Nakamura Sayuri, Sugawara Hiroko, Asada Ryo, Hatanaka Akito, Hori Hikaru
Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Front Psychiatry. 2024 Jun 4;15:1409027. doi: 10.3389/fpsyt.2024.1409027. eCollection 2024.
Depressive episodes with psychotic symptoms are prevalent among the older adults, emphasizing the need to differentiate them from dementia with Lewy bodies (DLB), in which depressive and psychotic symptoms commonly coexist. In contrast, psychotic symptoms occur more frequently in depressive episodes of bipolar disorder (BD) than in major depressive disorder (MDD). Although MDD is a significant risk factor for dementia, studies exploring the relationship between BD and dementia are lacking. This report details the case of a 74-year-old female who experienced severe psychotic depression that led to suicide attempts during a long-term course of young-onset BD. Ultimately, she was diagnosed with DLB based on her neurocognitive symptoms and results of the neuroimaging examination. She had experienced multiple relapses in the past, predominantly characterized by depressive episodes in her old age. Notably, she had never undergone lithium treatment, which is known for its potential efficacy in preventing relapse and dementia. Recent systematic reviews and meta-analyses have suggested that patients with BD have a higher risk of dementia than the general population, and that lithium usage is associated with a reduced risk. Moreover, patients with BD have been suggested to have an elevated risk of developing Parkinson's disease (PD), and the pathophysiological relationship between BD and PD may be attributed to dopamine dysregulation resulting from multiple relapses. Future research is imperative to identify strategies for preventing dementia in patients with BD and to develop interventions for the comorbidities of BD and DLB.
伴有精神病性症状的抑郁发作在老年人中很常见，这凸显了将其与路易体痴呆（DLB）区分开来的必要性，在DLB中抑郁和精神病性症状通常同时存在。相比之下，精神病性症状在双相情感障碍（BD）的抑郁发作中比在重度抑郁症（MDD）中更频繁出现。虽然MDD是痴呆的一个重要危险因素，但缺乏探索BD与痴呆之间关系的研究。本报告详细介绍了一名74岁女性的病例，她在青年期起病的BD的长期病程中经历了严重的精神病性抑郁并导致自杀未遂。最终，根据她的神经认知症状和神经影像学检查结果，她被诊断为DLB。她过去曾多次复发，主要表现为老年期的抑郁发作。值得注意的是，她从未接受过锂治疗，而锂治疗以其预防复发和痴呆的潜在疗效而闻名。最近的系统评价和荟萃分析表明，BD患者患痴呆的风险高于一般人群，且使用锂与风险降低有关。此外，有人提出BD患者患帕金森病（PD）的风险升高，BD与PD之间的病理生理关系可能归因于多次复发导致的多巴胺失调。未来的研究必须确定预防BD患者痴呆的策略，并开发针对BD和DLB共病的干预措施。
