早、晚发型重症肌无力患者临床特点对比研究

目的研究早、晚发型重症肌无力(MG)患者的临床特点。方法回顾性研究同期住院及门诊的191例MG患者资料,比较早、晚发型MG组患者的构成情况、首发症状、临床分型、伴随疾病、辅助检查、治疗及疗效等临床特点。结果 MG发病以晚发型人群为主,占63.35%。早发型MG组中,男∶女=1∶1.80;晚发型组中,男:女=1:0.92。两组患者首发症状及osserman分型构成比无统计学差异(P0.05),都以Ⅱ型居多,约占早发型58.57%,晚发型57.85%,但晚发型组Ⅱb型较早发型组比例高。晚发型伴随高血压、2型糖尿病、高脂血症比例高(分别42.98%和8.57%,23.97%和2.86%,13.22%和0%;P0.05),而胸腺瘤、甲状腺疾病、其他免疫疾病、肿瘤及副肿瘤综合征在两组患者中差异无统计学意义(P0.05)。早发型MG患者伴胸腺增生构成比例高,晚发型伴胸腺瘤构成比例高,男性患者胸腺瘤占比例高,女性患者胸腺增生占比例高,差异均有统计学意义(P0.05)。女性MG患者伴随甲状腺疾病比例高(P0.05)。两组患者行血清Titin-Ab检查,早发型患者阳性率较晚发型高(P0.05),余血清抗体检测、电生理检查和新斯的明试验比较,差异均无统计学意义(P0.05)。两组患者治疗有效率差异无统计学意义(P0.05),但晚发型有效率较早发型低。结论早、晚发型MG患者在性别构成、首发症状、伴随疾病、辅助检查及预后有所不同,在诊断及治疗时需要注意。     

中国汉族女性忧郁型与非忧郁型抑郁症患者临床特点与大五人格特征的比较研究

目的 比较忧郁型与非忧郁型抑郁症临床特点以及人格特征的差异.方法 对151例处于缓解或部分缓解期的中国汉族女性复发性抑郁症患者进行大五人格问卷(the Big Five Inventory,BFI)调查,然后对其中114例忧郁型抑郁症和37例非忧郁型患者的临床特点以及人格特征进行比较.结果 与非忧郁型组比较,忧郁型组总的症状数更多(OR=1.355,95％CI=1.166 ～ 0.1575,P＜ 0.01),认知症状包括注意涣散(OR=6.115,95％CI=2.268～16.493,P＜0.01)和犹豫不决(OR=4.167,95％CI=1.190 ～ 9.088,P＜0.01)更多见,负性认知包括无价值感(OR=5.024,95％CI=2.296 ～ 11.069,P＜0.01)、自卑感(OR=2.727,95％CI=1.243～ 5.984,P=0.012)更突出,伴发焦虑情绪的几率更大(OR=4.400,95％CI=1.688 ～ 11.470,P=0.002),出现自杀意念(OR=5.750,95％CI=2.420 ～ 13.655,P＜0.01)以及自杀计划(OR=3.036,95％CI=1.281～1.194,P=0.012)的风险更高.忧郁型抑郁症在BFI神经质维度上的得分(28.4±6.1)要明显高于非忧郁型抑郁症(25.3±6.0)(P＜0.05),但在宜人性、外向性、开放性、责任感得分上差异无统计学意义(P＞0.10).结论 对于中国汉族女性复发性抑郁症患者而言,忧郁型抑郁症相对于非忧郁型抑郁症,病情更为严重,神经质水平更高.     

