在严重抑郁症和轻度认知障碍中减缓认知衰退:一项随机临床试验
Tarek K Rajji1,2,3, Christopher R Bowie1,4, Nathan Herrmann2,5
1Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
JAMA psychiatry
|October 30, 2024
概括
认知补救 (CR) 加上跨直流刺激 (tDCS) 减缓了老年人的认知衰退缓解严重抑郁症 (rMDD) 或轻度认知障碍 (MCI). 这种组合疗法对患有rMDD和阿尔茨海默病遗传风险低的人特别有益.
科学领域:
- 神经科学是一个神经科学.
- 老年学是一门学科.
- 精神病学是一个精神病学.
背景情况:
- 患有严重抑郁症 (MDD) 或轻度认知障碍 (MCI) 的老年人面临认知能力下降的风险较高.
- 确定有效的干预措施来缓解这种衰退对于维持老龄人口的认知健康至关重要.
研究的目的:
- 评估认知补救 (CR) 结合跨直流刺激 (tDCS) 针对前额叶皮层的疗效.
- 该研究旨在确定这种联合疗法是否可以减缓认知衰退,急性改善认知,并减少老年人患有缓解性MDD (rMDD),MCI或两者的MCI或痴呆症的进展.
主要方法:
- 一项随机临床试验,涉及375名患有rMDD,MCI或两者的老年人,在5所学术医院进行.
- 参与者接受了8周的活性CR加tDCS或假干预,随后是维护增强剂和每天在家进行CR或假CR.
- 认知评估是在基线时进行的,2个月,每年进行3到7年.
主要成果:
- 在大约48个月的中位数随访期间,CR加tDCS显著减缓了患有rMDD或MCI的老年人的认知衰退 (60个月的调整后的z分数差异:0.21;P=.006).
- 该干预措施在2个月后没有显示出明显的急性认知改善 (调整后的z分数差异:0.06).
- 虽然延缓MCI或痴呆症进展的影响并不显著 (HR=0.66),但预先计划的分析显示了对执行功能和口头记忆的显著益处,特别是在rMDD和非携带APOE ε4等位基因的个体中.
结论:
- 认知补救 (CR) 与针对前额叶皮层的跨直流刺激 (tDCS) 结合,有效减缓风险较高的老年人认知衰退.
- 这种联合疗法对缓解性主要抑郁症 (rMDD),轻度认知障碍 (MCI) 或没有轻度认知障碍,以及阿尔茨海默病遗传风险较低的人群特别有希望.
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