정신신체의학 (Korean Journal of Psychosomatic Medicine)

한국정신신체의학회 (Korean Psychosomatic Society)
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정상인을 통해 알아본 우울 증상과 불안 증상이 특정 인지 기능에 미치는 영향

Effects of Depression and Anxiety Symptoms on Specific Cognitive Function by Evaluating Healthy Subjects

  • 김규호 (국립정신건강센터 정신건강의학과) ;
  • 남윤영 (국립정신건강센터 정신건강의학과) ;
  • 한지연 (국립정신건강센터 정신건강연구소) ;
  • 유리나 (국립정신건강센터 정신건강연구소) ;
  • 유빈 (국립정신건강센터 정신건강연구소)
  • Kim, Kyuho (Departments of Psychiatry, National Center for Mental Health) ;
  • Nam, Yoon-Young (Departments of Psychiatry, National Center for Mental Health) ;
  • Han, Jiyeon (Mental Health Research Institute, National Center for Mental Health) ;
  • Yu, Rina (Mental Health Research Institute, National Center for Mental Health) ;
  • Ryu, Vin (Mental Health Research Institute, National Center for Mental Health)
  • 투고 : 2021.04.12
  • 심사 : 2021.06.07
  • 발행 : 2021.06.30
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초록

연구목적 본 연구는 우울증의 동반증상으로 알려진 인지 기능 저하가 우울증보다 선행될 수 있다는 점에 착안하여 정상인에게서 우울 증상과 불안 증상이 인지 기능에 미치는 영향을 관찰하고자 한다. 방 법 일반인 50명을 모집하여 인지 기능 및 임상 증상에 대한 평가와 임상 증상이 인지 기능에 미치는 영향을 알아보기 위해 피어슨 상관분석과 다변량 회귀분석을 시행하였다. 우울증에서 흔히 저하되는 인지 영역을 평가하는 검사 소항목간의 상관성을 알아보기 위해 위해 소항목간 상관분석을 시행하였다. 결 과 선로잇기검사(B형)는 우울 증상(r=0.300, p=0.03)과 나이(r=0.323, p=0.02)와 상관 관계를 보였고 이에 영향을 미치는 독립변수는 우울 증상(β=0.304, p=0.03)과 나이(β=0.335, p=0.01)이며 선로잇기검사(B형)에 대해 14.8%의 설명력을 보여주었다. 주관적 인지 기능 검사는 불안 증상(r=0.434, p=0.002)과 상관 관계가 있었다. 인지 기능 소항목간 상관분석에서 주관적 인지 기능검사는 주의력검사를 제외한 나머지 항목과 상관 관계가 있었다. 결 론 본 연구에서 우울 증상은 나이, 교육기간 같은 인구학적 특성 외에 독립적으로 실행기능에 기여하는 것을 알 수 있었다. 우울증에서 인지 기능 저하가 흔한 장기적인 임상 결과임을 감안할 때 인지 기능에 대한 적극적인 조기 개입과 평가가 도움이 될 것으로 기대한다.

Objectives : Based on the fact that cognitive functions decline known as comorbid symptoms of depression can precede depression, this study seeks to observe the effects of depressive symptoms and anxiety symptoms on cognitive function in healthy subjects. Methods : To recruit 50 general populations to evaluate cognitive and clinical symptoms and to find out the effects of clinical symptoms on cognitive functions, Pearson correlation and multivariate regression were conducted. Correlation analysis of subdomain cognitive function was conducted for reliability analysis. Results : Trail making test-B that evaluates the execution function correlates with depressive symptoms (r=0.300, p=0.03) and age (r=0.323, p=0.02). Depressive symptoms (β=0.304, p=0.03) and age (β=0.335, p=0.01) were significantly related to Trail making test -B (Adjusted R2=0.148). Subjective cognitive tests correlates with anxiety symptoms (r=0.434, p=0.002). In the correlation between cognitive functional items, Subjective cognitive tests was found to be correlated with other test except Spotter. Conclusions : In this study, depressive symptoms contribute independently to executive functions in addition to demographic characteristics such as age and duration of education. Given that cognitive decline is a common long-term clinical outcome in depression, we expect active early intervention and evaluation of cognitive function to be helpful.