缓解期抑郁症患者认知功能特点的随访研究

目的 探讨缓解期抑郁症患者认知功能的特点。方法 以2017 年1 月—2017 年7 月于 沈阳军区总医院首次就诊的抑郁症患者130 例和100 名健康人作为研究对象。采用汉密尔顿抑郁量表 （HAMD）评价抑郁症的严重程度。采用威斯康星卡片分类测试、斯特鲁色词测验、连线测试、词语流畅 性测验和韦氏记忆测验分别对缓解期抑郁症患者的信息处理速度、词语流畅性、工作记忆、认知灵活 性、联接记忆和逻辑记忆等方面进行评估。使用草酸艾司西酞普兰对抑郁症患者进行治疗,治疗前和 治疗6 个月后评价患者的抑郁情绪和认知功能。结果 抑郁症组87 例和健康对照组69 人最终纳入本 研究。治疗前,抑郁症组认知功能明显较健康对照组差,差异有统计学意义（P＜ 0.05）。治疗6 个月后, 根据DSM-5 的标准,75 例抑郁症患者达到抑郁症缓解标准。治疗6 个月后,抑郁症患者HAMD 评分从 （34.52±5.01）分下降至（5.01±2.98）分,差异有统计学意义（F=23.132,P＜ 0.05）,且与健康对照组比较 差异无统计学意义（P=0.689）。抑郁症患者治疗6 个月后,除信息处理速度、词语流畅性外,其他认知功 能（工作记忆、认知灵活性、联接记忆和逻辑记忆即刻/ 延时）均明显改善,差异有统计学意义（P＜ 0.05）。 结论 抑郁症患者发病期会出现认知功能（信息处理速度、词语流畅性、工作记忆、认知灵活性、联接记 忆和逻辑记忆即刻/ 延时）损伤。缓解期时,除信息处理速度、词语流畅性外,其他认知功能均明显改善, 结果提示信息处理速度、词语流畅性可能是抑郁症的内表型,而其他认知因子可能是状态型。     

早发型与晚发型抑郁症遗传效应比较

目的:了解早发型与晚发型单相抑郁症之间是否存在遗传效应的差异. 方法:对符合中国精神障碍分类与诊断标准第3版抑郁发作诊断标准的115例单相抑郁症患者,以初发病年龄30岁为界,分为早发组47例和晚发组68例.对照组230名,无精神疾病,与患者组无血缘关系.对所得资料行单因素分析,用多基因阈值理论进行遗传率的估算. 结果:早发组有精神疾病家族史者为55.3%(26/47),显著高于晚发组35.3%(24/68);早发组一级亲属心境障碍和单相抑郁症发生率分别为9.1%(23/252)和7.9%(20/252),显著高于晚发组一级亲属的4.8%(23/479)和3.6%(17/479);两组一级亲属单相抑郁症发生率均显著高于对照组一级亲属的0.2%.早发组加权平均遗传率及标准误(96.3±1.3)%高于晚发组(75.7±1.2)%,脑部CT器质性改变亦少于晚发组(P<0.05或P<0.01). 结论:早发型及晚发型单相抑郁症均有明显的遗传效应,但二者的遗传效应存在差异.     

晚发型偏头痛与青年偏头痛临床特点的比较

目的 比较晚发型偏头痛和青年偏头痛患者的临床特点.方法 对40例晚发型偏头痛患者(晚发型组)和40例青年偏头痛患者(青年组)的临床资料进行收集和比较.结果 晚发型组19例(47.5％)发病有明显诱因,青年组3例(7.5％)有明显诱因,差异有统计学意义(P＜0.05).晚发型组中先兆型偏头痛6例(15.0％),无先兆型33例(82.5％),偏瘫型1例(2.5％);青年组先兆型偏头痛15例(37.5％),无先兆型25例(62.5％).晚发型组中先兆型比率显著低于青年组(P＜0.05).晚发型组单侧头痛及额部头痛的比率及头痛程度显著低于青年组,双侧头痛及全头痛的比率显著高于青年组(均P＜0.05).晚发型组伴面色苍白、厌食及口干的比率显著高于青年组(均P＜0.05).晚发型组头痛性质、持续时间、发作频率及缓解因素与青年组比较,差异无统计学意义.结论 与青年偏头痛相比,晚发型偏头痛患者发作有诱因的比率高,出现先兆症状少,头痛程度轻,多为双侧及全头痛;易合并自主神经症状.     

