Pattanayak Raman Deep, Sagar Rajesh
Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India-110029.
J Assoc Physicians India. 2011 Oct;59:650-2.
Depression and dementia share a complex and interesting relationship, with a possibility of biological linkages between the two disorders. Research has shown consistently increased prevalence of depression in patients suffering from dementia. As many as one fourth to half of dementia patients are likely to experience clinical depression during the course of illness. However, the onset of depressive symptoms is often misinterpreted as worsening of cognitive decline and hence, it remains under-diagnosed. The lack of a coherent account from patient, frequent overlap of symptoms, inadequate sensitization of physicians may enhance the diagnostic difficulty. Undetected depression adds to patient disability and caregiver burden. Early recognition and proper intervention will improve the patient outcomes including quality of life. Selective serotonin reuptake inhibitors, especially Sertraline and Citalopram, with a very gradual dose titration are likely to benefit. Certain behavioral interventions e.g involvement of patient in physical activity and pleasant activities has been found to be useful. All dementia cases should be routinely screened for depression and managed accordingly.
抑郁症和痴呆症之间存在着复杂而有趣的关系，这两种疾病之间可能存在生物学联系。研究一直表明，痴呆症患者中抑郁症的患病率持续上升。多达四分之一至一半的痴呆症患者在患病过程中可能会经历临床抑郁症。然而，抑郁症状的发作常常被误解为认知能力下降的恶化，因此，它仍然诊断不足。患者缺乏连贯的叙述、症状频繁重叠、医生的敏感度不足可能会增加诊断难度。未被发现的抑郁症会加重患者的残疾程度和照顾者的负担。早期识别和适当干预将改善患者的预后，包括生活质量。选择性5-羟色胺再摄取抑制剂，尤其是舍曲林和西酞普兰，采用非常缓慢的剂量滴定可能会有帮助。已发现某些行为干预措施，如让患者参与体育活动和愉快的活动，是有用的。所有痴呆症病例都应常规筛查抑郁症并进行相应管理。
