Association Of Sex Hormones And Cognitive Functions In The Elderly Men With First-episode Of Depression

Objective:1.To investigate the differences of sex hormone levels and cognitivefunctions in elderly men with first-episode depression and healthy elderly men.2.Toinvestigate the associations between serum sex hormone levels and cognition before andafter treatment in elderly men with first-episode depression.Methods: This is an8-week open-label study.40elderly men with first-episodedepression were enrolled as the case group and40healthy elderly men as the control group.All groups were tested with serum levels of testosterone(TESTO), estradiol(E2), folliclestimulating hormone(FSH), luteinizing hormone(LH), prolactin(PRL) and progesterone(PROG), being assessed cognitive functions with the Mini-Mental State Examination(MMSE), the Digit Span Forwards (DSF) and the Digit Span Backwards (DSB) tests, theTrail Making TestA（TMTA）and B（TMTB）, and being evaluated activities of daily livingwith the Activities of Daily Living Scale (ADL) at baseline. The cases were treated withLexapro (Escitalopram Oxalate) for8weeks and their depressive symptoms wereevaluated with the Geriatric Depression Scale (GDS). Data were collected and entered intothe SPSS17.0program for statistical analysis. T test, rank-sum test, Chi-square test,Spearman correlation analysis were used. The significance level of alpha was set at0.05for all tests.Results:1．Before the treatment, serum levels of TESTO and E2of the cases were significantlylower than the controls(P＜0.05); serum levels of FSH, LH, PRL and PROG were notfound to be different between the two groups(P＞0.05). After the treatment, TESTO andE2levels of the cases had increased(P＜0.01), PROG level was declined（P＜0.01）, levelsof FSH, LH, and PRL were found no significant change(P＞0.05). Sex hormone levels ofthe cases compared with the control group were not significantly different after thetreatment(P＞0.05). 2．Cognitive functions of the cases, before the treatment, were significantly poorerthan the controls(P＜0.01), ADL scores lower（Z=-6.678，P=0.000）。After the treatment,scores of MMSE，DSF， TMTAand TMTB of the cases were improved(P＜0.05）, scoreof DSB and difference score TMTB-TMTA had not changed significantly (P>0.05), andADL scores were improved（Z=-5.426，P=0.000）. However, cognitive functions andactivities of daily living of the cases were still significantly worse the controls（P＜0.05）.3． Serum testosterone level of the cases, before the treatment, was negativelycorrelated with GDS（r=-0.554，P=0.000）and ADL score（P＜0.01）, was related withscores of MMSE，DSF，TMTB and difference score TMTB-TMTA, and was no correlationwith age，course of depression，years of schooling，scores of DSB and TMTA.4．Before the treatment, serum E2level of the cases was correlated negatively withGDS score （r=-0.426，P=0.006）, but had no relevance to cognitive functions and ADLscore(P＞0.05).5．Before the treatment, serum levels of FSH, LH, PRL and PROG of the cases werenot found to be correlated with either GDS score or ADL score (P＞0.05), Only was LHlevel associated positively with scores of DSF（r=0.321，P=0.043）.6．Before the treatment, GDS score was associated negatively with DSF and MMSE,positively with ADL, but not associated with course of depression (P＞0.05), ADL scorewas found to be correlated with cognitive functions (P＜0.05）except for DSB score.7．Reduction of GDS score was relevant to neither changes of serum sex hormonelevels nor cognitive functions(P＞0.05).8． Some cognitive function improvement after the treatment in the cases wasassociated with changes in TESTO levels（P＜0.05）. Reduced scores of TMTA wereassociated positively with changes in LH levels（r=0.360，P=0.022）. Reduced scores ofDSF were associated negatively with changes in PRL levels（r=-0.375，P=0.017）.Conclusions:1．Elderly male patients with first-episode depression show lowered serum levels ofTESTO and E2, impaired cognitive functions such as executive functions, attention andmemory, reduced abilities of daily living. After the treatment, serum levels of TESTO and E2are back to normal, but impaired cognitive functions and abilities of daily living are notfully improved.2．GDS scores in elderly men with first-episode depression are inversely related toserum TESTO and E2levels, being not related to reduce scores of GDS. Lower Serumlevels of TESTO and E2may be the risk factors for elderly male to have their first episodeof depression.3．Improved cognitive functions in first-episode depression in elderly male patientshave no correlations with reduced symptoms (reduction of GDS score). Some cognitivefunction improvements are related to changes in serum TESTO levels, which low level is arisk factor for cognitive impairment in elderly male patients with first episode depression.