晚发型单相抑郁症遗传方式的研究

目的 探讨晚发型单相抑郁症的遗传实方式.方法 采用严格的纳入标准,对符合中国精神疾病分类方案与诊断标准第3版（CCMD-3）抑郁发作诊断标准,首次发病年龄＞30岁的68例单相抑郁症患者用医学遗传数学方法中分离分析和多基因阈值理论进行遗传实方式的研究.结果 晚发型一级亲属单相抑郁症加权平均遗传率及标准误为（75.7±1.2）%,预期发病率为5.0%,与实际发病率3.6 %相比较无显著性差异（u=1.5,P＞0.05）.结论 晚发型单相抑郁症的遗传方式符合多基因遗传.     

抑郁症患者的认知功能、事件相关电位P300和MR扩散张量成像研究

目的 联合应用事件相关电位P300和MR扩散张量成像(DTI)研究抑郁症患者的认知功能损害,探讨抑郁症合并认知损害的机制. 方法 选取深圳市第二人民医院心理门诊自2008年5月至2009年9月接收的30例首发抑郁症患者作为抑郁症组,同期与抑郁症患者年龄、教育程度相匹配的健康志愿者30名做为对照组.应用威斯康星卡片分类测验(WCST)、P300检查和DTI扫描分别检测WCST各亚项得分、P3潜伏期和P3波幅、脑不同解剖部位的各向异性(FA)值.并对三者进行相关性分析. 结果 抑郁症组患者WCST各亚项得分、P3潜伏期和P3波幅与对照组相比较差异均有统计学意义(P<0.05);与对照组相比,抑郁症组患者双侧额叶、扣带回前部、扣带回压部、胼胝体膝部和压部FA值下降,差异有统计学意义(P<0.05);抑郁症组患者P3潜伏期与持续性错误数呈正相关关系(r=0.677,P=0.009),P3波幅与持续性错误数、不能维持完整分类数数均呈负相关关系(r=0.765,P=0.001;r=0.654,P=0.012),抑郁症组患者左、右侧额叶白质FA值分别与持续性错误数、不能维持完整分类数呈负相关关系(P<0.05). 结论 神经心理学和事件相关电位P300检查反映了抑郁症患者存在认知功能损害,P3潜伏期和P3波幅可作为认知功能的参考指标,DTI结果 揭示了抑郁症患者存在白质区域神经纤维的异常,这可能是抑郁症合并认知损害的神经病理学基础之一.     

晚发型抑郁障碍与轻度认知功能损害患者的认知功能差异研究

目的 探讨晚发型抑郁障碍患者与轻度认知功能损害患者的认知功能损害的差异.方法 研究对象为2012年7月～2013年8月上海市精神卫生中心老年科住院与门诊就诊符合DSM—Ⅳ诊断标准且起病年龄≥60岁的抑郁障碍患者,共26例为晚发型抑郁障碍组（LOD组）,另选择26例轻度认知功能损害的患者（MCI组）与26例正常老年人（NC组）.认知功能评估采用简明精神状态量表（MMSE）、蒙特利尔量表（MoCA）.结果 MMSE总分、MMSE分测验中计算力与注意力及MoCA总分、MoCA分测验中连线、注意、持续注意、计算、复述、延迟回忆在LOD组与MCI组差比较异无统计学意义（P＞0.05）,两组与NC组比较差异有统计学意义（P＜0.05）.三组在MMSE分测验的时间定向、延迟回忆、三步指令、书写书面指令及MoCA分测验的复制图、画钟、命名比较,MCI组均值最低,与NC组比较差异有统计学意义（P＜0.05）,与LOD组比较差异无统计学意义（P＞0.05）.结论 LOD组认知功能在注意力、延迟回忆、连线测验方面与MCI组损害程度相当.MCI组认知功能受损范围较LOD组广泛.     

