Departments of Psychiatry,Clinical Neurosciences,and Community Health Sciences,Cumming School of Medicine,University of Calgary,Calgary,Canada.
Department of Psychiatry,Massachusetts General Hospital,Harvard Medical School,Boston,MA,USA.
Int Psychogeriatr. 2018 Feb;30(2):185-196. doi: 10.1017/S1041610217001880. Epub 2017 Sep 13.
Affective and emotional symptoms such as depression, anxiety, euphoria, and irritability are common neuropsychiatric symptoms (NPS) in pre-dementia and cognitively normal older adults. They comprise a domain of Mild Behavioral Impairment (MBI), which describes their emergence in later life as an at-risk state for cognitive decline and dementia, and as a potential manifestation of prodromal dementia. This selective scoping review explores the epidemiology and neurobiological links between affective and emotional symptoms, and incident cognitive decline, focusing on recent literature in this expanding field of research.
Existing literature in prodromal and dementia states was reviewed, focusing on epidemiology, and neurobiology. Search terms included: "mild cognitive impairment," "dementia," "prodromal dementia," "preclinical dementia," "Alzheimer's," "depression," "dysphoria," "mania," "euphoria," "bipolar disorder," and "irritability."
Affective and emotional dysregulation are common in preclinical and prodromal dementia syndromes, often being harbingers of neurodegenerative change and progressive cognitive decline. Nosological constraints in distinguishing between pre-existing psychiatric symptomatology and later life acquired NPS limit historical data utility, but emerging research emphasizes the importance of addressing time frames between symptom onset and cognitive decline, and age of symptom onset.
Affective symptoms are of prognostic utility, but interventions to prevent dementia syndromes are limited. Trials need to assess interventions targeting known dementia pathology, toward novel pathology, as well as using psychiatric medications. Research focusing explicitly on later life onset symptomatology will improve our understanding of the neurobiology of NPS and neurodegeneration, enrich the study sample, and inform observational and clinical trial design for prevention and treatment strategies.
抑郁、焦虑、欣快和易怒等情感和情绪症状是痴呆前期和认知正常老年人常见的神经精神症状（NPS）。它们构成轻度行为障碍（MBI）的一个领域，描述了它们在晚年作为认知衰退和痴呆的高危状态出现，以及作为前驱痴呆的潜在表现。本选择性范围综述探讨了情感和情绪症状与认知能力下降之间的流行病学和神经生物学联系，重点关注该不断发展的研究领域的最新文献。
综述了前驱和痴呆状态下的现有文献，重点关注流行病学和神经生物学。搜索词包括：“轻度认知障碍”、“痴呆”、“前驱痴呆”、“临床前痴呆”、“阿尔茨海默病”、“抑郁”、“烦躁”、“躁狂”、“欣快”、“双相障碍”和“易怒”。
情感和情绪失调在临床前和前驱痴呆综合征中很常见，通常是神经退行性变化和进行性认知下降的先兆。在区分先前存在的精神症状和晚年获得的 NPS 之间存在分类限制，限制了历史数据的实用性，但新兴研究强调了在症状出现和认知下降之间以及症状出现的年龄之间确定时间框架的重要性。
情感症状具有预后效用，但预防痴呆综合征的干预措施有限。需要评估针对已知痴呆病理的干预措施，针对新型病理，以及使用精神药物的干预措施。专门针对晚年发病症状的研究将提高我们对 NPS 和神经退行性变的神经生物学的理解，丰富研究样本，并为预防和治疗策略的观察性和临床试验设计提供信息。
