Bungener C, Jouvent R, Derouesné C
CNRS URA 1957, Hôpital de la Salpêtrière, Paris, France.
J Am Geriatr Soc. 1996 Sep;44(9):1066-71. doi: 10.1111/j.1532-5415.1996.tb02939.x.
To evaluate the emotional disturbances in patients with Alzheimer's disease (AD) using both a categorical and a dimensional approach.
Prospective study.
Outpatient clinic in a neurological department from a general University Teaching Hospital.
A semi-structured interview was used to fill in the Hamilton Depression Rating Scale, the Retardation Rating Scale for depression, the Tyrer and Covi scales for anxiety, and the Depressive Mood Scale for emotional disturbances. The cognitive status was assessed by the Mini-Mental State Examination and the Mattis Dementia Rating Scale.
One hundred eighteen consecutive AD outpatients fitting the criteria for probable or possible AD, according to the National Institute of Neurological and Communication Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, were compared with 34 community-dwelling healthy older controls and with 20 inpatients meeting the diagnostic criteria for depression according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition-Revised.
No AD patient met the criteria for Major Depressive Episode or Generalized Anxiety Disorder, but 10 (8%) met the criteria for Dysthymic Disorder. AD patients scored significantly higher than the control group but lower than the depressed group for depressive and anxious symptomatology. Depressive symptomatology was correlated negatively to the cognitive status and positively to anxious symptomatology. Two main dimensions in emotional disturbances were described using the Depressive Mood Scale: Emotional Deficit (anhedonia, hypoexpressiveness) and Loss of Control (felt irritability, hyperexpressiveness). Emotional Deficit was correlated positively to the depressive symptomatology and correlated negatively to the cognitive status and the Loss of Control dimension. Loss of Control was correlated positively to the severity of the depressive and anxious symptomatology and weakly to cognitive performance.
Affective changes were found frequently in AD patients, but no major affective disorder was found. The dimensional approach seems to be more appropriate than the categorical approach to describe the emotional disturbances in these patients.
采用分类法和维度法评估阿尔茨海默病（AD）患者的情绪障碍。
前瞻性研究。
一所综合大学教学医院神经科门诊。
采用半结构式访谈来填写汉密尔顿抑郁评定量表、抑郁迟缓评定量表、泰勒和科维焦虑量表以及情绪障碍抑郁情绪量表。认知状态通过简易精神状态检查表和马蒂斯痴呆评定量表进行评估。
118例符合美国国立神经疾病和中风研究所及阿尔茨海默病及相关疾病协会制定的可能或疑似AD标准的连续性AD门诊患者，与34名社区居住的健康老年对照者以及20名符合《精神疾病诊断与统计手册》第三版修订版抑郁诊断标准的住院患者进行比较。
没有AD患者符合重度抑郁发作或广泛性焦虑障碍的标准，但有10例（8%）符合恶劣心境障碍的标准。AD患者在抑郁和焦虑症状方面的得分显著高于对照组，但低于抑郁组。抑郁症状与认知状态呈负相关，与焦虑症状呈正相关。使用抑郁情绪量表描述了情绪障碍的两个主要维度：情绪缺陷（快感缺失、表情减少）和失控（易激惹感、表情过度）。情绪缺陷与抑郁症状呈正相关，与认知状态和失控维度呈负相关。失控与抑郁和焦虑症状严重程度呈正相关，与认知表现呈弱相关。
AD患者中经常发现情感变化，但未发现主要情感障碍。在描述这些患者的情绪障碍方面，维度法似乎比分类法更合适。
