Novais Filipa, Starkstein Sergio
Serviço de Psiquiatria e Saúde Mental, Departamento de Neurociências, Hospital de Santa Maria, Lisboa, Portugal.
School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia, and Fremantle Hospital, Fremantle, Western Australia.
J Alzheimers Dis. 2015;47(4):845-55. doi: 10.3233/JAD-148004.
Depression is among the most frequent psychiatric comorbid conditions in dementia. There is no strong consensus as to what criteria should be used to diagnose depression in AD. This is at least partially explained by the overlap between symptoms of depression and symptoms of AD. Recent studies using latent class analysis provided clarification to this diagnostic dilemma. All nine DSM-IV symptoms of major depression were found to characterize a class with a high chance (96% ) of having a clinical diagnosis of major depression, and symptoms of anxiety were also frequent. Other psychiatric symptoms may also be included under the construct of depression in AD, since both apathy and anxiety are among the most frequent comorbid conditions for major depression in AD. Subtypes of depression should also be validated in this condition. For instance, increased awareness of cognitive and functional deficits is significantly associated with dysthymia but not with major depression, suggesting that different depressive syndromes in AD may have different etiology.
抑郁症是痴呆症中最常见的精神共病之一。对于在阿尔茨海默病(AD)中应使用何种标准来诊断抑郁症,目前尚无强烈共识。这至少部分是由于抑郁症症状与AD症状之间存在重叠。最近使用潜在类别分析的研究为这一诊断困境提供了清晰的解释。发现所有九种DSM-IV重度抑郁症症状都表征了一个具有临床诊断为重度抑郁症的高概率(96%)的类别,并且焦虑症状也很常见。其他精神症状也可能包含在AD抑郁症的范畴内,因为淡漠和焦虑都是AD中重度抑郁症最常见的共病情况。抑郁症的亚型在这种情况下也应得到验证。例如,对认知和功能缺陷的意识增强与心境恶劣显著相关,但与重度抑郁症无关,这表明AD中不同的抑郁综合征可能有不同的病因。