摘要： 目的 探讨轻度认知损害（MCI）患者抑郁情绪与认知功能之间的相关性。方法 纳入2020年12月至2021年12月浙江大学医学院附属第一医院收治的106例轻度认知损害患者，根据老年抑郁量表（GDS）评分分为伴抑郁MCI组（53例）和无抑郁MCI组（53例），以及同期就诊的53例认知功能正常的抑郁患者（抑郁组）和53例无认知功能障碍且无抑郁的对照者（对照组）。采用简易智能状态检查量表（MMSE）和蒙特利尔认知评价量表（MoCA）评价整体认知功能，Rey-Osterrieth复杂图形测验（ROCFT）和画钟测验（CDT）评价视空间能力，逻辑记忆测验（LMT）和听觉词汇学习测验（AVLT）评价记忆力，Stroop色词测验（SCWT）和连线测验（TMT）评价注意力和执行功能，词语流畅性测验（VFT）和Boston命名测验（BNT）评价语言功能，日常生活活动能力量表（ADL）评价日常生活活动能力。Pearson相关分析和偏相关分析探讨抑郁情绪与认知功能之间的相关性。结果 4组受试者各项神经心理学测验差异具有统计学意义（均P<0.05），其中，伴抑郁MCI组MMSE和MoCA评分低于对照组（均P=0.000）、抑郁组（均P=0.000）和无抑郁MCI组（均P=0.000）；伴抑郁MCI组ROCFT-临摹和回忆、CDT评分低于对照组（均P=0.000）、抑郁组（均P=0.000）和无抑郁MCI组（均P=0.000）；伴抑郁MCI组和无抑郁MCI组LMT-即刻回忆和延迟回忆评分低于对照组（P=0.000，0.000，0.002，0.001）和抑郁组（P=0.000，0.000，0.040，0.043），伴抑郁MCI组LMT-延迟回忆评分低于无抑郁MCI组（P=0.030）；伴抑郁MCI组AVLT-即刻回忆、短延迟回忆、长延迟回忆和再认评分低于对照组（均P=0.000）、抑郁组（均P=0.000）和无抑郁MCI组（P=0.009，0.003，0.017，0.001）；伴抑郁MCI组SCWT-A、SCWT-B和SCWT-C、TMT-A和TMT-B完成时间长于对照组（P=0.001，0.000，0.000，0.000，0.000）、抑郁组（P=0.008，0.001，0.001，0.001，0.001）和无抑郁MCI组（P=0.001，0.000，0.000，0.000，0.004），SCWT-A、SCWT-B和SCWT-C正确个数少于对照组（P=0.003，0.008，0.001）和抑郁组（P=0.016，0.031，0.002），而SCWT-A和SCWT-C正确个数少于无抑郁MCI组（P=0.003，0.008）；伴抑郁MCI组VFT-动物和蔬菜、BNT正确个数少于对照组（均P=0.000）、抑郁组（P=0.016，0.003，0.000）和无抑郁MCI组（P=0.010，0.005，0.000）；伴抑郁MCI组ADL评分高于对照组（P=0.000）、抑郁组（P=0.001）和无抑郁MCI组（P=0.000），抑郁组ADL评分高于对照组（P=0.014）和无抑郁MCI组（P=0.001）；对照组和无抑郁MCI组的GDS评分低于抑郁组（均P=0.000）伴抑郁MCI组（均P=0.000）。相关分析显示，GDS评分与MMSE（r=-0.300，P=0.000），MoCA（r=-0.357，P=0.000），ROCFT-临摹（r=-0.192，P=0.006）和回忆（r=-0.142，P=0.044），CDT（r=-0.171，P=0.015），LMT-即刻回忆（r=-0.213，P=0.002）和延迟回忆（r=-0.193，P=0.005），AVLT-即刻回忆（r=-0.159，P=0.021）、短延迟回忆（r=-0.161，P=0.020）和长延迟回忆（r=-0.137，P=0.047），以及SCWT-A（r=-0.156，P=0.025）、VFT-动物（r=-0.271，P=0.000）和蔬菜（r=-0.145，P=0.038）、BNT（r=-0.194，P=0.005）正确个数呈负相关；与SCWT-A（r=0.162，P=0.020）、SCWT-B（r=0.189，P=0.007）、SCWT-C（r=0.184，P=0.009）、TMT-A（r=0.189，P=0.006）完成时间和ADL评分（r=0.367，P=0.000）呈正相关。结论 轻度认知损害伴抑郁情绪患者存在更广泛、更严重的认知域损害，临床照料轻度认知损害患者时应关注其情绪问题。