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과제정보

이 논문은 2019년 국립정신건강센터 내부연구과제(과제번호 R2019-5)의 지원을 받아 수행한 연구임.

참고문헌

  1. Rock P, Roiser J, Riedel W, Blackwell A. Cognitive impairment in depression: a systematic review and meta-analysis. Psychological Medicine 2014;44:2029. https://doi.org/10.1017/S0033291713002535
  2. Abas MA, Sahakian BJ, Levy R. Neuropsychological deficits and CT scan changes in elderly depressives. Psychological Medicine 1990;20:507-520. https://doi.org/10.1017/S0033291700017025
  3. Butters MA, Whyte EM, Nebes RD, Begley AE, Dew MA, Mulsant BH, Zmuda MD, Bhalla R, Meltzer CC, Pollock BG. The nature and determinants of neuropsychological functioning in late-lifedepression. Archives of General Psychiatry 2004;61:587-595. https://doi.org/10.1001/archpsyc.61.6.587
  4. Afridi MI, Hina M, Qureshi IS, Hussain M. Cognitive disturbance comparison among drug-naive depressed cases and healthy controls. J Coll Physicians Surg Pak 2011;21:351-355.
  5. Bhalla RK, Butters MA, Mulsant BH, Begley AE, Zmuda MD, Schoderbek B, Pollock BG, Reynolds III CF, Becker JT. Persistence of neuropsychologic deficits in the remitted state of late-life depression. The American Journal of Geriatric Psychiatry 2006;14:419-427. https://doi.org/10.1097/01.JGP.0000203130.45421.69
  6. Douglas KM, Porter RJ. Longitudinal assessment of neuropsychological function in major depression. Australian & New Zealand Journal of Psychiatry 2009;43:1105-1117. https://doi.org/10.3109/00048670903279887
  7. Potter GG, Kittinger JD, Wagner HR, Steffens DC, Krishnan KRR. Prefrontal neuropsychological predictors of treatment remission in late-life depression. Neuropsychopharmacology 2004;29:2266-2271. https://doi.org/10.1038/sj.npp.1300551
  8. Story TJ, Potter GG, Attix DK, Welsh-Bohmer KA, Steffens DC. Neurocognitive correlates of response to treatment in latelife depression. The American Journal of Geriatric Psychiatry 2008;16:752-759. https://doi.org/10.1097/JGP.0b013e31817e739a
  9. Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, Hwu H-G, Joyce PR, Karam EG, Lee CK, Lellouch J. Cross-national epidemiology of major depression and bipolar disorder. JAMA 1996;276:293-299. https://doi.org/10.1001/jama.1996.03540040037030
  10. Dotson VM, Resnick SM, Zonderman AB. Differential association of concurrent, baseline, and average depressive symptoms with cognitive decline in older adults. The American Journal of Geriatric Psychiatry 2008;16:318-330. https://doi.org/10.1097/JGP.0b013e3181662a9c
  11. Dotson VM, Szymkowicz SM, Kirton JW, McLaren ME, Green ML, Rohani JY. Unique and interactive effect of anxiety and depressive symptoms on cognitive and brain function in young and older adults. Journal of Depression & Anxiety;2014.
  12. Elderkin-Thompson V, Kumar A, Bilker WB, Dunkin JJ, Mintz J, Moberg PJ, Mesholam RI, Gur RE. Neuropsychological deficits among patients with late-onset minor and major depression. Archives of Clinical Neuropsychology 2003;18:529-549. https://doi.org/10.1016/S0887-6177(03)00022-2
  13. Judd LL, Paulus MP, Wells K, Rapaport M. Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population;1996.
  14. Jaeger J, Berns S, Uzelac S, Davis-Conway S. Neurocognitive deficits and disability in major depressive disorder. Psychiatry Research 2006;145:39-48. https://doi.org/10.1016/j.psychres.2005.11.011
  15. Paterniti S, Verdier-Taillefer M-H, Dufouil C, Alperovitch A. Depressive symptoms and cognitive decline in elderly people: longitudinal study. The British Journal of Psychiatry 2002;181:406-410. https://doi.org/10.1192/bjp.181.5.406
  16. Bassuk SS, Berkman LF, Wypij D. Depressive symptomatology and incident cognitive decline in an elderly community sample. Archives of General Psychiatry 1998;55:1073-1081. https://doi.org/10.1001/archpsyc.55.12.1073
