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Cognitive Outcomes After Antidepressant Pharmacotherapy for Late-Life Depression: A Systematic Review and Meta-Analysis
American Journal of Psychiatry ( IF 17.7 ) Pub Date : 2024-02-07 , DOI: 10.1176/appi.ajp.20230392
Nicholas J. Ainsworth 1 , Tulip Marawi 1 , Marta M. Maslej 1 , Daniel M. Blumberger 1 , Mary Pat McAndrews 1 , Argyrios Perivolaris 1 , Bruce G. Pollock 1 , Tarek K. Rajji 1 , Benoit H. Mulsant 1
Affiliation  

Objective:

The authors evaluated whether treatment of late-life depression (LLD) with antidepressants leads to changes in cognitive function.

Methods:

A systematic review and meta-analysis of prospective studies of antidepressant pharmacotherapy for adults age 50 or older (or mean age of 65 or older) with LLD was conducted. MEDLINE, EMBASE, and PsycInfo were searched through December 31, 2022. The primary outcome was a change on cognitive test scores from baseline to after treatment. Secondary outcomes included the effects of specific medications and the associations between changes in depressive symptoms and cognitive test scores. Participants with bipolar disorder, psychotic depression, dementia, or neurological disease were excluded. Findings from all eligible studies were synthesized at a descriptive level, and a random-effects model was used to pool the results for meta-analysis.

Results:

Twenty-two studies were included. Thirteen of 19 studies showed an improvement on at least one cognitive test after antidepressant pharmacotherapy, with the most robust evidence for the memory and learning (nine of 16 studies) and processing speed (seven of 10 studies) domains and for sertraline (all five studies). Improvements in depressive symptoms were associated with improvement in cognitive test scores in six of seven relevant studies. The meta-analysis (eight studies; N=493) revealed a statistically significant overall improvement in memory and learning (five studies: effect size=0.254, 95% CI=0.103–0.404, SE=0.077); no statistically significant changes were seen in other cognitive domains. The evaluated risk of publication bias was low.

Conclusion:

Antidepressant pharmacotherapy of LLD appears to improve certain domains of cognitive function, particularly memory and learning. This effect may be mediated by an improvement in depressive symptoms. Studies comparing individuals receiving pharmacotherapy with untreated control participants are needed.



中文翻译:

抗抑郁药物治疗晚年抑郁症后的认知结果:系统评价和荟萃分析

客观的:

作者评估了抗抑郁药物治疗晚年抑郁症 (LLD) 是否会导致认知功能发生变化。

方法:

对 50 岁或以上(或平均年龄 65 岁或以上)患有 LLD 的成年人进行抗抑郁药物治疗的前瞻性研究进行了系统回顾和荟萃分析。MEDLINE、EMBASE 和 PsycInfo 的检索截止日期为 2022 年 12 月 31 日。主要结果是认知测试分数从基线到治疗后的变化。次要结果包括特定药物的作用以及抑郁症状变化与认知测试分数之间的关联。患有双相情感障碍、精神病性抑郁症、痴呆或神经系统疾病的参与者被排除在外。所有符合条件的研究的结果均在描述性水平上进行综合,并使用随机效应模型来汇总结果以进行荟萃分析。

结果:

纳入了二十二项研究。19 项研究中的 13 项显示,抗抑郁药物治疗后至少一项认知测试有所改善,其中最有力的证据涉及记忆和学习(16 项研究中的 9 项)和处理速度(10 项研究中的 7 项)领域以及舍曲林(所有 5 项研究) )。在七项相关研究中有六项中,抑郁症状的改善与认知测试分数的改善相关。荟萃分析(八项研究;N=493)显示,记忆和学习的总体改善具有统计学意义(五项研究:效应大小=0.254,95% CI=0.103–0.404,SE=0.077);其他认知领域没有观察到统计上显着的变化。评估的发表偏倚风险较低。

结论:

LLD 的抗抑郁药物治疗似乎可以改善某些认知功能领域,特别是记忆和学习。这种作用可能是通过改善抑郁症状来介导的。需要对接受药物治疗的个体与未经治疗的对照参与者进行比较的研究。

更新日期:2024-02-07
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