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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Sleep disturbances and psychomotor retardation in the prediction of cognitive impairments in patients with major depressive disorder
Mi Wang, Wen-Tao Chen, Hao-Ting Wang, Bang-Shan Liu, Yu-Meng Ju, Qiang-Li Dong, Xiao-Wen Lu, Jin-Rong Sun, Liang Zhang, Hua Guo, Fu-Tao Zhao, Wei-Hui Li, Li Zhang, Ze-Xuan Li, Mei Liao, Yan Zhang, Jin Liu, Ling-Jiang Li
Mi Wang, Department of Mental Health Center, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Mi Wang, National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Mi Wang, Wen-Tao Chen, Hao-Ting Wang, Bang-Shan Liu, Yu-Meng Ju, Qiang-Li Dong, Xiao-Wen Lu, Jin-Rong Sun, Liang Zhang, Wei-Hui Li, Li Zhang, Ze-Xuan Li, Mei Liao, Yan Zhang, Jin Liu, Ling-Jiang Li, Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Hua Guo, Fu-Tao Zhao, Department of Psychiatry, Zhumadian Psychiatric Hospital, Zhumadian 463000, Henan Province, China
Co-corresponding authors: Ling-Jiang Li and Mei Liao.
Author contributions: Li LJ and Liu J codesigned the study; Liu BS, Ju YM, Dong QL, Lu XW, Sun JR, Zhang L, Guo H, Zhao FT, Li WH, Zhang L, Li ZX, Liao M and Zhang Y were responsible for participant recruitment and data collection; Chen WT and Wang M performed the statistical analyses; Chen WT wrote the initial draft of the manuscript. Wang M and Wang HT made substantial revisions to the manuscript. All the authors have approved the final version of this manuscript. In this study, both corresponding authors provided critical guidance and supervision at different stages. Li LJ played a central role in the early stages of study design and project initiation, being responsible for the construction of the study concept and the overall supervision of manuscript writing. Liao M, on the other hand, provided crucial support in the later stages of the study, particularly during the revision process, where she was responsible for data analysis and made significant contributions to the revision and refinement of the manuscript. The contributions of both corresponding authors are complementary and indispensable, and their joint designation as corresponding authors is a fair reflection of their sustained contributions.
Supported by National Key Research and Development Program of China, No. 2019YFA0706200; National Natural Science Foundation of China, No. 82301738; and Natural Science Foundation of Hunan Province, No. 2022JJ40701 and No. 2022JJ40697.
Institutional review board statement: This study was approved by the Medical Ethics Committees of the Second Xiangya Hospital of Central South University and the Zhumadian Psychiatric Hospital.
Informed consent statement: All the participants signed the written informed consent form before study initiation.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Mei Liao, Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, No. 139 Renmin Middle Road, Changsha 410011, Hunan Province, China.
liaomei123@csu.edu.cn
Received: July 3, 2024
Revised: August 26, 2024
Accepted: September 25, 2024
Published online: October 19, 2024
Processing time: 105 Days and 18.5 Hours
BACKGROUND
Symptoms of depression and comorbid anxiety are known risk factors for cognitive impairment in major depressive disorder (MDD). Understanding their relationships is crucial for developing targeted interventions to mitigate cognitive impairments in MDD patients. We expect that the severity of sleep disturbances and other depressive symptoms will be positively correlated with the degree of cognitive impairments. We also hypothesize that anxiety symptoms, especially psychic anxiety, is a key factor in predicting cognitive performance in MDD patients and may indirectly contribute to cognitive impairment by affecting sleep disturbances and other potential factors.
AIM
To determine which dimension of the depressive and anxiety symptoms predicts cognitive impairment during a depressive episode.
METHODS
A comprehensive neurocognitive test battery assessed executive function, attention, processing speed, and memory in 162 medication-free MDD patients and 142 matched healthy controls. The 24-item Hamilton Depression Rating Scale was used to assess depressive symptoms, and the 14-item Hamilton Anxiety Scale was used to assess anxiety symptoms. Linear regression analyses and mediation analyses were conducted to evaluate the impact of depressive and anxiety symptoms, as well as their interactions, on cognitive impairments.
RESULTS
Among the depressive symptoms, sleep disturbances were associated with poorer executive function (P = 0.004), lower processing speed (P = 0.047), and memory impairments (P < 0.001), and psychomotor retardation (PR) was associated with lower processing speed in patients with MDD (P = 0.019). Notably, PR was found to mediate the impact of sleep disturbances on the processing speed. Regarding anxiety symptoms, psychic anxiety, rather than somatic anxiety, was associated with cognitive impairments in all aspects. Sleep disturbances mediated the effect of psychic anxiety on executive function [β = -0.013, BC CI (-0.027, -0.001)] and memory [β = -0.149, BC CI (-0.237, -0.063)], while PR mediated its effect on processing speed (β = -0.023, BC CI (-0.045, -0.004)].
CONCLUSION
Sleep disturbances may be a key predictor of poorer executive function, lower processing speed, and memory loss, while PR is crucial for lower processing speed during a depressive episode. Psychic anxiety contributes to all aspects of cognitive impairments, mediated by sleep disturbances and PR.
Core Tip: In this study, four major cognitive domains were assessed in 162 patients with major depressive disorder and 142 healthy controls via a comprehensive cognitive battery. Linear regression analyses and mediation analyses revealed that sleep disturbances independently contributed to executive function, processing speed, and memory, whereas psychomotor retardation (PR) symptoms independently contributed to processing speed. PR symptoms completely mediated the effect of sleep disturbances on processing speed. Psychic anxiety symptoms contributed to impairment in all four cognitive domains. Sleep disturbances mediated the effect of psychic anxiety symptoms on executive function, and PR symptoms mediated the effect of psychic anxiety symptoms on processing speed.
