抑郁症患者电休克治疗后认知功能与临床反应的关系
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Cognitive function after electroconvulsive therapy for depression: relationship to clinical response
背景与目的
由于尚不确定临床反应是否会影响抑郁症患者电休克疗法(ECT)治疗后的认知功能，因此我们在ECT疗程4个月后观察了缓解状态对抑郁症患者认知功能的影响。
方 法
对完成ECT4个月后患者按缓解状态进行分类的抑郁症患者进行二次对照研究的随机对照试验，所有参与者接受氯胺酮增强治疗。通过自评记忆、顺行性言语和视觉记忆、言语流利性以及工作记忆的神经心理学测试来评估认知功能，并使用方差分析进行比较。
结 果
在4个月的随访中，缓解期患者（N=18）的平均MADRS抑郁评分为3.8(95% CI 2.2–5.4)，而非缓解期患者为27.2(23.0–31.5)（N=19），两组之间没有明显差异。患者在基线时的所有认知指标均受损。ECT治疗后4个月，病情没有恶化，并有一些指标得到改善，与那些保持抑郁状态的患者相比，缓解期患者的自评记忆，顺行性言语记忆和言语流利性明显改善。
结 论
本研究并未发现ECT治疗后认知功能持续受损的证据。
原始文献摘要
Ian M. Anderson , R. Hamish McAllister-Williams , Darragh Downey. Cognitive function after electroconvulsive therapy for depression: relationship to clinical response. Psychological Medicine,2020, 11,1-10.
Background. As uncertainty remains about whether clinical response influences cognitive function after electroconvulsive therapy (ECT) for depression, we examined the effect of remission status on cognitive function in depressed patients 4 months after a course of ECT.
Method. A secondary analysis was undertaken on participants completing a randomised controlled trial of ketamine augmentation of ECT for depression who were categorised by remission status (MADRS ⩽10 v. >10) 4 months after ECT. Cognition was assessed with self-rated memory and neuropsychological tests of anterograde verbal and visual memory, autobiographical memory, verbal fluency and working memory. Patients were assessed through the study, healthy controls on a single occasion, and compared using analysis of variance.
Results. At 4-month follow-up, remitted patients (N = 18) had a mean MADRS depression score of 3.8 (95% CI 2.2–5.4) compared with 27.2 (23.0–31.5) in non-remitted patients (N= 19), with no significant baseline differences between the two groups. Patients were impaired on all cognitive measures at baseline. There was no deterioration, with some measures improving, 4-months after ECT, at which time remitted patients had significantly improved self-rated memory, anterograde verbal memory and category verbal fluency compared with those remaining depressed. Self-rated memory correlated with category fluency and autobiographical memory at follow-up.
Conclusions. We found no evidence of persistent impairment of cognition after ECT.Achieving remission improved subjective memory and verbal memory recall, but other aspects of cognitive function were not influenced by remission status. Self-rated memory may be useful to monitor the effects of ECT on longer-term memory
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翻译：唐剑 编辑：冯玉蓉 审校：王贵龙