Kwak Yong Tae, Yang YoungSoon, Pyo Seon Jong, Koo Min-Seong
Department of Neurology, Hyoja Geriatric Hospital, Yongin shi, Korea.
Geriatr Gerontol Int. 2014 Jul;14(3):660-6. doi: 10.1111/ggi.12154. Epub 2013 Sep 30.
Depression in Alzheimer's disease (AD) has different clinical manifestations from primary depression of non-demented patients. We designed the present study to explore the following: (i) to determine the clinical characteristics of patients with and without depression according to observational and subjective depression screening scale; and (ii) to examine the depression prevalence rate in patients with AD according to these criteria.
The Geriatric Depression Scale (GDS, observational scale) and Neuropsychiatry Inventory Depression subscale (NPI-D; subjective scale) were administered to 257 patients with drug-naïve probable AD. The study groups were classified into the three subgroups of "no-depression", GDS depression and NPI-DS (NPI-D significant) depression group, and the clinical characteristics of these subgroups were examined.
The NPI-DS depression group showed lower scores on the Korean version of the Mini-Mental State Examination compared with the no-depression group, and higher NPI subdomain scores compared with other groups. The GDS depression group showed higher NPI motor subdomain scores compared with the no-depression group. Depression defined by NPI-DS was the least frequent (10.5%), and NPI-DA (NPI-D any) was the most frequent (56.4%). The prevalence of depression defined by GDS and anti-depressant usage was 30.0% and 16.0% each. The level of agreement between the screening tools determined through the kappa index was from low to moderate.
The present study showed that different depression screening tools revealed a different prevalence and poor concordance rate among depression screening tools. Considering lower cognitive functions and higher BPSD symptoms in the NPI-DS depression group, NPI-DS could be associated with disease severity in AD patients. However, the clinical significance of GDS remains uncertain.
阿尔茨海默病（AD）中的抑郁与非痴呆患者的原发性抑郁有不同的临床表现。我们设计了本研究以探索以下内容：（i）根据观察性和主观性抑郁筛查量表确定有抑郁和无抑郁患者的临床特征；（ii）根据这些标准检查AD患者的抑郁患病率。
对257例未服用过药物的可能患有AD的患者进行老年抑郁量表（GDS，观察性量表）和神经精神科问卷抑郁分量表（NPI-D；主观性量表）评估。研究组分为“无抑郁”、GDS抑郁和NPI-DS（NPI-D显著）抑郁组三个亚组，并检查这些亚组的临床特征。
与无抑郁组相比，NPI-DS抑郁组在韩国版简易精神状态检查表上的得分更低，与其他组相比NPI子领域得分更高。与无抑郁组相比，GDS抑郁组的NPI运动子领域得分更高。由NPI-DS定义的抑郁发生率最低（10.5%），而NPI-DA（NPI-D任何情况）发生率最高（56.4%）。由GDS定义的抑郁患病率和抗抑郁药使用率均为30.0%。通过kappa指数确定的筛查工具之间的一致性水平为低到中度。
本研究表明，不同的抑郁筛查工具显示出不同的患病率，且抑郁筛查工具之间的一致性较差。考虑到NPI-DS抑郁组认知功能较低且BPSD症状较多，NPI-DS可能与AD患者的疾病严重程度相关。然而，GDS的临床意义仍不确定。
