Conejero Ismael, Navucet Sophie, Keller Jacques, Olié Emilie, Courtet Philippe, Gabelle Audrey
Department of Psychiatry, Caremeau Hospital, University Hospital of Nîmes, Nîmes, France.
Inserm U1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France.
Front Neurosci. 2018 Jun 1;12:371. doi: 10.3389/fnins.2018.00371. eCollection 2018.
Suicide rates are high among older adults and many conditions have been related to suicide in this population: chronic illnesses, physical disabilities, cancer, social isolation, mental disorders and neurocognitive disorders. Among neurocognitive disorders, analysis of the relationships between dementia and suicidal behaviors led to conflicting results and some questions are still without answer. Particularly, it is not known whether (i) Alzheimer's disease (AD) increases the risk of suicidal ideation and suicide attempts (SA) or the frequency of death by suicide; (ii) the presence of suicidal ideation or SA in people older than 65 years of age is an early dementia sign; and (iii) amyloid load in frontal areas facilitates SA by modifying the decision-making pathway. Therefore, in this narrative review, we searched the PubMed database using the medical subject heading (MeSH) terms ("Suicide" AND "Depression") OR ("Amyloid" OR "Dementia") to identify recent (from 2000 to 2017) original studies on the links between suicidal behavior, dementia and brain amyloid load. We also explored the clinical and pathophysiological role of depression in these relationships. The findings from these studies suggest that late stage dementia could protect against suicidal ideation and SA. Conversely, the risk of complete suicide is increased during the early phase of cognitive decline. Serious cognitive impairment and decline of executive functions could protect against negative thoughts related to cognitive disability awareness and against suicide planning.Several factors, including brain amyloid load, could be involved in the increased suicide rate early after the diagnosis of dementia.
老年人的自杀率很高，许多情况都与该人群的自杀有关：慢性病、身体残疾、癌症、社会隔离、精神障碍和神经认知障碍。在神经认知障碍中，对痴呆症与自杀行为之间关系的分析得出了相互矛盾的结果，一些问题仍未得到解答。特别是，尚不清楚：（i）阿尔茨海默病（AD）是否会增加自杀意念和自杀未遂（SA）的风险或自杀死亡的频率；（ii）65岁以上人群中自杀意念或SA的存在是否是痴呆症的早期迹象；以及（iii）额叶区域的淀粉样蛋白负荷是否通过改变决策途径促进SA。因此，在这篇叙述性综述中，我们使用医学主题词（MeSH）术语（“自杀”和“抑郁”）或（“淀粉样蛋白”或“痴呆”）搜索了PubMed数据库，以识别最近（2000年至2017年）关于自杀行为、痴呆症和脑淀粉样蛋白负荷之间联系的原始研究。我们还探讨了抑郁在这些关系中的临床和病理生理作用。这些研究的结果表明，晚期痴呆症可能预防自杀意念和SA。相反，在认知衰退的早期阶段，完全自杀的风险会增加。严重的认知障碍和执行功能的下降可能预防与认知残疾意识相关的消极想法和自杀计划。包括脑淀粉样蛋白负荷在内的几个因素可能与痴呆症诊断后早期自杀率的增加有关。
