老年抑郁症与认知障碍——最新进展
Geriatric Depression and Cognitive Impairment-An Update.
作者信息
Mukku Shiva Shanker Reddy, Dahale Ajit Bhalchandra, Muniswamy Nagalakshmi Rajavoor, Muliyala Krishna Prasad, Sivakumar Palanimuthu Thangaraju, Varghese Mathew
机构信息
Geriatric Clinic and Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
出版信息
Indian J Psychol Med. 2021 Jul;43(4):286-293. doi: 10.1177/0253717620981556. Epub 2021 Jan 21.
BACKGROUND
Depression and cognitive impairment often coexist in older adults. The relation between depression and cognitive impairment is complex. The objective of this article is to review recent literature on cognitive impairment in older adults with depression and provide clinicians an update.
METHODS
We searched PubMed, Google Scholar, Science Direct, and Psych Info for the articles published in the English language related to late-life depression (LLD)/geriatric depression and cognitive impairment. We considered original research articles, relevant systematic reviews, chapters, and important conceptual articles published in the last 9 years (2011-2019). We selected relevant articles for this narrative review.
CONCLUSION
The concept pseudodementia, indicating depression with cognitive impairment mimicking dementia, is now seen only as a historical concept. The current literature strongly agrees with fact that cognitive deficits often exist in LLD. The cognitive deficits in depression were initially seen as trait marker; however, some recent studies suggest that cognitive deficits persist even in the remission phase. There is heterogeneity among the studies in terms of the nature of the cognitive deficits, but higher number of studies reported impairment in attention and executive function. LLD with cognitive deficits is at a higher risk of progression to dementia. In older adults, depression with cognitive impairments requires a comprehensive evaluation. Electroencephalography, event-related potentials, fluorodeoxyglucose-positron emission tomography, amyloid positron emission tomography, and CSF amyloid will supplement clinical evaluation in differentiating functional depressive disorder with cognitive impairment from depression with an underlying degenerative condition.
背景
抑郁症和认知障碍在老年人中常常并存。抑郁症与认知障碍之间的关系很复杂。本文的目的是回顾关于老年抑郁症患者认知障碍的近期文献,并为临床医生提供最新信息。
方法
我们在PubMed、谷歌学术、科学Direct和Psych Info中搜索了以英文发表的与老年抑郁症(LLD)/老年期抑郁症和认知障碍相关的文章。我们纳入了过去9年(2011 - 2019年)发表的原创研究文章、相关的系统评价、章节以及重要的概念性文章。我们为这篇叙述性综述选择了相关文章。
结论
假性痴呆这一概念,即伴有模仿痴呆的认知障碍的抑郁症,现在仅被视为一个历史概念。当前文献强烈认同LLD中常常存在认知缺陷这一事实。抑郁症中的认知缺陷最初被视为特质标志物;然而,一些近期研究表明,即使在缓解期认知缺陷依然存在。在认知缺陷的性质方面,各研究存在异质性,但更多研究报告了注意力和执行功能的损害。伴有认知缺陷的LLD进展为痴呆的风险更高。在老年人中,伴有认知障碍的抑郁症需要全面评估。脑电图、事件相关电位、氟脱氧葡萄糖 - 正电子发射断层扫描、淀粉样蛋白正电子发射断层扫描和脑脊液淀粉样蛋白检测将辅助临床评估,以区分伴有认知障碍的功能性抑郁症与伴有潜在退行性疾病的抑郁症。
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