摘要
目的:探讨伴认知功能障碍的老年抑郁症患者的临床特征。方法:选择2003-01/2004-06在南京医科大学脑科医院住院的老年抑郁症患者60例,患者或其家属知情同意。根据是否合并认知功能障碍将患者分为两组,分组条件:①主观感觉有记忆力减退。②简易智能状态检查评分≤24分。③日常生活能力量表评分≥22分。符合①②③为伴有认知功能障碍组共28例,不伴认知功能障碍组32例。治疗前使用自编的一般情况调查表、汉密顿抑郁量表(总分大于35分重度抑郁;小于8分无抑郁症状)、简易智能状态检查量表(划界分:文盲组17分、小学组20分、中学或以上组24分,低于划界分为认知功能受损)和日常生活能力量表(共10项,0～100分,0～20分极严重功能缺陷,100分自理)对两组患者进行评定。使用抗抑郁药治疗6周后再次评定两组患者的汉密顿抑郁量表、简易智能状态检查和日常生活能力评分,并进行疗效评定,显效为汉密顿抑郁量表总分≤8分;有效为汉密顿抑郁量表减分率≥50%;无效为汉密顿抑郁量表减分率<50%。结果:60例患者全部进入结果分析。①两组患者的年龄和发病年龄:伴有认知功能障碍组显著高于不伴认知功能障碍组犤(67.0±7.2,57.9±9.1)岁;(62.2±7.6,54.4±11.5)岁(t=2.536,2.035,P<0.05)犦。②汉密顿抑郁量表和日常生活能力评分:两组患者治疗6周后评分均较治疗前显著降低(t=2.614～26.840,P<0.01)。③简易智能状态评分:治疗6周后伴认知功能障碍组评分较治疗前显著升高(t=4.371,P<0.01)。④两组患者治疗6周后的疗效:伴认知功能障碍组患者的有效率和显效率均低于不伴认知功能障碍组患者(64.3%,32.1%;75.0%,46.9%),但差异无显著性意义(P>0.05)。结论:年龄与认知损害有关,伴有认知功能障碍老年抑郁症患者的近期干预效果较差。抑郁症患者的认知功能障碍有可能存在于抑郁症状之外,这是抑郁症患者在改善抑郁症状后仍不能恢复正常社会功能的主要原因。
AIM：To explore clinical features in patients with elderly depression and cognitive dysfunction. METHODS：Sixty patients with elderly depression, who hospitalized at the Brain Hospital, Nanjing Medical University from January 2003 to June 2004, were selected with the knowledge of fact and agreement of their family member. According to the consolidation or non-consolidation of the cognitive dysfunction, the patients were divided into two groups. Condition of dividing group：①Subjective sensation had decrement of anamnesis. ② The score of simple intellectual status was ≤24 points. ③ The score of ability of daily living scale was≥ 22 points. Those who were accorded with the condition of ①, ②and③were considered as the cognitive dys-function group with 28 cases, and the without cognitive dysfunction group with 32 cases. Before treatment, the self-made common investigation scale, Hamilton depression rating scale （total score over 35 points was severe depression; less than 8 points was without depressive symptom）, mini mental state examination （cut off score： illiteracy group with 17 points, elementary school group with 20 points, middle school or over group with 24 points, lower than cut off score was cognitive function damage） and ability of daily living scale （totally 10 items, 0-100 points, 0-20 points for most severe functional defect, 100 points for self-care） were used to assess the patients in the two groups. After taking 6-week drug of anti-depression, the patients were detected again by the Hamilton depression rating scale, mini mental state examination and ability of daily living to perform effective assessment. The general score of Hamilton depression rating scale ≤8 points had significant effects; The reducing score rating of Hamilton depression rating scale ≥ 50% was effective; The reducing score rating of Hamilton depression rating scale 〈 50% was ineffective. RESULTS：Sixty patients were all involved in the result analysis.①The age and the age of episode in the patients of the two groups： It was significantly higher in the cognitive dysfunction group than that in the non-cognitive dysfunction group [ （67.0±7.2,57.9±9.1） years old： （62.2±7.6, 54.4±11.5） years old, （t=2.536, 2.035, P 〈 0.05） ].② Scores of Hamilton depression rating scale and ability of daily living scale： The scores were significantly lower after 6-week treatment in the patients of the two groups those before treatment （t=2.614-26.840, P 〈 0.01） .③ The mini mental state examination ：That was higher significantly after 6-week treatment in the cognitive dysfunction group than that before treatment （t=4.371, P 〈 0.01）.④Effects of the patients after 6-week treat-ment in the two groups： The efficiency and appearing efficiency in the pa-tients of cognitive dysfunction group were lower than that in the patients of non-cognitive dysfunction group （64.3%, 32.1%： 75.0%, 46.9%）, but there was insignificant difference （P 〉 0.05） . CONCLUSION：The age has related with the cognitive lesion, and the effects of intervention in the near future in patients with elderly depression and cognitive dysfunction are bad.The cognitive dysfunction in the patients with depression maybe exist outside of the depressive symptom, which is the main factor that the patients with depression still cannot recover to the normal social function after the amelioration of depressive symptom.
出处
《中国临床康复》
CSCD
北大核心
2005年第32期26-28,共3页
Chinese Journal of Clinical Rehabilitation
基金
中央保健委员会保健专项资金(苏C057)
江苏省科技厅社会发展资金(BS2002001)~~