首发与复发抑郁症患者的认知功能特征比较

目的 探讨首发与复发抑郁症患者的认知功能特征及两者间的差异,以及与疾病严重程度的相关性.方法 招募符合DSM-Ⅳ中抑郁症诊断标准的首发抑郁症患者共31例为首发组,复发性抑郁症患者30例为复发组,健康志愿者31名为对照组,对3组进行韦氏数字广度(DS)测验、威斯康星卡片分类测验(WCST)和爱荷华赌博任务(IGT)测验,比较3组被试在各测量指标上的差异,同时用HAMD-24评估患者组的抑郁程度,并分析其与认知功能各指标的相关性.结果 (1)3组患者DS评分的差异有统计学意义(P<0.05),其中复发组低于对照组(P<0.05),首发组与复发组及首发组与对照组差异均无统计学意义(P>0.05).(2)3组患者WCST评分的差异有统计学意义,其中复发组与对照组及复发组与首发组间差异均有统计学意义(P<0.05),首发组和对照组差异无统计学意义(P>0.05).(3)3组患者IGT评分的差异有统计学意义(P<0.05),其中复发组除第二模块外,其余各项指标均高于对照组(P<0.05),复发组的总分、第三模块和第五模块评分均高于首发组(P<0.05).(4)患者组(首发组+复发组)的HAMD总分与DS评分、WCST分类数呈负相关(r=-0.373,P=0.003;r=-0.299,P=0.019),与WCST的错误应答数、持续性错误应答数、非持续错误应答数和IG T的总分、第三模块评分、第五模块评分呈正相关(r=0.265~0.461,P<0.05),与IG T第一模块、第二模块和第四模块无相关性(P>0.05).结论 首发抑郁症患者无明显短时记忆和执行功能损害,在情感决策方面,其倾向于低收益,低风险决策;而复发抑郁症患者的短时记忆、执行功能均有明显损害,且在情感决策上比首发患者对损失更为敏感;抑郁症患者的抑郁程度与认知损害呈正相关.疾病复发和病情加重都会对抑郁症患者的认知损害造成不良影响.     

中重度晚发抑郁症患者的神经认知功能损害分析

目的探讨中重度晚发抑郁症患者神经认知功能损害的特征。方法选取2017年2月至2019年2月我院收治的中重度晚发抑郁症患者50例作为观察组,采用重复性成套神经心理状态测验(RBANS)、词语流畅性测验(VFT)、威斯康星卡片分类测验(WCST)对神经认知功能损害情况予以评定,与同期收治的对照组50名健康体检者进行比较。采用汉密顿抑郁量表(HAMD-17)评估观察组抑郁严重程度,并分析它与认知损害的关系。结果在RBANS测验中,观察组晚期抑郁症患者即刻记忆、延时记忆、视觉广度、注意力、言语能力各维度评分均低于对照组,差异具有统计学意义(P0.05);观察组VFT测验评分经评定低于对照组(P0.05);在WCST测验中,两组完成分类数、完成第一分类所需应答数评分无差异(P0.05),观察组错误应答数、持续性错误百分数、持续性错误数、持续性应答数评分均高于对照组,概念化水平应答百分数评分高于对照组,P0.05);Spearman相关分析发现RBANS测验中的即刻记忆、延时记忆、视觉广度、注意力、言语能力各维度均与HAMD-17评分具正相关(r=0.39,0.42,0.45,0.38,0.40,P0.05);VFT和WCST测验中的持续性应答因子与HAMD-17评分呈负相关(r=-0.43,-0.51,P0.05)。结论中重度晚发抑郁症患者容易出现神经认知功能损害,认知功能损害与抑郁程度密切相关。     

晚发性和早发性抑郁症的临床比较研究

目的：比较晚发性和早发性抑郁症的病前因素和临床特征。方法：对99例晚发性抑郁症和114例早发性抑郁症在遗传史,发病诱因,既往躯体疾病,性格特征,临床症状以及BEAM和TCD异常进行评定和比较,结果：晚发组的遗传史显著少于早发组（P＜0．01）,而发病诱因和既往躯体疾病显著多于后者（P＜0．05,P＜0．01）,兴趣丧失和自杀行为多于后者（P＜0．05）,自责自罪少于后者（P＜0．05）,而严重性,活动减少,悲观,躯体症状和焦虑无差异（P＞0．05）,BEAM和TCD异常明显多于后者（P＜0．01）,结论：性格内向的老年人易在应急下诱发抑郁症,发病后兴趣丧失和自杀行为明显增多,加强对老年人的关怀,减少生活中的应激因素,加强脑血管危险因素的检查和治疗,对减少晚发性抑郁症将起一定作用。     

