Inoue Jun, Hoshino Ryoichi, Nojima Hidenori, Ishida Wataru, Okamoto Norio
Department of Psychiatry and Neurology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Okamoto Clinic, Kikugawa, Shizuoka, Japan.
Psychogeriatrics. 2016 Jan;16(1):54-61. doi: 10.1111/psyg.12121. Epub 2015 Apr 27.
Depression is a frequent comorbid condition in patients with Alzheimer's disease (AD). In the present study, we reported the effect of additional donepezil treatment for patients with geriatric depression who exhibited cognitive deficit and were diagnosed with AD during treatment for depression.
The present retrospective study investigated 14 AD outpatients who were diagnosed with geriatric depression at first and received antidepressant treatment. When apparent cognitive decline was observed, all of them were diagnosed with AD and received donepezil (5 mg/day) for at least 1 year. All patients underwent periodic examination of cognitive function (Mini-Mental State Examination, Rorschach Cognitive Index) and clinical evaluation (Clinical Dementia Rating). The 14 patients were classified into three groups according to their treatment course: (i) 'A' group, patients who showed cognitive impairment during a long course of treatment for depression; (ii) 'B' group, patients who showed cognitive impairment at an early stage of treatment for depression and started to take additional donepezil at least 20 months after the first examination; and (iii) 'C' group, patients who showed cognitive impairment at an early stage of treatment for depression and began taking additional donepezil within 10 months of the first examination. The clinical feature and treatment effects were examined for each group.
At 1 and 2 years after the start of treatment, the proportion of patients who had improved or maintained their Clinical Dementia Rating score was higher in 'A' and 'C' groups than in 'B' group. In 'B' group, additional donepezil treatment commenced later than in the other groups. Therefore, donepezil had an insufficient curative effect.
The results of this study suggested that early induction of donepezil treatment was necessary when apparent cognitive decline was identified during the treatment of geriatric depression.
抑郁症是阿尔茨海默病（AD）患者常见的共病情况。在本研究中，我们报告了对患有老年抑郁症且在抑郁症治疗期间出现认知缺陷并被诊断为AD的患者额外使用多奈哌齐治疗的效果。
本回顾性研究调查了14例最初被诊断为老年抑郁症并接受抗抑郁治疗的AD门诊患者。当观察到明显的认知衰退时，他们均被诊断为AD并接受多奈哌齐（5毫克/天）治疗至少1年。所有患者均接受认知功能的定期检查（简易精神状态检查表、罗夏认知指数）和临床评估（临床痴呆评定量表）。根据治疗过程将这14例患者分为三组：（i）“A”组，在抑郁症的长期治疗过程中出现认知障碍的患者；（ii）“B”组，在抑郁症治疗早期出现认知障碍且在首次检查后至少20个月开始额外服用多奈哌齐的患者；（iii）“C”组，在抑郁症治疗早期出现认知障碍且在首次检查后10个月内开始额外服用多奈哌齐的患者。对每组的临床特征和治疗效果进行了检查。
治疗开始后1年和2年时，“A”组和“C”组中临床痴呆评定量表评分改善或维持的患者比例高于“B”组。在“B”组中，额外的多奈哌齐治疗开始时间比其他组晚。因此，多奈哌齐的治疗效果不足。
本研究结果表明，在老年抑郁症治疗期间发现明显认知衰退时，早期引入多奈哌齐治疗是必要的。
