军人中的抑郁和痴呆。
Depression and dementias among military veterans.
机构信息
Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
出版信息
Alzheimers Dement. 2014 Jun;10(3 Suppl):S166-73. doi: 10.1016/j.jalz.2014.04.007.
Depression is very common throughout the course of veterans' lives, and dementia is common in late life. Previous studies suggest an association between depression and dementia in military veterans. The most likely biologic mechanisms that may link depression and dementia among military veterans include vascular disease, changes in glucocorticoid steroids and hippocampal atrophy, deposition of β-amyloid plaques, inflammatory changes, and alterations of nerve growth factors. In addition, military veterans often have depression comorbid with posttraumatic stress disorder or traumatic brain injury. Therefore, in military veterans, these hypothesized biologic pathways going from depression to dementia are more than likely influenced by trauma-related processes. Treatment strategies for depression, posttraumatic stress disorder, or traumatic brain injury could alter these pathways and as a result decrease the risk for dementia. Given the projected increase of dementia, as well as the projected increase in the older segment of the veteran population, in the future, it is critically important that we understand whether treatment for depression alone or combined with other regimens improves cognition. In this review, we summarize the principal mechanisms of this relationship and discuss treatment implications in military veterans.
抑郁症在退伍军人的一生中非常常见，而痴呆症在晚年很常见。先前的研究表明，抑郁症与退伍军人的痴呆症之间存在关联。可能将抑郁症和痴呆症联系起来的最可能的生物学机制包括血管疾病、糖皮质激素类固醇和海马体萎缩的变化、β-淀粉样斑块的沉积、炎症变化以及神经生长因子的改变。此外，退伍军人经常患有与创伤后应激障碍或创伤性脑损伤相关的抑郁症。因此，在退伍军人中，从抑郁症到痴呆症的这些假设的生物学途径很可能受到与创伤相关的过程的影响。治疗抑郁症、创伤后应激障碍或创伤性脑损伤的策略可能会改变这些途径，从而降低痴呆症的风险。鉴于痴呆症的预计增加，以及退伍军人中老年人群体的预计增加，未来，我们必须了解仅治疗抑郁症或与其他方案联合治疗是否可以改善认知能力，这一点至关重要。在这篇综述中，我们总结了这种关系的主要机制，并讨论了在退伍军人中的治疗意义。
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