晚发性抑郁症患者血浆脑源性神经营养因子水平与认知功能

目的 探讨晚发性抑郁症患者血浆脑源性神经营养因子(BDNF)水平与抑郁症发病及认知功能之间的关系.方法 采用酶联免疫吸附法测定34例未经治疗的晚发性抑郁症患者(患者组)和32名正常对照(对照组)血浆BDNF水平;对患者组及对照组进行17项汉密尔顿抑郁量表( HAMD17)评估及神经心理学测试;对患者组的血浆BDNF水平及HAMD17总分与认知功能进行Pearson相关分析.结果 患者组治疗前的神经认知测试成绩显著差于对照组(P＜0.01);患者组的血浆BDNF水平[(3.24±2.67) μg/L]低于对照组[(6.71±3.16)μg/L,P＜0.01].血浆BDNF水平与各项认知成绩、HAMD17总分值均无显著相关性(P＞0.05).结论 部分晚发性抑郁症患者存在认知功能广泛受损;血浆BDNF水平低下与晚发性抑郁症发病密切相关,与认知功能可能无直接相关性.     

Cognition in late onset depression

The aim of study was to assess cognition in patients with late onset depression in a symptom-free remission period measuring event-related potentials and reaction times (RT) in a modified computer version of the Stroop test. Thirty four patients with late-onset depression were included after they had reached remission. They were compared to age-, gender- and education-matched healthy controls. Each participant completed a single item computer version of the Stroop Color-word task using verbal response mode. EEG and RT were simultaneously recorded. RTs were significantly prolonged in patients in all conditions of the Stroop paradigm, and the interference effect was significantly greater in patients compared to controls. Results also revealed abnormal late positive Stroop related potentials in the period of about 500–600 ms period corresponding to the so-called P300b wave. Our study supports the view that patients with late onset depression are also cognitively impaired and that this impairment persists in the period of early remission. Using more sensitive ERP measurement of the Stroop task we demonstrated impaired information processing at an earlier, pre-response related stage.     

Depression and quality of life in monogenic compared to idiopathic,early‐onset Parkinson's disease

Quality of life (QoL) is decreased in PD and is linked with depression and anxiety. However, little is known about QoL in monogenic PD. Subjects with mutations in PD genes were recruited from ongoing family and genetic studies (manifesting carriers, n = 23; nonmanifesting carriers, n = 19). For comparison purposes, we included patients with idiopathic PD (IPD; n = 128; early onset, n = 38; late onset, n = 90), healthy controls (n = 127), and data on depressive symptoms of 144 patients with major depression (treated controls). Depression affected 31% of early‐onset PD cases, 21% of late‐onset cases, and 44% of manifesting carriers of mutations in PD genes, but was rare in the nonmanifesting carriers (7%) and healthy controls (5%). Subjects with Parkinson‐associated depression reported fewer feelings of guilt or self‐doubt than treated controls, but the occurrence of suicidal ideation was associated with severity of depression only. Social phobia (P = 0.018) and agoraphobia (P = 0.059) were more common in manifesting carriers than in any other group. QoL was decreased in the Parkinson groups, particularly in the early‐onset cases (P < 0.001), and QoL correlated with depression in all analyses. In our study, monogenic and IPD cases were comparable in QoL and depression characteristics. The QoL and, possibly, overall prognosis of all PD patients can be improved by appropriate attention and treatment for depression, sleep impairments, and anxiety, even if the treatment of the motor problems cannot be further optimized. © 2012 Movement Disorder Society     

