Study Of Cognitive Function In Patients With First-episode Major Depressive Disorder With And Without Insomnia Symptoms

Objective 1.To explore the cognitive differences and change characteristics of major depressive disorder(Major depressive disorder,MDD)with insomnia and without insomnia.2.Analyze the correlation between insomnia symptom severity and cognitive function to better intervene and provide a basis for individualized treatment.Methods According to the entry and exclusion criteria,64 patients with MDD were included,in cluding 34 patients with insomnia and 30 patients without insomnia.24 healthy volunteers were recruited as normal control group during the same period.The general population data of all subjects were collected.The 17-item Hamilton Depression Rating Scale(HAMD-17)was used to assess the severity of depression in all subjects,and the Pittsburgh sleep qualit y index(PSQI)was used to assess the quality of sleep in all subjects.Subjects’ cognitive fu nctioning was assessed using the repeatable battery for the assessment of neuropsychologic al status(RBANS)and event-related potentials(ERP).The latency and amplitude of N1,N2,P2,P3 a,P3b and N400 were recorded.SPSS26.0 software was used for statistical analysi s.The qualitative data among the three groups were compared with "n and%" test or Fisher exact test.Age,years of education,total scores of HAMD-17 and RBANS and each factor score,total score of PSQI were described by median(upper and lower quartile)"[M(QL,Q U)]",and Kruskal-Wallis H test was used for comparison among the three groups.The laten cy and amplitude of each component of ERP accorded with approximate normal distributio n.The analysis of variance of repeated measurement was used and described by mean ±stan dard deviation(variance ±s).Further pairwise comparison was corrected by Bonferroni.Ta king age and years of education as control variables,partial correlation analysis was used to analyze the correlation between PSQI,RBANS and ERP,and then multiple linear model w as used for regression analysis.Results 1.Comparison of the severity of general demographic and clinical symptoms among the three groups The differences in gender,age,years of education,and marital status among the three groups were not statistically significant(P > 0.05);the MDD group had higher HAMD-17 total score and all factor scores and PSQI total score than the control group,and the differences were statistically significant(P < 0.05);the two comparisons revealed that the MDD group with insomnia had higher HAMD-17 total score and weight,sleep disorder factor score,and PSQI total score than the those without insomnia,and the differences were statistically significant(P < 0.05).2.Comparison of cognitive function among three groups At the level of neuropsychological tests,the total RBANS score and the attention factor were lower in the MDD group than in the control group,and the total RBANS score and the immediate memory and visual breadth factor scores were lower in the group with insomnia than in the group without insomnia,and the differences were statistically significant(P < 0.05).At the neurophysiological level,the N1 latency was prolonged in MDD with insomnia at the Cz electrode site compared with the control group,and at the Pz electrode site,the N1 wave amplitude was reduced in MDD without insomnia compared with the control group,and the differences were all statistically significant(P < 0.05);at the Fz electrode site,the P2 and N400 wave amplitudes were reduced in the MDD group compared with the control group,and the differences were statistically significant(P < 0.05).3.Study on the correlation between PSQI and RBANS in MDD group After excluding the effect of age and years of education on the results,immediate memory was found to be negatively correlated with sleep quality,time to sleep,sleep efficiency,daytime dysfunction,and total PSQI score(r=-0.507,-0.427,-0.277,-0.287,-0.428,P<0.001 or P<0.05);visual breadth was negatively correlated with sleep quality,sleep efficiency,and PSQI total score was negatively correlated(r=-0.264,-0.398,-0.320,P<0.05);speech function was positively correlated with sleep efficiency(r=0.279,P<0.05);total RBANS score was negatively correlated with sleep quality and time to sleep(r=-0.267,-0.284,P<0.05).Multifactorial linear regression analysis showed that a 1 increase in sleep quality score was followed by a 15.802 decrease in immediate memory;a 1 increase in sleep duration score was followed by a 5.023 decrease in visual breadth and a 6.961 decrease in verbal function.4.Study on the correlation between PSQI and ERP in MDD group After excluding the effect of age and years of education on the results,sleep quality was found to be positively correlated with Pz electrode point N2 latency(r=0.156,P<0.05)and negatively correlated with Pz electrode point P2 wave amplitude(r=-0.062,P<0.05).Sleep time was positively correlated with Fz,Cz,Pz electrode point N2 latency,and Pz electrode point P3 b latency(r=0.285,0.300,0.323,0.242,P<0.05).Sleep duration was positively correlated with Pz electrode point N2 and N400 latencies and Fz electrode point P3 a latencies(r=0.326,0.253,0.269,P<0.05)and negatively correlated with Pz electrode point P2 and P3 a wave amplitudes and Fz electrode point N400 wave amplitude(r=-0.005,-0.252,-0.310,P<0.05).Sleep disturbance was positively correlated with P3 a latency at Pz electrode point and N400 latency at Cz electrode point(r=0.264,0.242,P<0.05).Hypnotic drugs were negatively correlated with N2 wave amplitude at the Cz electrode point(r=-0.277,P<0.05).Daytime dysfunction was positively correlated with Pz electrode point N1 latency(r=0.333,P<0.05)and negatively correlated with Fz electrode point P2 wave amplitude(r=-0.248,P<0.05).Multivariate linear regression analysis showed that for every 1 increase in sleep quality score,the latency of Pz electrode point N2 increased by 18.597 ms,the Pz electrode point P2 amplitude decreased by 1.615 μV,for every 1 increase in sleep time score,the latency of Pz electrode point P3 b increased by 16.372 ms,and for every 1 increase in sleep disturbance,the latency of Cz electrode point N400 increased by 35.569 ms.Conclusion 1.Patients with MDD with insomnia had more severe depressive symptoms and more significant cognitive impairment than those without MDD with insomnia,especially in two dimensions of immediate memory and visual breadth.2.In the cognitive potentials of ERP,there were differences between MDD and normal controls,mainly in the N1 latency at the Cz electrode point,the N1 wave amplitude at the Pz electrode point,and the P2 and N400 wave amplitudes at the Fz electrode point,but no differences were found between MDD with insomnia and MDD without insomnia in the ERPrelated electrode point indexes.3.The more severe the insomnia symptoms in depressed patients,the more severe the cognitive decline,especially the worse the sleep quality,the shorter the actual sleep time at night,the more difficult to fall asleep the more obvious the cognitive decline.