Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
Departments of Psychiatry and Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
J Clin Psychiatry. 2018 Jul 31;79(5):17r11772. doi: 10.4088/JCP.17r11772.
Little is known about the overall prevalence of major depressive disorder (MDD) in persons with dementia (ie, "depression in dementia": DpD). The aim of this systematic review and meta-analysis was to determine the prevalence and factors associated with DpD among older adults (age range 58.7-87.8 years). The protocol was registered in the PROSPERO registry (2015:CRD42015020681).
We searched the following electronic databases: MEDLINE (1946-February 2017), Embase (1980-2017 week 5), and PsycINFO (1967-February 2017) using medical subject headings and free-text search terms for studies in the English language.
We screened 9,421 studies, and 55 met the inclusion criteria (ie, used validated criteria for both MDD and dementia).
Two independent reviewers extracted data from included studies. Meta-analysis was used to determine the pooled estimates and 95% confidence intervals for the prevalence of DpD. Prevalence across dementia subtypes, study setting, diagnostic criteria, and dementia severity was compared in subgroup analyses.
The prevalence of MDD in all-cause dementia was 15.9% (95% CI, 12.6%-20.1%). The prevalence of MDD was higher among individuals with vascular dementia (24.7%) compared to Alzheimer's disease (14.8%). Studies using the provisional diagnostic criteria for DpD reported a higher prevalence (35.6%) compared to studies using either the DSM-III-R (13.2%) or DSM-IV (17.3%) criteria.
Depression is common among individuals with dementia, and the type of dementia and diagnostic criteria affect prevalence estimates of DpD. Further studies are required to understand factors that lead to the development of DpD and strategies to prevent and treat DpD.
痴呆患者（即“痴呆相关抑郁”）中重度抑郁障碍（MDD）的总体患病率知之甚少。本系统评价和荟萃分析旨在确定老年人群（年龄范围 58.7-87.8 岁）中 MDD 的患病率和相关因素。该方案已在 PROSPERO 注册库（2015：CRD42015020681）中注册。
我们检索了以下电子数据库：MEDLINE（1946 年-2017 年 2 月）、Embase（1980 年-2017 年第 5 周）和 PsycINFO（1967 年-2017 年 2 月），使用医学主题词和自由文本检索词检索英文研究。
我们筛选了 9421 项研究，其中 55 项符合纳入标准（即使用 MDD 和痴呆的验证标准）。
两名独立的审查员从纳入的研究中提取数据。使用荟萃分析确定 DpD 患病率的汇总估计值和 95%置信区间。在亚组分析中比较了痴呆亚型、研究环境、诊断标准和痴呆严重程度的患病率。
所有病因痴呆患者 MDD 的患病率为 15.9%（95%CI，12.6%-20.1%）。血管性痴呆患者（24.7%）MDD 的患病率高于阿尔茨海默病患者（14.8%）。与使用 DSM-III-R（13.2%）或 DSM-IV（17.3%）标准的研究相比，使用 DpD 临时诊断标准的研究报告的患病率更高（35.6%）。
抑郁在痴呆患者中很常见，痴呆类型和诊断标准影响 DpD 的患病率估计。需要进一步研究以了解导致 DpD 发展的因素以及预防和治疗 DpD 的策略。
