Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, The Johns Hopkins University, 5300 Alpha Commons Drive, Baltimore, MD 21224, USA.
Curr Psychiatry Rep. 2013 Sep;15(9):384. doi: 10.1007/s11920-013-0384-1.
Depression and cognitive disorders, including dementia and mild cognitive impairment, are common in the elderly. Depression is also a common feature of cognitive impairment although the symptoms of depression in cognitive impairment differ from depression without cognitive impairment. Pre-morbid depression approximately doubles the risk of subsequent dementia. There are two predominant, though not mutually exclusive, constructs linking pre-morbid depression to subsequent cognitive impairment: Alzheimer's pathology and the vascular depression hypothesis. When evaluating a patient with depression and cognitive impairment, it is important to obtain caregiver input and to evaluate for alternative etiologies for depressive symptoms such as delirium. We recommend a sequential approach to the treatment of depression in dementia patients: (1) a period of watchful waiting for milder symptoms, (2) psychosocial treatment program, (3) a medication trial for more severe symptoms or failure of psychosocial interventions, and (4) possible ECT for refractory symptoms.
抑郁和认知障碍，包括痴呆和轻度认知障碍，在老年人中很常见。抑郁也是认知障碍的常见特征，尽管认知障碍中的抑郁症状与无认知障碍的抑郁不同。前驱期抑郁使随后发生痴呆的风险大约增加一倍。有两个主要的但并非相互排斥的结构将前驱期抑郁与随后的认知障碍联系起来：阿尔茨海默病病理学和血管性抑郁假说。在评估有抑郁和认知障碍的患者时，重要的是要获得护理人员的意见，并评估抑郁症状的其他病因，如谵妄。我们建议对痴呆患者的抑郁采用序贯治疗方法：（1）对较轻的症状进行观察等待期，（2）心理社会治疗方案，（3）对更严重的症状或心理社会干预失败进行药物试验，以及（4）对难治性症状可能进行电休克治疗。