老年抑郁症患者认知功能损害与血清皮质醇的关系研究

目的探讨老年抑郁症(LLD)患者认知功能损害与血清皮质醇水平的关系。方法纳入LLD认知损害患者35例、LLD认知正常患者14例、正常对照组25例,采用汉密尔顿抑郁量表17项版(HAMD-17)和简易智能状态评价量表(MMSE)分别评定抑郁症状和总体认知功能,采用化学发光微粒子免疫法测定血清皮质醇浓度。结果 LLD认知损害患者的血清皮质醇水平高于LLD认知正常者[(11.83±4.70)ug/d Lvs.(8.21±3.64)ug/d L,P0.01]。LLD发作期伴认知损害者[(11.6±4.6)ug/d L]、LLD恢复期伴认知损害者[(12.4±5.2)ug/d L]血清皮质醇水平均高于LLD恢复期认知正常者[(8.5±3.7)ug/d L]及正常对照组[(8.6±4.3)ug/d L](P均0.05)。结论伴有认知损害的LLD患者,无论是处于发作期还是恢复期,血清皮质醇水平均升高。皮质醇水平可能是影响LLD患者认知功能的重要因素。     

Cognitive function in late life depression: relationships to depression severity, cerebrovascular risk factors and processing speed.

BACKGROUND: A number of studies have examined clinical factors linked to worse neuropsychological performance in late life depression (LLD). To understand the influence of LLD on cognition, it is important to determine if deficits in a number of cognitive domains are relatively independent, or mediated by depression- related deficits in a basic domain such as processing speed. METHODS: Patients who met DSM-IV criteria for major depression (n = 155) were administered a comprehensive neuropsychological battery of tasks grouped into episodic memory, language, working memory, executive function, and processing speed domains. Multiple regression analyses were conducted to determine contributions of predictor variables to cognitive domains. RESULTS: Age, depression severity, education, race and vascular risk factors all made significant and independent contributions to one or more domains of cognitive function, with all five making independent contributions to processing speed. Age of onset made no independent contribution, after accounting for age and vascular risk factors. Of the five cognitive domains investigated, changes in processing speed were found to most fully mediate the influence of predictor variables on all other cognitive domains. CONCLUSIONS: While slowed processing speed appears to be the most core cognitive deficit in LLD, it was closely followed by executive function as a core cognitive deficit. Future research is needed to help clarify mechanisms leading to LLD- related changes in processing speed, including the potential role of white matter abnormalities.     

Late-life depression: the differences between early- and late-onset illness in a community-based sample

BACKGROUND: Several studies have described etiological and clinical differences between elderly depressed patients with early onset of their illness compared to late onset. While most studies have been carried out in clinical samples it is unclear whether the findings can be generalized to the elderly population as a whole. The aim of this study was to compare early-onset (EOD) and late-onset (LOD) depressive illness in a community-based sample. METHODS: Large (n = 3107) representative sample of older persons (55-85 years) in the Netherlands. Two-stage screen procedure to identify elderly with MDD. The Center for Epidemiologic Studies Depression scale (CES-D) was used as a screen and the Diagnostic Interview Schedule (DIS) to diagnose MDD. Data on 90 older persons with early-onset depression and 39 with late-onset depression were available. RESULTS: Those with LOD were older, and more often widowed. Family psychiatric history, vascular pathology, and stressful early and late life events did not differ between groups. EOD subjects had more often double depression and more anxiety. CONCLUSIONS: In a community-based sample we did not detect clear differences in etiology and phenomenology between EOD and LOD. This discrepancy with reports from clinical samples could be due to selection bias in clinical studies. Consequently, all patients with late-life depression deserve a diagnostic work-up of both psychosocial and somatic risk factors and treatment interventions should be focused accordingly.     

