The Study Of Features,Related Factors And Erps(N2/N450/P300) In Elderly MDD Patients With Cognitive Impairment

ObjectivesExploring the features,related factors and ERPs N2/N450/P300 component wave amplitude and latency changes in elderly MDD patients with cognitive impairment.MethodsSixty-five elderly patients with the diagnosis of depression or recurrent depressive disorder with DSM-IV criteria and 20 cases of normal control(NC)group were included in the baseline level.Among the late life depression(LLD)patients,26 cases of first-episode geriatric depression(FGD)patients and 39 cases of recurrent geriatric depression(RGD)patients were included in the study group.General demographic information and clinical data were collected from all patients or participants.The Mini-mental State Examination(MMSE),the Montreal Cognitive Assessment Scale(MoCA),and the Memory and Executive Screening(MES)are used to evaluate the cognitive function.The Hamilton Depression Scale(HAMD-17)and the Geriatric Depression Scale(GDS)are used to evaluate the extent of depression.Hamilton anxiety scale(HAMA),Activity of Daily Living Scale(ADL),Social Support revalued scale(SSRS)and other neuropsychological test tools were used to assess the degree of anxiety,social function,social support etc.After all this evaluation,we can compare the difference of clinical features between the acute period of FGD and RGD patients.Then,the one-way ANOVA was used to tell the difference of cognitive impairment features between FGD,RGD,and NC groups.Sixty-five acute period elderly patients with major depressive disorder(MDD)were divided into low cognitive damage impairment group(MMSE total score was greater than or equal to 26 points and MoCA total score was greater than or equal to 20 points)and severe cognitive damage Group(MMSE total score was less than 26 points and MoCA total score was less than 20 points).General demographic data,HAMD-17 total,HAMA total,ADL total and other clinical psychological score are compared,and the factors which may affect cognitive function are included for logistic return analysis.We look forward to find the destructive or protective factors of LLD patients with cognitive impairment.Thirty-six LLD patients who have been taken the antidepressants for at least four weeks,HAMD-17 total score is less than 18 points,and HAMD-17 reduction ratio is great than or equal to 50%will enter into follow-up(time in 4 to 12 week).Based on MMES,MoCA,MES cognition assessment scale combined with event-related potentials Stroop task and Oddball stimulus paradigm to assess cognitive impairment features of remission period of LLD patients and 18 case NC group.Acute and remission period of features in LLD patients with cognitive impairment will be compared,to explore antidepressant treatment effects on cognitive function of LLD patients.Compare remission LLD patients with the NC group with ERPs N2/N450/P300 component in Pz,Cz,Fz,Fc1,Fc2 leads the wave amplitude and latency changes,LLD patients in remission from a neurophysiological perspective of cognitive impairment in patients with features.Results1,Compare the clinical features of acute phase FGD group and RGD group,the FGD group have more incentives(x~2=4.333,P=0.037),subjective memory loss(x~2=4.134,P=0.042)and physical discomfort(x~2=4.333,P=0.037)than the RGD group,the difference is statistically significant different.2,The comparison of MMSE,MoCA,MES between acute phase FGD group and RGD group,MMSE-total,and direction,instant memory,and language capacity score,MoCA-total,space and executive function,attention,language speaking,abstract mind,and direction score,MES-total,sentences 1~5,fluency,contradictions stimulus,continuous action ability of both hands,MES-M(memory),and MES-E(executive function)score has statistics differences(P<0.01).The FGD group are different from the RGD group when it comes to MMSE-language,MoCA-abstract mind,MES-total,fluency,contradiction stimulation,both continuous motion,MES-E score,there were statistical differences(P<0.05).3,The logistic regression analysis of factor influencing cognitive impairment in acute phase LLD patients shows that the level of education is protective factor for cognitive impairment(OR=0.708,P=0.021);and the HAMA total score(OR=1.247,P=0.018),ADL total score(OR=3.902,P=0.000)are the risk factors for cognitive impairment.4,Comparison of the acute and remission phase LLD patients MMSE,MoCA and MES score:expect the MoCA-name(Z=-2.028,P=0.043),MoCA-attention(t=-2.033,P=0.042)have improved in remission phase LLD patients,the remaining score were not statistically significant different(P>0.05),all of the remaining MMSE score,MES score have no statistically significant difference in the score(P>0.05).5,Remission period of LLD patients and NC group's N2/N450/P300 cognitive event-related potential study:when N2 in the Stroop task consistency(S11)reaction,FC1-lead has an increased wave amplitude(Z=-2.954,P=0.003).When N450 in Stroop S11(t=-2.176,P=0.007)and inconsistency(S12)(Z=-2.477,P=0.013)task reaction experiment take place,Cz-lead amplitude is lowering.when P3(P300)in Stroop S11 task response,Pz-lead and Fc2-lead amplitude is reduced,there was statistical difference;in the Stroop S12 task response Pz,Cz,Fz,Fc1,Fc2 guided the amplitude is reduced,the difference was statistically significant(P<0.05).In the Stroop S11 and S12 task,Pz,Cz,Fz-lead latent period longer compared with normal control group,but the difference was not statistically significant(P>0.05).P300 in Oddball stimulus paradigm,Cz,Pz,Cp1-lead latent period longer compared with NC group,the difference was statistically significant(P<0.05).Pz-lead has an increased wave amplitude,the difference was statistically significant(P<0.05),the same result in stroop S11 and S12 tasks.Conclusion1,The characteristics of clinical and cognitive impairment in elderly patients with first onset depressive disorder were different from the elderly patients with recurrent depressive disorder:the predisposing factors,somatic discomfort and subjective memory decrease were more prominent in elderly patients with first onset depressive disorder;patients with recurrent depressive disorder have more severe function impairment;and cognitive impairment has hardly improved after depressive symptoms remission.2,Low levels of education,more anxiety feeling,poor ability of daily living may be risk factors for cognitive impairment in elderly patients with MDD.3,Compared with the normal elderly,there exists the changes in amplitude of ERPs N2/N450/P300 component and P300 latency period extended in elderly patients with MDD,objectively confirmed that the elderly depressive patients have decision-making process,attention,language and executive function damage.