Teixeira Antonio L, Gregg Allison, Gentry Melanie T, Gujral Swathi, Rapp Ellie, Oberlin Lauren, Ajilore Olusola, Weisenbach Sara, Patrick Regan
Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio (Teixeira); McLean Hospital, Harvard Medical School, Belmont, Massachusetts (Gregg, Weisenbach, Patrick); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Gentry); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Rapp, Gujral); Department of Neuroscience, AdventHealth Research Institute, Orlando, Florida, and Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, New York (Oberlin); Department of Psychiatry, University of Illinois Chicago, Chicago (Ajilore).
Focus (Am Psychiatr Publ). 2025 Apr;23(2):183-194. doi: 10.1176/appi.focus.20240046. Epub 2025 Apr 15.
Cognitive symptoms and deficits are core features of late-life depression (LLD), with an estimated 20%-50% of affected individuals meeting diagnostic criteria for mild cognitive impairment (MCI). Cognitive deficits, especially executive dysfunction, have consistently been associated with poorer treatment outcomes among people with LLD. Furthermore, distinguishing depression with cognitive complaints or cognitive impairment from the early stages of Alzheimer's disease (AD) can be challenging. Cognitive concerns are often emphasized among those with LLD, although, paradoxically, their description of memory difficulty may include detailed recall of specific memory lapses. Conversely, people with AD often have limited insight into their progressive cognitive decline, minimizing and concealing their cognitive difficulties. Neuropsychological assessment is one of the most useful means of clarifying this differential diagnosis. A subcortical cognitive pattern is commonly observed among people with LLD, including psychomotor slowing, variable attention, and executive dysfunction, which can affect memory encoding and free recall. A broad range of therapeutic approaches have been applied to older adults experiencing LLD along with cognitive symptoms, MCI, or dementia. Most studies focus on treatments to address LLD or MCI, with relatively fewer examining treatments specifically at this intersection. Nonpharmacological strategies, including aerobic exercise, cognitive remediation, and neuromodulation, are highly recommended to improve both depression and cognition. Antidepressants may have benefits for elements of cognition among people with LLD, but they have less evidence for their efficacy for people with cognitive deficits and dementia. This review provides an updated conceptual and practical framework for clinicians evaluating and treating LLD.
认知症状和缺陷是老年期抑郁症（LLD）的核心特征，估计有20%-50%的受影响个体符合轻度认知障碍（MCI）的诊断标准。认知缺陷，尤其是执行功能障碍，一直与LLD患者较差的治疗结果相关。此外，将伴有认知主诉或认知障碍的抑郁症与阿尔茨海默病（AD）的早期阶段区分开来可能具有挑战性。认知问题在LLD患者中经常受到强调，然而，矛盾的是，他们对记忆困难的描述可能包括对特定记忆失误的详细回忆。相反，AD患者往往对其进行性认知衰退认识有限，淡化并隐瞒自己的认知困难。神经心理学评估是明确这种鉴别诊断最有用的方法之一。LLD患者中通常观察到一种皮质下认知模式，包括精神运动迟缓、注意力波动和执行功能障碍，这可能会影响记忆编码和自由回忆。广泛的治疗方法已应用于伴有认知症状、MCI或痴呆的LLD老年人。大多数研究集中在针对LLD或MCI的治疗上，专门研究这一交叉领域治疗方法的相对较少。强烈推荐非药物策略，包括有氧运动、认知康复和神经调节，以改善抑郁和认知。抗抑郁药可能对LLD患者的认知方面有益，但对于有认知缺陷和痴呆的患者，其疗效证据较少。本综述为临床医生评估和治疗LLD提供了一个更新的概念和实用框架。
