Valiengo Leandro da Costa Lane, Stella Florindo, Forlenza Orestes Vicente
Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Sao Paulo.
Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Sao Paulo; Biosciences Institute, Universidade Estadual Paulista, Rio Claro, Brazil.
Neuropsychiatr Dis Treat. 2016 Aug 24;12:2105-14. doi: 10.2147/NDT.S94643. eCollection 2016.
Despite the lower prevalence of severe mood disorders in the elderly as compared to younger adults, late-life depression and bipolar disorder (BD) are more strongly associated with negative outcomes related to the presence of medical comorbidities, cognitive deficits, and increased suicide risk and overall mortality. The mechanisms that contribute to these associations are probably multifactorial, involving pathological factors related directly and indirectly to the disease itself, ranging from biological to psychosocial factors. Most of the accumulated knowledge on the nature of these associations derives from naturalistic and observational studies, and controlled data are still scarce. Nonetheless, there has clearly been a recent growth of the scientific interest on late-life BD and geriatric depression. In the present study, we review the most relevant studies on prevalence, clinical presentation, and cognitive/functional impact of mood disorders in elderly. Several clinical-epidemiological studies were dedicated to the study of the prevalence of mood disorders in old age in distinct settings; however, fewer studies investigated the underlying neurobiological findings and treatment specificities in late-life depression and BD. In the present study, we further discuss the implications of these findings on the management of mood disorders in older adults.
尽管与年轻人相比，老年人中重度情绪障碍的患病率较低，但老年期抑郁症和双相情感障碍（BD）与因合并躯体疾病、认知缺陷、自杀风险增加及总体死亡率上升而导致的负面后果关联更为紧密。导致这些关联的机制可能是多因素的，涉及直接和间接与疾病本身相关的病理因素，从生物因素到社会心理因素不等。关于这些关联本质的大多数积累知识来自自然主义和观察性研究，而对照数据仍然稀缺。尽管如此，最近对老年期双相情感障碍和老年抑郁症的科学兴趣明显增加。在本研究中，我们回顾了关于老年人情绪障碍患病率、临床表现以及认知/功能影响的最相关研究。一些临床流行病学研究致力于在不同环境中研究老年期情绪障碍的患病率；然而，较少有研究调查老年期抑郁症和双相情感障碍潜在的神经生物学发现及治疗特异性。在本研究中，我们进一步讨论这些发现对老年人情绪障碍管理的影响。
