Modrego Pedro J, de Cerio Leyre D, Lobo Antonio
Servicio de Neurologia, Hospital Miguel Servet de Zaragoza, Spain.
Department of Psychiatry, University of Zaragoza, Spain.
Ann Indian Acad Neurol. 2023 Jul-Aug;26(4):315-325. doi: 10.4103/aian.aian_326_23. Epub 2023 Sep 11.
Depression and Alzheimer's disease (AD) are frequent interacting diseases in the elderly with a negative impact on the quality of life of patients and caregivers. Late-life depression may be regarded either as an early symptom of AD or a risk factor for AD, depending on the context. This review was focused on the latest developments in the fields of the neurobiological basis and treatment of depression in AD. We found that some plausible hypotheses are emerging to correlate with depression in AD, such as neuroinflammation and dysimmune regulation. It seems that depression is not related to amyloid deposition, but this issue is not completely resolved. The response to antidepressants is controversial according to the evidence from 10 small double-blind randomized placebo-controlled clinical trials with antidepressants in AD patients with depression: four with sertraline, one with three arms (sertraline, mirtazapine, placebo), one with fluoxetine, one with imipramine, one with clomipramine, one with escitalopram, and one with vortioxetine. The total number of treated patients completing the trials was 638. The main criterion of a positive response was a reduction in the scores of clinical scales for depression of at least 50%. The weighted OR (odds ratio) was calculated with the method of Mantel-Haenszel: 1.29; 95% CI: 0.77-2.16. No significant differences were found compared with placebo. Antidepressants did not have a meaningful negative influence on cognition, which was measured with the mini-mental state examination (MMSE) in 18 clinical trials. Alternatives other than drugs are also discussed. Although there have been important advances in this field, pathophysiology and treatment deserve further research.
抑郁症和阿尔茨海默病（AD）是老年人中常见的相互影响的疾病，对患者及照料者的生活质量产生负面影响。根据具体情况，老年期抑郁症既可能被视为AD的早期症状，也可能是AD的一个危险因素。本综述聚焦于AD中抑郁症的神经生物学基础和治疗领域的最新进展。我们发现一些看似合理的假说是与AD中的抑郁症相关的，比如神经炎症和免疫调节异常。抑郁症似乎与淀粉样蛋白沉积无关，但这个问题尚未完全解决。根据10项针对AD伴抑郁症患者使用抗抑郁药的小型双盲随机安慰剂对照临床试验的证据，抗抑郁药的疗效存在争议：其中4项试验使用舍曲林，1项试验有三个治疗组（舍曲林、米氮平、安慰剂），1项试验使用氟西汀，1项试验使用丙咪嗪，1项试验使用氯米帕明，1项试验使用艾司西酞普兰，1项试验使用伏硫西汀。完成试验的治疗患者总数为638例。阳性反应的主要标准是抑郁临床量表得分至少降低50%。采用Mantel-Haenszel方法计算加权比值比（OR）：1.29；95%置信区间：0.77 - 2.16。与安慰剂相比未发现显著差异。在18项临床试验中，通过简易精神状态检查表（MMSE）测量发现抗抑郁药对认知功能没有显著负面影响。文中还讨论了药物以外的其他治疗方法。尽管该领域已取得重要进展，但病理生理学和治疗仍值得进一步研究。
