研究背景：
回顧先前的研究，雖然有不少關於老年重鬱症執行功能方面的研究，但仍可發現受試者平均年齡大多在75歲以下，且大多研究較少獨立探討自殺率高且在台灣社會中社會支持薄弱的老年榮民，此族群正是重鬱症的高危險群，而過去研究雖已探討許多有關老年重鬱症者執行功能的研究，但研究結果尚不一致。此外，過去研究老年重鬱症執行功能的文獻，顯示在重鬱症者中合併有較多的腦血管疾病危險因子或腦血管變化，在有慢性血管疾病、高血壓、心臟疾病、糖尿病等身體疾病的老年人，和一般正常老年人比較起來，在執行功能測量的表現上明顯較差，這也可能使過去老年重鬱症執行功能的研究產生不一致的結果。

研究目的：
本研究主要探討對象為平均年齡75歲以上，在台灣社會中屬於重鬱症高危險群的老年榮民，並使用臨床上普遍又容易施測的威斯康辛卡片分類測驗（Wisconsin Card Sorting Test，WCST）及路徑描繪測驗（Trail Making Test，TMT），本研究將進一步控制腦血管疾病危險因子，再探討有無合併重鬱症者之執行功能。

研究方法：
本研究採用病例對照研究法（case-control study），個案來自某榮家，取樣方式為立意取樣。本研究依照有無重鬱症及有無腦血管疾病危險因子，將個案分成四組，先以簡短式智能評估（Mini-Mental State Examination，MMSE）排除懷疑失智症個案，並以迷你國際神經精神疾病會談量表（Mini International Neuropsychiatric Interview，MINI）確定重鬱症診斷，測驗前以修正版簡式老年憂鬱量表（revised Geriatric Depression Scale-Short Form，GDS-SF）評估其憂鬱嚴重度，並接受威斯康辛卡片分類測驗（WCST）、路徑描繪測驗（TMT），評估執行功能，腦血管疾病危險因子的診斷，由家庭醫師進行病史詢問、病歷回顧以確認。

研究結果：
皆有腦血管疾病危險因子，有無合併重鬱症兩組，在威斯康辛卡片分類測驗之錯誤反應的總次數、抓到分類概念的反應數、完成的種類數量、完成第一個嘗試所用的嘗試次數等指標上，有顯著差異，顯示皆有腦血管疾病危險因子者，有重鬱症者的執行功能較無重鬱症者差。皆有重鬱症，有無合併腦血管疾病危險因子兩組，在各神經心理測量指標上均沒有差異。有腦血管疾病危險因子且有重鬱症組與正常組比較，在路徑描繪測驗A部分、威斯康新卡片分類測驗之完成的種類數量上，有顯著差異。

研究結論：
本研究結果，可提供老年醫學的臨床工作者，除了需同時治療重鬱症與腦血管疾病危險因子外，並能針對執行功能障礙做治療或復健，減緩認知功能與日常生活自理能力的退化，將可協助重鬱症合併腦血管疾病危險因子的高齡老人，及早就其執行功能障礙尚可恢復或減緩退化的部分，做適當的治療及復健，將有助於患者病情及生活滿意度的改善。

Background: There were several studies about executive functions in geriatric major depression, but most participants were aged below 75. Previous studies neglected older veteran servicemen, who had high suicide rate and poor social support in Taiwan society. They were high risk population of major depression. Previous studies showed inconsistent results about executive functions in geriatric major depression. It has been documented, however, that patients with risk factors of cerebrovascular disease or cerebrovascular changes performed poorer executive functions than those without such risk factors or changes. Patients with chronic vascular diseases, hypertension, heart diseases, and diabetes, performed significantly worse on executive measures compared to normal comparison subjects. This might be a reason of inconsistent results of previous studies about executive functions in geriatric major depression.

Objectives: Participants of this study aged average 75 and over, who were older veteran servicemen and high risk population of major depression in Taiwan society. We used tests that were common and easily administered in clinical settings, such as Wisconsin Card Sorting Test (WCST) and Trail Making Test (TMT). The present study controlled for risk factors of cerebrovascular disease and studied the executive functioning differences among patients with or without major depression.

Methods: Case-control study was used in the present study. Subjects were sampled from one veterans home. The study used a two-by-two factorial design in which one factor was major depression (present versus absent ) and the second factor was risk factors of cerebrovascular disease (present versus absent). The Mini-Mental State Examination (MMSE) was used to screen out subjects suspected of dementia. The Mini International Neuropsychiatric Interview (MINI) and the revised Geriatric Depression Scale-Short Form (GDS-SF) were utilized to confirm diagnosis of major depressive episode, and measure the severity of depression, respectively. Executive functions were assessed using the Wisconsin Card Sorting Test (WCST) and Trail Making Test (TMT). Family doctors obtained past histories of risk factors of cerebrovascular disease through physical examinations, chart reviews and further history taking.

Results: From our results, depressed old men with risk factors of cerebrovascular disease were found to manifest more executive impairments than their non-depressed counterparts, especially in total number of errors, conceptual level responses, number of categories completed, and trails to complete first category of Wisconsin Card Sorting Test. For subjects with major depression, there were no significant differences between patients with and without risk factors of cerebrovascular disease in all neuropsychological measures. Relative to normal controls, depressed old men with risk factors of cerebrovascular disease performed significantly worse in Trail Making Test A and number of categories completed of Wisconsin Card Sorting Test.

Conclusion: In conclusion, when treating major depression and risk factors of cerebrovascular disease, clinical geriatric professionals should pay more attention to the therapy or rehabilitation of executive dysfunction in order to decelerate the deterioration of cognitive impairments and daily living functions which in turn will improve the quality of life among the old population who are burdened with a comorbidity of major depression and risk factors of cardiovascular disease.

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