Sakai Kazuo, Yamane Yumiko, Yamamoto Yasuji, Maeda Kiyoshi
Department of Physical Therapy, Takarazuka University of Medical and Health Care.
Ibogawa Hospital.
Seishin Shinkeigaku Zasshi. 2013;115(11):1127-34.
Depression is a risk factor for dementia in general, including Alzheimer's disease (AD), its premorbid signs are commonly observed, and the morbidity of depression is higher in dementia patients. Dementia with Lewy bodies (DLB) is considered to have an even higher depression prevalence and premorbid depression rate than other dementias such as AD. This led to depression being listed as a supportive feature in the 2005 criteria for the clinical diagnosis of DLB. However, studies investigating the difference in depression between AD and DLB failed to show consistent results. We examined the Geriatric Depression Scale score, which is designed specifically to rate depression in the elderly, for DLB and AD patients. The scores for DLB patients were twice as high as those for AD patients. There was no correlation between the GDS score and age, sex, or Mini-Mental Sate Examination scores. Depression-specific symptoms were more frequent in the DLB group than non-specific symptoms, while less than one third of DLB patients with very high GDS scores were diagnosed with depression or prescribed antidepressants for depressive symptoms. Other researchers reported that depression of DLB was associated with a higher prevalence of psychiatric symptoms other than major depression, and suggested that depression of DLB might be a part of psychiatric syndrome. There has been no systematic study on the validity or risk of pharmacological therapy, as well as the necessity of intervention, for depression or a high GDS score in DLB. Therefore, intervention must rely on the clinical decision of each doctor. In spite of the paucity of current findings, studies on depression of DLB may play a key role in the elucidation of its neuropathology and psychopathology and offer a new view point on understanding depression itself.
一般来说，抑郁症是痴呆症的一个风险因素，包括阿尔茨海默病（AD），其病前体征较为常见，且痴呆症患者中抑郁症的发病率更高。路易体痴呆（DLB）被认为比AD等其他痴呆症的抑郁症患病率和病前抑郁症发生率更高。这导致抑郁症被列为2005年DLB临床诊断标准中的一个支持性特征。然而，调查AD和DLB之间抑郁症差异的研究未能得出一致结果。我们检查了专门用于评估老年人抑郁症的老年抑郁量表（Geriatric Depression Scale）得分，针对DLB和AD患者进行评估。DLB患者的得分是AD患者的两倍。GDS得分与年龄、性别或简易精神状态检查得分之间没有相关性。DLB组中特定于抑郁症的症状比非特定症状更常见，而GDS得分非常高的DLB患者中，不到三分之一被诊断为抑郁症或因抑郁症状而开具抗抑郁药。其他研究人员报告说，DLB的抑郁症与除重度抑郁症之外的精神症状患病率较高有关，并表明DLB的抑郁症可能是精神综合征的一部分。目前尚无关于DLB中抑郁症或高GDS得分的药物治疗有效性或风险以及干预必要性的系统研究。因此，干预必须依赖每位医生的临床判断。尽管目前的研究结果有限，但对DLB抑郁症的研究可能在阐明其神经病理学和精神病理学方面发挥关键作用，并为理解抑郁症本身提供新的视角。
