Potter Guy G, Steffens David C
From the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
Neurologist. 2007 May;13(3):105-17. doi: 10.1097/01.nrl.0000252947.15389.a9.
The objective of this review is to provide information for clinicians regarding current research and opinions on the association of depression to conditions of cognitive impairment and dementia. We also intend to integrate this current research and thinking into strategies for the assessment and treatment of depression in the context of cognitive impairment.
Depression is highly prevalent in mild cognitive impairment and most dementias. It may be a risk factor for the subsequent development of dementia and in some conditions may be a prodromal symptom. It is important to detect and effectively treat depression because the comorbidity of depression and cognitive impairment is associated with greater cognitive and functional decline and higher rates of institutionalization. Depression often can be differentiated from Alzheimer disease and other dementias based on characteristics of clinical history and presentation. Screening of depression and cognitive impairment will help characterize the presence and severity of these conditions, but limitations in screening approaches may necessitate comprehensive assessment in complex cases where differential diagnosis is important to treatment planning.
Although depression and cognitive impairment are important issues in the treatment of older adults, there are particular risks when they occur together. Appropriate assessment and screening can help guide the clinician to appropriate and timely interventions. Pharmacologic and nonpharmacologic treatment approaches are both efficacious in reducing depression in cognitive impairment and dementia.
本综述的目的是为临床医生提供有关抑郁症与认知障碍及痴呆症之间关联的当前研究和观点的信息。我们还打算将当前的研究和思路整合到认知障碍背景下抑郁症的评估和治疗策略中。
抑郁症在轻度认知障碍和大多数痴呆症中非常普遍。它可能是痴呆症后续发展的一个风险因素，在某些情况下可能是前驱症状。检测并有效治疗抑郁症很重要，因为抑郁症与认知障碍的共病与更大程度的认知和功能衰退以及更高的机构化率相关。抑郁症通常可以根据临床病史和表现特征与阿尔茨海默病及其他痴呆症相鉴别。抑郁症和认知障碍的筛查将有助于确定这些病症的存在和严重程度，但筛查方法的局限性可能需要在复杂病例中进行全面评估，在这些病例中，鉴别诊断对治疗计划很重要。
虽然抑郁症和认知障碍是老年人治疗中的重要问题，但它们同时出现时存在特殊风险。适当的评估和筛查可以帮助指导临床医生进行适当及时的干预。药物和非药物治疗方法在减轻认知障碍和痴呆症中的抑郁症方面都有效。
