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深度大脑刺激对治疗耐药抑郁症认知功能的影响:系统性审查和元分析

N Runia^1,2,3, G J J Mol^4,5, T Hillenius⁴

¹Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. n.runia@amsterdamumc.nl.

Molecular psychiatry

|September 21, 2023

概括

对治疗耐药性抑郁症 (TRD) 的深度大脑刺激 (DBS) 显示,在长达18个月的时间内,认知能力没有下降. 结果表明潜在的小认知改善,特别是在记忆和执行功能方面,由于有限的受控数据,需要谨慎解释.

科学领域:

神经科学是一个神经科学.
精神病学是一个精神病学.
神经外科神经外科

背景情况:

深度大脑刺激 (DBS) 是一种新兴的治疗治疗耐药性抑郁症 (TRD) 的方法.
在TRD患者中,DBS的认知效应尚未得到充分证实,因为之前的研究样本大小小小.
了解认知影响对于评估DBS对TRD的整体疗效至关重要.

研究的目的:

系统地审查和对现有研究进行元分析,研究DBS对TRD患者认知功能的影响.
估计DBS在干预后的不同时间点对各种认知领域的影响.
评估TRD中与DBS治疗相关的潜在认知衰退或改善.

主要方法:

进行了PubMed的系统文献搜索.
包括10项研究,比较DBS前后的神经心理测试或TRD中的活跃与虚假DBS.
对不同认知领域和随访期 (<6个月,6-18个月,>18个月) 进行了随机效应元分析.

主要成果:

在DBS治疗的前6个月内没有观察到任何显著的认知变化.
在6-18个月之间,在口头记忆 (g=0.22),视觉记忆 (g=0.37),注意力/精神运动速度 (g=0.26) 和执行功能 (g=0.37) 中发现了小到中等的改善.
在长达18个月的时间内,没有发现认知能力下降;定性分析表明,主动DBS和假DBS之间没有显著差异.

结论:

对TRD的DBS似乎不会在18个月内导致认知能力下降.
证据表明,在6-18个月的DBS后,在记忆,注意力和执行功能方面可能有很小的认知益处.
需要对更大规模的受控研究进行进一步的研究,以证实这些发现并探索长期影响.

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