Valkanova Vyara, Ebmeier Klaus P, Allan Charlotte L
Practitioner. 2017 Jan;261(1800):11-5.
Depression and dementia are both common conditions in older people, and they frequently occur together. Late life depression affects about 3.0-4.5% of adults aged 65 and older. Depression occurs in up to 20% of patients with Alzheimer’s disease and up to 45% of patients with vascular dementia. Rather than a risk factor, depression with onset in later life is more likely to be either prodromal to dementia or a condition that unmasks pre-existing cognitive impairment by compromising cognitive reserve. Depression can be a psychological response to receiving a diagnosis of dementia. The distinction between depression and early dementia may be particularly difficult. Detailed histories obtained from patients and their relatives as well as longitudinal follow-up are important. Cognitive testing can be very helpful. It is preferable to use a neuropsychological test that is sensitive to subtle cognitive changes and assesses all cognitive domains, such as the Montreal Cognitive Assessment. Older people with depression are at raised risk of dementia and this risk is increased if they have had symptoms for a long time, if their symptoms are severe, where there are multiple (vascular) comorbidities, and where there are structural brain changes including hippocampal atrophy and white matter abnormalities.
抑郁症和痴呆症在老年人中都是常见病症，且常常同时出现。老年期抑郁症影响约3.0%-4.5%的65岁及以上成年人。在阿尔茨海默病患者中，抑郁症的发生率高达20%，在血管性痴呆患者中则高达45%。老年期起病的抑郁症更有可能是痴呆症的前驱症状，或者是一种通过损害认知储备而使已存在的认知障碍显现出来的病症，而非危险因素。抑郁症可能是对痴呆症诊断的一种心理反应。区分抑郁症和早期痴呆症可能特别困难。从患者及其亲属那里获取详细病史以及进行纵向随访很重要。认知测试会非常有帮助。最好使用对细微认知变化敏感且能评估所有认知领域的神经心理学测试，比如蒙特利尔认知评估。患有抑郁症的老年人患痴呆症的风险增加，如果他们症状持续时间长、症状严重、存在多种（血管性）合并症以及存在包括海马萎缩和白质异常在内的脑结构改变，这种风险会更高。
