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[老年精神病学中的跨学科研究策略——痴呆症和抑郁症患者的研究及结果]

[Interdisciplinary research strategies in geriatric psychiatry--studies and results in dementia and depressed patients].

作者信息

Wagner O, Oesterreich K, Hoyer S

机构信息

Psychiatrische Universitätsklinik, Sektion Gerontopsychiatrie, Heidelberg.

出版信息

Z Gerontol. 1987 Jul-Aug;20(4):195-203.

PMID:3660917
Abstract

Eighty-one patients (mean age: 66 +/- 9 years) who had been in gerontopsychiatric in-patient care were included in the study. As well as physical, psychiatric and neurological examinations, EEG, brain CT scanning and the determination of the Ischemic Scale were performed, in order to confirm the clinical diagnosis of dementia of Alzheimer type (DAT), dementia of vascular type (DVT) or multi-infarct dementia (MID), and depression in old age, as based on the DSM III criteria. A comprehensive psychological test battery was administered, to one section of the subjects. Our results indicate that EEG and Ischemic Score can differentiate patients with DAT and DVT to a satisfactory degree, whereas CT findings and psychometric assessment were apt to confirm the overall diagnosis of dementia (DAT/DVT) and depression. Patients with dementia showed memory impairment to a greater extent than depressive patients, as could be proved by a memory test (Syndrom-Kurztest). However, a dementia screening test (Information-Memory-Concentration Test) could more accurately differentiate dementia and depression. The application of a comprehensive psychometric testing procedure did not prove to be an effective diagnostic tool in the assessment of various stages of dementia. Short dementia tests and rating scales seem to be appropriate to distinguish depression from dementia, especially in cases of mild to moderate dementia. In patients with very mild and insignificant organic brain disturbances these screening methods fall short of diagnostic validity. Beyond this, there is a current need for assessment instruments in the evaluation of alterations in personality and affectivity, such as are seen in depression.

摘要

81名曾在老年精神科住院治疗的患者(平均年龄:66±9岁)被纳入该研究。除了进行身体、精神和神经学检查外,还进行了脑电图(EEG)、脑部CT扫描以及缺血量表测定,以根据《精神疾病诊断与统计手册》第三版(DSM III)标准确诊阿尔茨海默型痴呆(DAT)、血管性痴呆(DVT)或多发梗死性痴呆(MID)以及老年抑郁症。对一部分受试者进行了全面的心理测试。我们的结果表明,脑电图和缺血评分能够在一定程度上令人满意地区分DAT和DVT患者,而CT检查结果和心理测量评估则有助于确诊痴呆(DAT/DVT)和抑郁症。通过记忆测试(综合征简短测试)可以证明,痴呆患者的记忆损害程度比抑郁症患者更大。然而,痴呆筛查测试(信息-记忆-注意力测试)能够更准确地区分痴呆和抑郁症。在评估痴呆的各个阶段时,全面的心理测量测试程序并未被证明是一种有效的诊断工具。简短的痴呆测试和评定量表似乎适合区分抑郁症和痴呆,尤其是在轻度至中度痴呆的情况下。对于患有非常轻微且不显著的器质性脑功能障碍的患者,这些筛查方法缺乏诊断效度。除此之外,目前在评估人格和情感变化(如抑郁症中所见)方面需要评估工具。

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