Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
J Affect Disord. 2018 Aug 15;236:149-156. doi: 10.1016/j.jad.2018.04.034. Epub 2018 Apr 10.
Depression is common in people with Alzheimer's disease (AD), and is associated with increased risk of institutionalization and mortality. Understanding risk factors for depression in AD is key to its development and treatment.
We searched the MEDLINE, EMBASE, PsycINFO, and CINAL databases for longitudinal prospective cohort studies that evaluated risk factors for depression in people with AD. Two authors independently selected articles for inclusion and assessed quality of studies using predetermined criteria.
In seven studies that met the inclusion criteria, 2029 participants were followed up for a median of 5 years. Gender and educational attainment were not predictors of depression risk. History of a past psychiatric disorder and greater cognitive impairment predicted increased risk of depression in more than one study. In single studies, younger age, having a family history of psychiatric disorder, neuroticism, functional decline, presence of sleep disturbance and aggression, and increased cardiovascular risk predicted depression risk. Not being within 6 months of dementia onset and, counterintuitively having two comorbid disorders were protective factors in one study.
A small number of studies exist overall and only a few have examined the same risk factors. Most of the studies have measured depression using scales that are not validated in AD.
These results inform a preliminary model of depression risk in people with AD. Unlike in the general population, men and women and those with higher and lower educational levels of attainment may be equally at risk of depression. Clinicians should be aware of these possible differences in the risk profile for depression in AD populations, to assist detection and enable early treatment. Interventions to delay cognitive and functional decline may reduce depression risk.
抑郁症在阿尔茨海默病（AD）患者中很常见，并且与住院和死亡风险增加有关。了解 AD 患者抑郁的风险因素对于其发展和治疗至关重要。
我们在 MEDLINE、EMBASE、PsycINFO 和 CINAL 数据库中搜索了评估 AD 患者抑郁风险因素的纵向前瞻性队列研究。两位作者独立选择纳入的文章，并使用预定标准评估研究质量。
在符合纳入标准的七项研究中，有 2029 名参与者的中位随访时间为 5 年。性别和教育程度并不是抑郁风险的预测因素。过去有精神病史和认知障碍程度更严重的患者在多项研究中预测了抑郁风险增加。在单项研究中，年龄较小、有精神病史家族史、神经质、功能下降、存在睡眠障碍和攻击行为、心血管风险增加等预测了抑郁风险。在一项研究中，距痴呆发作不足 6 个月和相反地存在两种共病是保护因素。
总体而言，研究数量较少，只有少数研究检查了相同的风险因素。大多数研究使用的量表在 AD 中未经验证。
这些结果为 AD 患者抑郁风险的初步模型提供了信息。与普通人群不同，男性和女性以及受教育程度较高和较低的人群可能同样面临抑郁的风险。临床医生应该意识到 AD 人群中抑郁风险的这种可能的差异，以协助检测并实现早期治疗。延迟认知和功能下降的干预措施可能会降低抑郁风险。
