Molchan S E, Hill J L, Mellow A M, Lawlor B A, Martinez R, Sunderland T
Unit on Geriatric Psychopharmacology, National Institute of Mental Health, Bethesda, Maryland.
Int Psychogeriatr. 1990 Fall;2(2):99-122. doi: 10.1017/s1041610290000370.
Patients with Alzheimer's disease (AD) have been reported to have a rate of nonsuppression on the dexamethasone suppression test (DST) comparable to that of patients with major depression. With symptoms of depression being increasingly recognized in patients with AD, studying their DST response may provide clues to the etiology of the abnormal response in both diagnostic groups. A correlation between dementia severity and post-dexamethasone cortisol was found within the group of male, but not female AD patients. Within the group of elderly depressives, a correlation between post-dexamethasone cortisol and ratings of depression was found. Serum dexamethasone levels were not significantly lower in the nonsuppressors as compared with suppressors in either diagnostic group. Within the AD group, dexamethasone levels themselves correlated significantly with ratings of dementia severity and with the Wechsler Memory Scale score. Cerebrospinal fluid (CSF) 3-methoxy-4-hydroxyphenylglycol (MHPG) correlated positively with 4:00 pm post-dexamethasone cortisol level and with ratings of dementia severity in the AD patients. Findings are discussed in light of the known clinical and other biological similarities between AD and major depression, followed by a review of theories regarding the etiology of the hypothalamic-pituitary-adrenal abnormalities in these two illnesses.
据报道，阿尔茨海默病（AD）患者的地塞米松抑制试验（DST）无抑制率与重度抑郁症患者相当。随着AD患者的抑郁症状越来越受到认可，研究他们的DST反应可能为这两个诊断组异常反应的病因提供线索。在男性AD患者组中发现痴呆严重程度与地塞米松给药后皮质醇之间存在相关性，但在女性AD患者组中未发现。在老年抑郁症患者组中，发现地塞米松给药后皮质醇与抑郁评分之间存在相关性。在任一诊断组中，无抑制者的血清地塞米松水平与抑制者相比均无显著降低。在AD组中，地塞米松水平本身与痴呆严重程度评分以及韦氏记忆量表得分显著相关。脑脊液（CSF）3-甲氧基-4-羟基苯乙二醇（MHPG）与AD患者下午4点地塞米松给药后皮质醇水平以及痴呆严重程度评分呈正相关。根据AD与重度抑郁症之间已知的临床和其他生物学相似性对研究结果进行了讨论，随后回顾了关于这两种疾病下丘脑-垂体-肾上腺异常病因的理论。
