Fitz A G, Teri L
University of Washington School of Medicine, Seattle 98195.
J Am Geriatr Soc. 1994 Feb;42(2):186-91. doi: 10.1111/j.1532-5415.1994.tb04950.x.
To investigate the relationship of depression to functional and cognitive impairment in patients with Alzheimer's disease (AD).
Clinic-based study comparing AD patients with and without depression.
Geriatric outpatient clinic at the University of Washington Medical Center, Seattle, WA.
Ninety-one AD patients, 46 with major depression and 45 without.
The relationship of the Mattis Dementia Rating Scale (mDRS), DSM-III-R diagnosis of depression, and Hamilton Depression Rating Scale (HDRS) to daily functioning as measured by the Activities of Daily Living (ADL), Independent Activities of Daily Living (IADL), and Communication subscales of the Record of Independent Living (RIL) was examined.
Both depression and mDRS related significantly to functional impairment, but the amount of variance contributed differed by level of cognitive impairment and functional area investigated. In mildly cognitively impaired subjects, diagnosis and severity of depression (combined) was significantly related to IADL and Communication subscales, after controlling for age and mDRS. No predictor was significantly related to ADL functioning. In contrast, for moderately cognitively impaired subjects, depression diagnosis was significantly related to ADL and Communication performance, but not to IADL functioning. mDRS also significantly predicted ADL, IADL, and Communication subscales. Severity of depression was not significant.
These findings, that the presence (diagnosis) and severity (HDRS score) of depression significantly predicted functional status, but that the degree of association varied by level of cognitive severity, has important diagnostic and treatment implications. In particular, the importance of examining whether functional impairment in depressed AD patients can be modified by depression treatment is discussed.
研究阿尔茨海默病（AD）患者中抑郁与功能及认知障碍之间的关系。
基于临床的研究，比较有抑郁和无抑郁的AD患者。
华盛顿大学医学中心老年门诊，西雅图，华盛顿州。
91例AD患者，46例患有重度抑郁，45例无抑郁。
研究马蒂斯痴呆评定量表（mDRS）、DSM-III-R抑郁诊断及汉密尔顿抑郁评定量表（HDRS）与通过日常生活活动（ADL）、独立日常生活活动（IADL）以及独立生活记录（RIL）中的沟通分量表所测量的日常功能之间的关系。
抑郁和mDRS均与功能障碍显著相关，但所贡献的方差量因认知障碍水平和所研究的功能领域而异。在轻度认知障碍的受试者中，在控制年龄和mDRS后，抑郁的诊断和严重程度（综合）与IADL和沟通分量表显著相关。没有预测因素与ADL功能显著相关。相比之下，对于中度认知障碍的受试者，抑郁诊断与ADL和沟通表现显著相关，但与IADL功能无关。mDRS也显著预测了ADL、IADL和沟通分量表。抑郁严重程度不显著。
这些发现，即抑郁的存在（诊断）和严重程度（HDRS评分）显著预测功能状态，但关联程度因认知严重程度水平而异，具有重要的诊断和治疗意义。特别是，讨论了检查抑郁治疗是否可以改善抑郁AD患者功能障碍的重要性。