  17. Chen P, Ganguli M, Mulsant BH, DeKosky ST. The temporal relationship between depressive symptoms and dementia: a community-based prospective study. Archives of General Psychiatry 1999;56:261-266. https://doi.org/10.1001/archpsyc.56.3.261
  18. Geerlings MI, Bouter L, Schoevers R, Beekman A, Jonker C, Deeg D, Van Tilburg W, Ader H, Schmand B. Depression and risk of cognitive decline and Alzheimer's disease: Results of two prospective community-based studies in The Netherlands. The British Journal of Psychiatry 2000;176:568-575. https://doi.org/10.1192/bjp.176.6.568
  19. Ferreri F, Lapp LK, Peretti CS. Current research on cognitive aspects of anxiety disorders. Current Opinion in Psychiatry 2011;24:49-54. https://doi.org/10.1097/YCO.0b013e32833f5585
  20. Potvin O, Hudon C, Dion M, Grenier S, Preville M. Anxiety disorders, depressive episodes and cognitive impairment no dementia in community-dwelling older men and women. International Journal of Geriatric Psychiatry 2011;26:1080-1088. https://doi.org/10.1002/gps.2647
  21. Sinoff G, Werner P. Anxiety disorder and accompanying subjective memory loss in the elderly as a predictor of future cognitive decline. International Journal of Geriatric Psychiatry 2003;18:951-959. https://doi.org/10.1002/gps.1004
  22. Mantella RC, Butters MA, Dew MA, Mulsant BH, Begley AE, Tracey B, Shear MK, Reynolds III CF, Lenze EJ. Cognitive impairment in late-life generalized anxiety disorder. The American Journal of Geriatric Psychiatry 2007;15:673-679. https://doi.org/10.1097/JGP.0b013e31803111f2
  23. Beaudreau SA, O'Hara R. The association of anxiety and depressive symptoms with cognitive performance in community-dwelling older adults. Psychology and Aging 2009;24:507. https://doi.org/10.1037/a0016035
  24. Stillman AN, Rowe KC, Arndt S, Moser DJ. Anxious symptoms and cognitive function in non-demented older adults: An inverse relationship. International Journal of Geriatric Psychiatry 2012;27:792-798. https://doi.org/10.1002/gps.2785
  25. Bierman EJ, Comijs HC, Rijmen F, Jonker C, Beekman AT. Anxiety symptoms and cognitive performance in later life: results from the longitudinal aging study Amsterdam. Aging and Mental Health 2008;12:517-523. https://doi.org/10.1080/13607860802224276
  26. Salthouse TA. How general are the effects of trait anxiety and depressive symptoms on cognitive functioning? Emotion 2012;12:1075. https://doi.org/10.1037/a0025615
  27. Cha DS, Carmona NE, Rodrigues NB, Mansur RB, Lee Y, Subramaniapillai M, Phan L, Cha RH, Pan Z, Lee JH. Cognitive impairment as measured by the THINC-integrated tool (THINC-it): the association with self-reported anxiety in major depressive disorder. Journal of Affective Disorders 2018;238:228-232. https://doi.org/10.1016/j.jad.2018.05.006
  28. Lee RS, Hermens DF, Porter MA, Redoblado-Hodge MA. A meta-analysis of cognitive deficits in first-episode major depressive disorder. Journal of Affective Disorders 2012;140:113-124. https://doi.org/10.1016/j.jad.2011.10.023
  29. Svendsen AM, Kessing LV, Munkholm K, Vinberg M, Miskowiak KW. Is there an association between subjective and objective measures of cognitive function in patients with affective disorders? Nordic Journal of Psychiatry 2012;66:248-253. https://doi.org/10.3109/08039488.2011.626870
  30. Bakkour N, Samp J, Akhras K, El Hammi E, Soussi I, Zahra F, Duru G, Kooli A, Toumi M. Systematic review of appropriate cognitive assessment instruments used in clinical trials of schizophrenia, major depressive disorder and bipolar disorder. Psychiatry Research 2014;216:291-302. https://doi.org/10.1016/j.psychres.2014.02.014
  31. Strand SEB: How we can THINC-it Better: A new Digital Screening Tool in Depression Assessment. The University of Bergen; 2018.