Early onset Alzheimer's disease is associated with a distinct neuropsychological profile

Alzheimer's disease (AD) in younger patients is associated with a higher prevalence of atypical symptoms. We examined neuropsychological performance according to age-at-onset. We assessed cognition in 172 patients with AD (81 early and 91 late onset) in five cognitive domains (memory, language, visuo-spatial functioning, executive functioning, attention). Dementia severity was assessed using the Mini-Mental State Examination (MMSE) and global cognitive decline using Cambridge Cognitive Examination (CAMCOG). Analyses of variance were performed with age-at-onset as between-subjects factor, and gender and education as covariates. Analysis was repeated after stratification for dementia severity (based on median MMSE). In early onset AD, age (mean ± SD) was 60 ± 4 years; 44 (54%) were female. In late onset AD, age was 72 ± 5 years; 47 (52%) were female. Dementia severity and global cognitive decline did not differ between groups (early onset: MMSE: 20 ± 5, CAMCOG: 69 ± 15, late onset: MMSE: 21 ± 5, CAMCOG: 70 ± 15; p > 0.05). Early onset patients performed worse than late onset patients on visuo-spatial functioning (p < 0.01), executive functioning (p < 0.001), and attention (p < 0.01). Late onset patients performed worse on memory, although not significantly (p = 0.11). Stratification for dementia severity showed that in mildly demented early onset patients, memory function was remarkably preserved compared to late onset patients (p < 0.01). In moderate AD, differences in memory function disappeared, but early onset patients performed worse on visuo-spatial functioning (p < 0.01), executive functioning (p < 0.001), and attention (p < 0.01) than late onset patients. Adjustment for APOE left results unchanged. In conclusion, early onset AD presents with a different cognitive profile and the disease course seems different. Relative sparing of memory function in early stages stresses the need to adequately test other cognitive domains.     

Longitudinal increase in the volume of white matter hyperintensities in late-onset depression

BACKGROUND: Cerebrovascular disease is thought to play a role in the pathogenesis of geriatric major depression. One finding supporting such a "vascular depression" is the increased neuropathology in the form of white matter hyperintensities (WMH) found in patients diagnosed with a late-onset depression. However, at present there is little evidence that a longitudinal increase in WMH burden within an individual is associated with the onset of a late-life depression. METHODS: This study examined three-year longitudinal change in WMH volume and in cognition in: (a) an older man who developed his first episode of major depression during the study period, and (b) a comparison group of twelve older individuals who remained depression free. All subjects received at baseline and three years later a structural magnetic resonance imaging (MRI) using fast-FLAIR technology. The images were analyzed with semi-automated computerized software to obtain WMH volumes. Subjects also received at both time points the Mini Mental State Exam (MMSE) as well a series of cognitive tasks assessing executive abilities (verbal fluency, Trail Making Test and Stroop test) since executive dysfunction is thought to be characteristic of a vascular depression. RESULTS: The individual who became depressed during the followup showed an increase in WMH volume that exceeded the 95% Confidence Intervals (CI) for change in the comparison group. This individual also showed a similar decline on the measures of executive function but not on the MMSE. CONCLUSIONS: These results are consistent with cerebrovascular disease being a factor in the pathogenesis of late-onset depression (i.e. "vascular depression").     

帕金森病合并抑郁患者认知功能和P300的研究

目的 探讨帕金森病（PD）合并抑郁患者认知功能和P300的改变。方法 对67例PD患者依据Zung抑郁自评量表（SDS）和汉密顿抑郁量表（HAMD）评分分为PD抑郁组（22例）和PD非抑郁组（45例），分别对两组患者进行认知功能评定和P300检测，并对结果进行比较和相关性分析。结果 本组PD患者简明智力状态量表（MMSE）评分尚在正常范围，但明显低于正常对照组（P〈0．05），PD抑郁组MMSE评分更低（P〈0.01）；与正常对照组比较，PD组P300潜伏期延长、波幅降低（均P〈0．05），PD抑郁组改变更为明显（均P〈0．01）；PD组P300潜伏期与MMSE评分呈负相关（r=-0．413，P〈0．05），波幅与MMSE评分呈正相关（r=0．398，P〈0．05）。结论 PD患者存在认知功能障碍，以记忆损害最为明显；抑郁对认知功能有负性影响，P300检测可以早期发现PD患者的认知功能障碍。