Bonin-Guillaume S, Clément J P, Chassain A P, Léger J M
SHU Psychiatrie, Centre Hospitalier Esquirol, Limoges.
Encephale. 1995 Jan-Feb;21(1):25-34.
Depression in the elderly is frequent but often unknown (in 30 to 50% of the cases) because of difficulties in detecting or diagnosing it. This is due to the clinical features and prognosis of depression in this kind of population but also to the non-existence of specific diagnostic tests. Most of the authors consider that the most useful diagnostic tests are screening assessments. Some are rating scales that have been validated in general population then secondarily in the elderly: Hamilton Rating Depression Scale (HDRS), Montgomery & Asberg Depression Rating Scale (MADRS), Zung Self Rating Depression Scale (Zung SDS), Beck Depression Inventory (BDI) or Center for Epidemiological Studies Depression Scale (CES-D). They usually involve biases linked to age and more particularly to somatic items; and the educational level required to answer is too high for this population. However, the MADRS is still interesting for measuring change under treatment and the CES-D for detection of depressive elderly. On the other hand, some screening scales are specific of depression in the elderly. The most commonly used is the GDS (Geriatric Depression Scale) with 30 items. Some points have been discussed to increase the achievement of these methods. For example, inventories are better than interviews and should be integrated into semi-standardized interviews which do not last more than 30 minutes. The quotation 'yes' or 'no' is preferable. The instrument have to be short but have to contain specific items for depression in the elderly. Several short forms are already validated or in progress such as GDS with 15 items and, recently, with 4 items, BASDEC, short Zung IDS, BDI with 13 items and DGDS. However, these screening scales loose a part of their validity in the moderate or severe demented elderly. Few instruments can screen depression in a demented population although depression and dementia syndromes are frequently associated. Some of the inventories used are not specific: they evaluate the general psychopathology in the elderly and contains subscales which screen depression or organic brain disease. Thus, GMS-AGECAT Package, CAMDEX, CARPER, BAS are often used by the Anglo-Saxons. At present, only one specific instrument has been validated: the Cornell Scale for Depression in Dementia. Recently, new screening instruments have been put forward: Dementia Mood Assessment Scale and Canberra Interview for the elderly which seem interesting but need further studies.
老年人抑郁症很常见，但由于检测或诊断困难，往往不为人所知（30%至50%的病例）。这是由于这类人群中抑郁症的临床特征和预后，也由于不存在特定的诊断测试。大多数作者认为，最有用的诊断测试是筛查评估。有些是在普通人群中得到验证，随后在老年人中得到验证的评定量表：汉密尔顿抑郁评定量表（HDRS）、蒙哥马利-阿斯伯格抑郁评定量表（MADRS）、zung自评抑郁量表（zung SDS）、贝克抑郁量表（BDI）或流行病学研究中心抑郁量表（CES-D）。它们通常存在与年龄相关的偏差，尤其是与躯体项目相关的偏差；而且回答所需的教育水平对这类人群来说过高。然而，MADRS对于测量治疗中的变化仍然很有意义，而CES-D对于检测老年抑郁症患者很有意义。另一方面，一些筛查量表是专门针对老年人抑郁症的。最常用的是有30个条目的老年抑郁量表（GDS）。人们已经讨论了一些要点以提高这些方法的成效。例如，问卷比访谈更好，并且应该纳入不超过30分钟的半标准化访谈中。回答“是”或“否”更可取。工具必须简短，但必须包含针对老年人抑郁症的特定条目。已经有几种简短形式得到验证或正在验证中，如15个条目的GDS，以及最近的4个条目的GDS、BASDEC、简短的zung IDS、13个条目的BDI和DGDS。然而，这些筛查量表在中度或重度痴呆老年人中会失去部分有效性。尽管抑郁症和痴呆综合征经常同时出现，但很少有工具能够筛查痴呆人群中的抑郁症。所使用的一些问卷并不具有特异性：它们评估老年人的一般精神病理学情况，并且包含筛查抑郁症或器质性脑疾病的分量表。因此，盎格鲁-撒克逊人经常使用GMS-AGECAT软件包、CAMDEX、CARPER、BAS。目前，只有一种特定工具得到了验证：痴呆抑郁康奈尔量表。最近，已经提出了新的筛查工具：痴呆情绪评估量表和堪培拉老年人访谈量表，它们看起来很有意义，但需要进一步研究。
