Abstract：
BACKGROUND: Late-life depression (LLD) is associated with cognitive impairment, yet substantial heterogeneity exists among patients. Data on the extent of cognitive impairments is inconclusive, particularly in patients with treatment-resistant depression (TRD). We investigated the cognitive profiles of patients with treatment-resistant vs. nonresistant LLD and aimed to identify distinct cognitive subgroups. Additionally, we examined whether cognitive subgroups differentially responded to treatment with bilateral repetitive transcranial magnetic stimulation (rTMS).
METHODS: 165 patients with LLD were divided into treatment-resistant and nonresistant groups and compared to healthy controls (HC) on measures of executive function, information processing speed, verbal learning, and memory. Cluster analysis identified subgroups based on cognitive scores. Demographic and clinical variables, as well as outcomes with bilateral rTMS, were compared between cognitive subgroups.
RESULTS: Patients with LLD, particularly TRD, exhibited significantly worse cognitive performance than HC. A three-cluster solution was found, including \"Cognitively Intact\" (n = 89), \"Cognitively Diminished\" (n = 29), and \"Impaired Memory\" (n = 47) subgroups. Both the \"Cognitively Diminished\" and \"Impaired Memory\" subgroups had more anxiety symptoms and a higher proportion of patients with TRD than the \"Cognitively Intact\" group, though the latter did not survive multiple comparison correction. No significant differences were observed in outcomes to rTMS treatment.
CONCLUSIONS: Patients with LLD exhibited impairments across cognitive domains, which were more pronounced in TRD. Three identified cognitive subgroups responded similarly to rTMS treatment, indicating its effectiveness across cognitive profiles, especially when medications are not tolerated. Future research should examine the relationship among cognitive subgroups, cognitive decline, and neurodegeneration.
METHODS: 165 patients with LLD were divided into treatment-resistant and nonresistant groups and compared to healthy controls (HC) on measures of executive function, information processing speed, verbal learning, and memory. Cluster analysis identified subgroups based on cognitive scores. Demographic and clinical variables, as well as outcomes with bilateral rTMS, were compared between cognitive subgroups.
RESULTS: Patients with LLD, particularly TRD, exhibited significantly worse cognitive performance than HC. A three-cluster solution was found, including \"Cognitively Intact\" (n = 89), \"Cognitively Diminished\" (n = 29), and \"Impaired Memory\" (n = 47) subgroups. Both the \"Cognitively Diminished\" and \"Impaired Memory\" subgroups had more anxiety symptoms and a higher proportion of patients with TRD than the \"Cognitively Intact\" group, though the latter did not survive multiple comparison correction. No significant differences were observed in outcomes to rTMS treatment.
CONCLUSIONS: Patients with LLD exhibited impairments across cognitive domains, which were more pronounced in TRD. Three identified cognitive subgroups responded similarly to rTMS treatment, indicating its effectiveness across cognitive profiles, especially when medications are not tolerated. Future research should examine the relationship among cognitive subgroups, cognitive decline, and neurodegeneration.
摘要：
背景：晚年抑郁症（LLD）与认知障碍有关，然而，患者之间存在实质性异质性。有关认知障碍程度的数据尚无定论，特别是在患有难治性抑郁症（TRD）的患者中。我们调查了耐药患者的认知特征非耐药性LLD，旨在识别不同的认知亚组。此外,我们检查了认知亚组对双侧重复经颅磁刺激(rTMS)治疗的反应是否不同.
方法：将165例LLD患者分为治疗抵抗和非抵抗组，并与健康对照组（HC）的执行功能测量进行比较。信息处理速度，口头学习，和记忆。聚类分析根据认知得分识别亚组。人口统计学和临床变量，以及双边RTMS的结果，在认知亚组之间进行比较。
结果：LLD患者，特别是TRD，表现出比HC明显更差的认知能力。找到了一个三簇解决方案，包括“认知完整”(n=89)，“认知能力下降”(n=29)，和“记忆受损”(n=47)子组。与“认知完整”组相比，“认知功能减弱”和“记忆障碍”亚组的焦虑症状更多，TRD患者比例更高，尽管后者未能在多重比较校正中幸存下来。在rTMS治疗的结果中没有观察到显著差异。
结论：LLD患者表现出跨认知领域的损伤，这在TRD中更为明显。三个确定的认知亚组对rTMS治疗的反应相似，表明它在认知概况中的有效性，特别是当药物不耐受时。未来的研究应该检查认知亚组之间的关系，认知能力下降,和神经变性。
方法：将165例LLD患者分为治疗抵抗和非抵抗组，并与健康对照组（HC）的执行功能测量进行比较。信息处理速度，口头学习，和记忆。聚类分析根据认知得分识别亚组。人口统计学和临床变量，以及双边RTMS的结果，在认知亚组之间进行比较。
结果：LLD患者，特别是TRD，表现出比HC明显更差的认知能力。找到了一个三簇解决方案，包括“认知完整”(n=89)，“认知能力下降”(n=29)，和“记忆受损”(n=47)子组。与“认知完整”组相比，“认知功能减弱”和“记忆障碍”亚组的焦虑症状更多，TRD患者比例更高，尽管后者未能在多重比较校正中幸存下来。在rTMS治疗的结果中没有观察到显著差异。
结论：LLD患者表现出跨认知领域的损伤，这在TRD中更为明显。三个确定的认知亚组对rTMS治疗的反应相似，表明它在认知概况中的有效性，特别是当药物不耐受时。未来的研究应该检查认知亚组之间的关系，认知能力下降,和神经变性。