  32. McIntyre RS, Best MW, Bowie CR, Carmona NE, Cha DS, Lee Y, Subramaniapillai M, Mansur RB, Barry H, Baune BT. The THINC-integrated tool (THINC-it) screening assessment for cognitive dysfunction: validation in patients with major depressive disorder. The Journal of Clinical Psychiatry 2017;78:873-881. https://doi.org/10.4088/JCP.16m11329
  33. Harrison JE, Barry H, Baune BT, Best MW, Bowie CR, Cha DS, Culpepper L, Fossati P, Greer TL, Harmer C. Stability, reliability, and validity of the THINC-it screening tool for cognitive impairment in depression: a psychometric exploration in healthy volunteers. International Journal of Methods in Psychiatric Research 2018;27:e1736. https://doi.org/10.1002/mpr.1736
  34. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The MiniInternational Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry;1998.
  35. Andersson S, Lovdahl H, Malt UF. Neuropsychological function in unmedicated recurrent brief depression. Journal of Affective Disorders 2010;125:155-164. https://doi.org/10.1016/j.jad.2009.12.023
  36. Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, Markowitz JC, Ninan PT, Kornstein S, Manber R. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological Psychiatry 2003;54:573-583. https://doi.org/10.1016/S0006-3223(02)01866-8
  37. Jin-Pyo H, Sung-jin P, Su-Bin P, A-Young L, Dae-Jong J. Reliability and Validity study of the Korean Self rating Version of Quick Inventory of Depressive Symptomatology (K-QIDS-SR). Mood Emot 2013;11:44-50.
  38. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 1988;56:893. https://doi.org/10.1037/0022-006X.56.6.893
  39. Yook S, Kim Z. A clinical study on the Korean version of Beck Anxiety Inventory: comparative study of patient and non-patient. Korean J Clin Psychol 1997;16:185-197.
  40. Elliott R. Executive functions and their disorders: Imaging in clinical neuroscience. British Medical Bulletin 2003;65:49-59. https://doi.org/10.1093/bmb/65.1.49
  41. Diamond A. Executive functions. Annual Review of Psychology 2013;64:135-168. https://doi.org/10.1146/annurev-psych-113011-143750
  42. Talarowska M, Zajaczkowska M, Galecki P. Cognitive functions in first-episode depression and recurrent depressive disorder. Psychiatria Danubina 2015;27:0-43.
  43. Vinberg M, Miskowiak KW, Kessing LV. Impairment of executive function and attention predicts onset of affective disorder in healthy high-risk twins. The Journal of Clinical Psychiatry 2013;74:747-753. https://doi.org/10.4088/JCP.12m08258
  44. Bortolato B, F Carvalho A, S McIntyre R. Cognitive dysfunction in major depressive disorder: a state-of-the-art clinical review. CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders) 2014;13:1804-1818. https://doi.org/10.2174/1871527313666141130203823
  45. Hammar A, Ardal G. Cognitive functioning in major depression-a summary. Frontiers in Human Neuroscience 2009;3:26. https://doi.org/10.3389/neuro.09.026.2009
  46. Mondal S, Sharma V, Das S, Goswami U, Gandhi A. Neurocognitive functions in patients of major depression. Indian Journal of Physiology and Pharmacology 2007;51:69.
  47. Bierman E, Comijs H, Jonker C, Beekman A. Effects of anxiety versus depression on cognition in later life. The American Journal of Geriatric Psychiatry 2005;13:686-693. https://doi.org/10.1097/00019442-200508000-00007
  48. Purcell R, Maruff P, Kyrios M, Pantelis C. Neuropsychological function in young patients with unipolar major depression. Psychological Medicine 1997;27:1277-1285. https://doi.org/10.1017/S0033291797005448
  49. Brown R, Scott L, Bench C, Dolan RJ. Cognitive function in depression: its relationship to the presence and severity of intellectual decline. Psychological Medicine 1994;24:829-847. https://doi.org/10.1017/S0033291700028932