesterolemia in rats impairs the cholinergic system and leads to memory deficits[J].Mol Cell Neurosci,2010,45(4):408-417.
[20]刘艳丽,董春雪,周妍妍,等.血管性危险因素与阿尔茨海默病关系的研究进展[J].中国当代医药,2013,20(4):18-19.
[21]Xie C,Lund EG,Turley SD,et al.Quantitation of two pathways for cholesterol excretion from the brain in normal mice and mice with neurodegeneration[J].J Lipid Res,2003,44(9):1780-1789.
[22]肖玉娴.血管性痴呆与高血压、高血脂、高血糖的相关性[J].中国临床研究,2011,24(2):142-143.
[23]Elias PK,Elias MF,D'Agostino RB,et al.Serum cho-lesterol and cognitive performance in the Framingham Heart Study[J].Psychosom Med,200567(1):24-30.
[24]Mielke MM,Zandi PP,Sjogren M,et al.High totalcholesterol levels in late life associated with a reducedrisk of dementia[J].Neurology,2005,64(10):1689-1695.
[25]Evans RM,Emsley CL,Gao S,et al.Serum cholesterol,APOE genotype,and the risk of Alzheimer's disease:a population-based study of African Americans[J].Neurology,2000,54(1)240-242.