关键词: 认知障碍, 抑郁, 神经心理学测验

Abstract: Objective To explore the relationship between depression and cognitive function in patients with mild cognitive impairment (MCI). Methods Total 106 patients with MCI were selected from December 2020 to December 2021, including 53 patients with depression based on Geriatric Depression Scale (GDS). Total 106 normal cognitive function people who received physical examination at the same time were selected, also including 53 with depression. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate overall cognitive function, Rey-Osterrieth Complex Figure Test (ROCFT) and Clock Drawing Test (CDT) were used to evaluate visual spatial ability, Logical Memory Test (LMT) and Auditory Verbal Learning Test (AVLT) were used to evaluate memory, Stroop Colour-Word Test (SCWT) and Trail Making Test (TMT) were used to evaluate attention and executive function, Verbal Fluency Test (VFT) and Boston Naming Test (BNT) were used to evaluate verbal fluency and naming ability, and Activities of Daily Living Scale (ADL) were used to evaluate activities of daily living. Results There were statistically significant differences in cognitive function of multiple dimensions among 4 groups (P<0.05, for all). The MMSE and MoCA scores of the MCI group with depression were lower than those of the control group (P=0.000, for all), the depression group (P=0.000, for all) and the MCI group without depression (P=0.000, for all). The ROCFT-imitation, recall, and CDT scores in the MCI group with depression were lower than those in the control group (P=0.000, for all), the depression group (P=0.000, for all), and the MCI group without depression (P=0.000, for all). The LMT-immediate and delayed recall scores of the MCI group were lower than those of the control group (P=0.000, 0.000, 0.002, 0.001) and the depression group (P=0.000, 0.000, 0.040, 0.043). The LMT-delayed recall scores of the MCI group with depression were lower than those of the MCI group without depression (P=0.030). The AVLT-immediate recall, short delayed recall, long delayed recall, and recognition scores in the MCI group with depression were lower than those in the control group (P=0.000, for all), the depression group (P=0.000, for all), and the MCI group without depression (P=0.009, 0.003, 0.017, 0.001). The time of SCWT-A, SCWT-B and SCWT-C, TMT-A, and TMT-B in the MCI group with depression was longer than that in the control group (P=0.001, 0.000, 0.000, 0.000, 0.000), the depression group (P=0.008, 0.001, 0.001, 0.001, 0.001), and the MCI group without depression (P=0.001, 0.000, 0.000, 0.000, 0.004). The correct number of SCWT-A, SCWT-B and SCWT-C was less than that in the control group (P=0.003, 0.008, 0.001), and the depression group (P=0.016, 0.031, 0.002). The correct number of SCWT-A and SCWT-C was lower than that of the MCI group without depressive (P=0.003, 0.008). The correct number of VFT-animals and vegetables, BNT in the MCI group with depression was lower than that in the control group (P=0.000, for all), the depression group (P=0.016, 0.003, 0.000), and the MCI group without depression (P=0.010, 0.005, 0.000). The ADL score of the MCI group with depression was higher than that of the control group (P=0.000), the depression group (P=0.001), and the MCI group without depression (P=0.000), while the ADL score of the depression group was higher than that of the control group (P=0.014) and the MCI group without depression (P=0.001). The GDS scores of the control group and the MCI group without depressive were lower than those of the depressive group (P=0.000, for all) and the MCI group with depression (P=0.000, for all). Correlation analysis showed that GDS scores were correlated with MMSE (r=-0.300, P=0.000), MoCA (r=-0.357, P=0.000), ROCFT-copy (r=-0.192, P=0.006) and recall (r=-0.142, P=0.044), CDT (r=-0.171, P=0.015), LMT-immediate recall (r=-0.213, P=0.002), delayed recall (r=-0.193, P=0.005), AVLT-immediate recall (r=-0.159, P=0.021), short delay recall (r=-0.161, P=0.020) and long delay recall (r=-0.137, P=0.047), correct number of SCWT-A (r=-0.156, P=0.025), VFT-animals (r=-0.271, P=0.000) and vegetables (r=-0.145, P=0.038), BNT (r=-0.194, P=0.005) were negatively correlated; compared with the completion time of SCWT-A (r=0.162, P=0.020), SCWT-B (r=0.189, P=0.007), SCWT-C (r=0.184, P=0.009) and TMT-A (r=0.189, P=0.006), and ADL score (r=0.367, P=0.000) were positively correlated. Conclusions MCI patients with depression have more extensive and severe cognitive deficits, and their psycho-mental states should be paid more attention.

Key words: Cognition disorders, Depression, Neuropsychological tests