Butters Meryl A, Young Jeffrey B, Lopez Oscar, Aizenstein Howard J, Mulsant Benoit H, Reynolds Charles F, DeKosky Steven T, Becker James T
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pennsylvania, USA.
Dialogues Clin Neurosci. 2008;10(3):345-57. doi: 10.31887/DCNS.2008.10.3/mabutters.
There is a strong association between late-life depression, cognitive impairment, cerebrovascular disease, and poor cognitive outcomes, including progressive dementia, especially Alzheimer's disease. While neuroimaging evidence suggests that cerebrovascular disease plays a prominent role, it seems that depression alone may also confer substantial risk for developing Alzheimer's disease. The relationships between the prominent cerebrovascular changes, other structural abnormalities, specific forms of cognitive dysfunction, and increased risk for developing Alzheimer's disease among those with late-life depression have been difficult to reconcile. The varied findings suggest that there are likely multiple pathways to poor cognitive outcomes. We present a framework outlining multiple, non-mutually exclusive etiologic links between depression, cognitive impairment, and progressive decline, including dementia. Importantly, the model is both testable and falsifiable. Going forward, using models such as this to inform research should accelerate knowledge acquisition on the depression/dementia relationship that may be useful for dementia prevention, monitoring the impact of depression treatment on clinical status and course of illness.
晚年抑郁症、认知障碍、脑血管疾病与包括进行性痴呆（尤其是阿尔茨海默病）在内的不良认知结局之间存在密切关联。虽然神经影像学证据表明脑血管疾病起主要作用，但似乎仅抑郁症本身也可能大幅增加患阿尔茨海默病的风险。在患有晚年抑郁症的人群中，显著的脑血管变化、其他结构异常、特定形式的认知功能障碍与患阿尔茨海默病风险增加之间的关系一直难以协调。各种研究结果表明，可能存在多种导致不良认知结局的途径。我们提出了一个框架，概述了抑郁症、认知障碍和包括痴呆症在内的进行性衰退之间多个并非相互排斥的病因联系。重要的是，该模型既可以进行检验，也可以被证伪。展望未来，使用这样的模型为研究提供信息应能加速对抑郁症/痴呆症关系的知识获取，这可能有助于预防痴呆症，监测抑郁症治疗对临床状况和病程的影响。
