Lobo A, Saz P, Marcos G, Día J L, De-la-Cámara C
Psychosomatic Service, Faculty of Medicine, Universidad de Zaragoza, Spain.
Arch Gen Psychiatry. 1995 Jun;52(6):497-506. doi: 10.1001/archpsyc.1995.03950180083011.
Provocative international disparities reported in the prevalence rates of dementia and depression require further investigation. This is the first psychiatric study, to the best of our knowledge, about the prevalence of DSM-III-R dementing and depressive disorders and their relationships in a representative, stratified community sample of the elderly in both a Spanish-speaking country and southern Europe.
A two-stage screening was completed in 1080 elderly. Sampling with replacement was done, and the cumulative response rate was 88%. In phase 1, lay interviewers administered the Spanish versions of the Mini-Mental State examination and the Geriatric Mental State Schedule-Automated Geriatric Examination for Computer Assisted Taxonomy package. In phase 2, research psychiatrists administered the same instruments and the History and Aetiology Schedule to all the probable cases and a similar number of randomly selected, probably normal subjects.
An estimated 5.5% of the elderly were considered to have a dementing disorder, the most prevalent types being primary degenerative dementia, Alzheimer's type (4.3%), and multi-infarct dementia (0.6%). Depressive disorders were found in 4.8% of the elderly. Psychiatric morbidity, specifically depression, was associated with lower educational levels. "Case levels" of depression were documented in 25.4% of the demented cases and case levels of "organic" disturbance were seen in 18.2% of cases of major depression.
Among the elderly, the prevalence of Alzheimer's disease and multi-infarct dementia, as opposed to depression, increases steeply with age. The overlap found between dementia and depression may have nosological implications. There could be an effect of lower education levels on psychiatric morbidity, particularly on depression.
报道的痴呆症和抑郁症患病率在国际上存在显著差异，这需要进一步调查。据我们所知，这是第一项关于痴呆症和抑郁症患病率及其关系的精神病学研究，研究对象是一个讲西班牙语国家和南欧具有代表性的分层社区老年样本。
对1080名老年人进行了两阶段筛查。采用有放回抽样，累积应答率为88%。在第一阶段，非专业访谈员使用西班牙语版的简易精神状态检查表和老年精神状态量表——计算机辅助分类法自动老年检查包。在第二阶段，研究精神科医生对所有可能的病例以及相同数量的随机选择的、可能正常的受试者使用相同的工具以及病史和病因量表。
估计5.5%的老年人被认为患有痴呆症，最常见的类型是原发性退行性痴呆，阿尔茨海默型（4.3%）和多发梗死性痴呆（0.6%）。4.8%的老年人患有抑郁症。精神疾病，特别是抑郁症，与较低的教育水平相关。25.4%的痴呆病例记录有“病例水平”的抑郁症，18.2%的重度抑郁症病例有“器质性”障碍的病例水平。
在老年人中，与抑郁症不同，阿尔茨海默病和多发梗死性痴呆的患病率随年龄急剧增加。痴呆症和抑郁症之间的重叠可能具有疾病分类学意义。较低的教育水平可能对精神疾病发病率有影响，特别是对抑郁症。
