Rubin E H, Kinscherf D A, Grant E A, Storandt M
Alzheimer's Disease Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110.
Am J Psychiatry. 1991 Sep;148(9):1164-71. doi: 10.1176/ajp.148.9.1164.
The performance on standard clinical and psychometric assessments of eight elderly individuals with major unipolar depression alone and seven with depression plus mild senile dementia of the Alzheimer type was compared with that of 41 nondepressed subjects suffering from very mild senile dementia of the Alzheimer type, 66 with mild senile dementia of the Alzheimer type, and 83 age-matched subjects without senile dementia.
Subjects with depression alone, depression plus mild senile dementia of the Alzheimer type, and very mild and mild senile dementia of the Alzheimer type met strict inclusionary and exclusionary criteria. A 90-minute semistructured interview, including several brief standardized clinical scales, was used to assign a Clinical Dementia Rating to each subject according to published guidelines, and each subject was given a 2-hour psychometric test battery. Data were analyzed by one-way multivariate analysis of variance to ascertain if there was an effect of group on clinical and psychometric test scores.
The eight depressed subjects without concurrent dementia performed as well as the 83 nondepressed subjects without dementia on most clinical measures; however, their performance on most psychometric measures closely resembled that of the 41 nondepressed subjects with very mild dementia. The performance of the seven subjects with depression plus mild dementia was comparable to that of the 66 nondepressed subjects with mild dementia on most clinical and psychometric measures.
Although depressed subjects performed as well as subjects without dementia on many clinical assessments, psychometric testing was not able to distinguish depressed subjects from those with very mild senile dementia of the Alzheimer type. This demonstrates the need for careful psychiatric evaluation before interpreting deficits on psychometric tests as indicating the presence of very mild senile dementia of the Alzheimer type.
将8名仅患有重度单相抑郁症的老年人以及7名患有抑郁症加轻度阿尔茨海默型老年痴呆症患者在标准临床和心理测量评估中的表现，与41名患有极轻度阿尔茨海默型老年痴呆症的非抑郁症患者、66名患有轻度阿尔茨海默型老年痴呆症的患者以及83名年龄匹配的无老年痴呆症患者的表现进行比较。
仅患有抑郁症、患有抑郁症加轻度阿尔茨海默型老年痴呆症以及患有极轻度和轻度阿尔茨海默型老年痴呆症的受试者均符合严格的纳入和排除标准。采用一次90分钟的半结构化访谈，包括几个简短的标准化临床量表，根据已发表的指南为每位受试者评定临床痴呆评定量表，并且每位受试者都接受了一次为时2小时的心理测量测试组。通过单向多变量方差分析对数据进行分析，以确定组对临床和心理测量测试分数是否有影响。
8名无并发痴呆症的抑郁症受试者在大多数临床指标上的表现与83名无痴呆症的非抑郁症受试者相同；然而，他们在大多数心理测量指标上的表现与41名患有极轻度痴呆症的非抑郁症受试者非常相似。7名患有抑郁症加轻度痴呆症的受试者在大多数临床和心理测量指标上的表现与66名患有轻度痴呆症的非抑郁症受试者相当。
尽管抑郁症受试者在许多临床评估中的表现与无痴呆症的受试者相同，但心理测量测试无法将抑郁症受试者与患有极轻度阿尔茨海默型老年痴呆症的受试者区分开来。这表明在将心理测量测试中的缺陷解释为表明存在极轻度阿尔茨海默型老年痴呆症之前，需要进行仔细的精神病学评估。
