| Background:Affective disorders in the elderly crowd in the high prevalence of a kind of mental disorders, and with pathy, loneliness and inferiority of depressive symptoms as outstanding performance. Patients often associated with anxiety, sleep disorder, suicide idea and physical discomfort. And these signs seriously affected the living and quality of life in the elderly population, will lead to a decline in somatic function of the elderly, increase in disability rate and mortality rate of of somatic diseases, extend hospitalization period, and raise medical expenses. Epidemiological investigation revealed that the prevalence rate of severe depression in the elderly over 65 was about 1～4%, and the annual rate was about 0.15%. Mild and moderate depression prevalence was 4～13%. Senile affective disorders, especially senile depression, has become the focus of attention at present. Therefore, the internal mechanism research of affective disorders in the elderly, especially senile depression, and the dynamic observation of the antidepressant drugs of different reaction will be a very practical and profound significance.Currently the pathogenesis of the disease is still not clear. Psychological factors, social factors, the brain physiological function deterioration, such as the hypothalamus-pituitary-adrenal cortex axis adjustment function weaken, central neurotransmitter changes of regulating emotions such as 5-HT and noradrenaline function insufficiency and monoamine oxidase activity of increase may be involved in the process of pathophysiology the disease.The nerve-endocrine-immune system regulates jointly and maintains the stability of the organism environment. The immunization transmitters regulating immune systems and hypothalamus-pituitary-adrenal axis affect neuroendocrine function. Earlier research found that patients in depression have changes in peripheral blood white blood cells subsets, injury in neutrophil phagocytosis and inhibitory in cytotoxicity of NK cell, and that cellular immune function in depression patients generally lower. At present, thers were not very common in the study of comparison between the elderly affective disorder patients and normal elderly population difference with nerve-immunity-endocrine as a whole. Affective disorder in senile people as a general study were enrolled. Blood samples were adopted for enzyme linked immunosorbent assay of serum macrophage migration inhibitory factor (MIF) and the radioimmunoassay measurement of IL-1β, IL-6 and cortisol levels.The patients group was tested by neuropsychology scales both before and after selective serotonin reuptake inhibitors (SSRIs) treatment. Therefore, identification of these risk factors may shed some light on the pathophysiology of affective disorders in the elderly and also provide new potential avenues for its prevention and treatment.Senile depressive disorder patients apart from symptoms of depression in itself, often accompanied by varying degrees of cognitive function decline. Sometimes due to apathy, retardation of thought and ability of daily life in attenuation performance, it can easily be mistaken for " senile dementia ". Many studies have confirmed that depression in elderly patients is to promote progress with mild cognitive impairment or even an important risk factors for dementia. At present, it is not clear that depression is an independent risk factors of cognitive impairment or a subclinical manifestations of dementia in early stage. We applied the neuropsychological tests and depression scales to assess the outcome of cognitive function of the elderly patients with depression after treatment, which will help explore the relationship between senile depression and cognitive impairment, and provide new potential avenues for early intervention of cognitive impairment. PART ONEObjective:To explore the changes of serum cytokines, cortisol levels and cognitive functions of elderly patients with affective disorders before and after SSRIs treatment.Methods:50 patients with affective disorder in the elderly (patients group) and 45 normal controls were enrolled. Blood samples were adopted for enzyme linked immunosorbent assay of serum macrophage migration inhibitory factor (MIF) and the radioimmunoassay measurement of IL-1β, IL-6 and cortisol levels.The patients group was tested by neuropsychology scales both before and after selective serotonin reuptake inhibitors (SSRIs) treatment.Results:1,Before treatment, the patients with affective disorder were higher in MIF, IL-1β, IL-6 and Cor than control and after treatment(P<0.05). There was positive correlation(P<0.01) between MIF, IL-1β, IL-6, Cor and the score of 24 item Hamilton depression scale(HAMD24) and Pittsburgh sleep quality index (PQSI).The score of 14 item Hamilton anxiety scale(HAMA14) positively correlated with results of MIF and IL-6(P<0.05).2,The patients with affective disorder made improvements in the neuropsychological tests after treatment(P<0.01).3,The score in sleeping disturbance symptom was negatively correlated to the improvement in visuospatial and executive ability(r=-0.251, P<0.01), verbal ability(r=-0.326, P<0.01), delay memory(r=-0.296, P<0.01), and the score in anxiety and somatization was negatively correlated to the improvement in visuospatial and executive ability(r=-0.204, P<0.01), verbal ability (r=-0.398, P<0.01), abstract score (r=-0.307, P<0.01) and delay memory(r=-0.236, P<0.05).Conclusion:Serum cytokines and cortisol levels increase in patients with affective disorder in the elderly is related to the severity of anxiety and depression. Selective serotonin uptake inhibitors can inhibit expression of inflammatory factors to improve cognitive function of patients.PART TWOObjective:To explore the changes of cognitive functions and risks factors of depression in the elderly after therapy.Methods:81 cured or excellent patients with depression in the elderly (patients group) after antidepressant treatment for 3 weeks, and 67 normal controls were enrolled. Geriatric depression scale(GDS3o), Hamilton depression scale-24(HAMD24) and some neuropsyehological tests were applied to evaluate depression and cognitive function after baseline and 12 weeks.Results:1,The score of HAMD24 and GDS30 negatively correlated with results of the age of patients groups(r=0.324和0.279, P<0.01) and positively correlated with results of Mini-mental state examination(MMSE) (r=-0.241和-0.225, P<0.05) and Montreal cognitve assessment(MoCA)(r=-0.216和-0.342, P<0.05).2,After baseline and 12 weeks, the patients groups had lower score in the MMSE, MoCA, auditory verbal learning test (AVLT)-delayed memory AVLT-recognition, clock drawing test (CDT) and Stroop color-word test(CWT-C) than controls (P<0.05).Conclusion:The ageing of patients in the elderly could be one of important risk factors to predict the degree of depression. After depression symptoms improved, cognitive impairment of patients is still deteriorating. Depression could be one of sub-clinical manifestations of cognitive impairment. |
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