University of New South Wales, Sydney, Australia.
Alzheimers Dement. 2010 Jan;6(1):75-82. doi: 10.1016/j.jalz.2009.04.1229.
Diagnosis of dementia is occurring earlier, and much research concerns the identification of predementia states and the hunt for biomarkers of Alzheimer's disease. Reports of suicidal behavior and requests for euthanasia in persons with dementia may be increasing.
We performed a selective literature review of suicide risk in persons with dementia and the ethical issues associated with euthanasia in this population.
In the absence of any effective treatments for Alzheimer's disease or other types of dementia, there is already evidence that persons with mild cognitive change and early dementia are at risk of suicidal behavior, often in the context of comorbid depression. The ensuing clinical, ethical, and legal dilemmas associated with physician-assisted suicide and euthanasia in the context of dementia are a subject of intense debate. By analogy, the preclinical and early diagnoses of Huntington's disease are associated with an increased risk of suicidal behavior. Thus there is the potential for a preclinical and early diagnosis of Alzheimer's disease (through biomarkers, neuroimaging, and clinical assessment) to result in increased suicide risk and requests for physician-assisted suicide.
Although dementia specialists have long recognized the importance of a sensitive approach to conveying bad news to patients and families and the possibility of depressive reactions, suicidal behavior has not been regarded as a likely outcome. Such preconceptions will need to change, and protocols to monitor and manage suicide risk will need to be developed for this population.
痴呆症的诊断时间提前，许多研究都关注于识别前驱期状态和寻找阿尔茨海默病的生物标志物。痴呆症患者报告自杀行为和请求安乐死的情况可能在增加。
我们对痴呆症患者的自杀风险以及该人群安乐死相关的伦理问题进行了选择性文献回顾。
在没有任何针对阿尔茨海默病或其他类型痴呆症的有效治疗方法的情况下，已经有证据表明，轻度认知改变和早期痴呆症患者有自杀行为的风险，通常是在共病抑郁的背景下。随之而来的与痴呆症背景下的医生协助自杀和安乐死相关的临床、伦理和法律困境是激烈辩论的主题。类似地，亨廷顿病的临床前和早期诊断与自杀行为的风险增加有关。因此，有可能通过生物标志物、神经影像学和临床评估对阿尔茨海默病进行临床前和早期诊断，从而增加自杀风险和请求医生协助自杀。
尽管痴呆症专家早就认识到对患者和家属传达坏消息以及出现抑郁反应的可能性时需要采取敏感的方法，但自杀行为并未被视为可能的结果。这种先入为主的观念将需要改变，并且需要为该人群制定监测和管理自杀风险的方案。
