Alexopoulos G S, Meyers B S, Young R C, Campbell S, Silbersweig D, Charlson M
Cornell Institute of Geriatric Psychiatry, Cornell University Medical College, White Plains, NY, USA.
Arch Gen Psychiatry. 1997 Oct;54(10):915-22. doi: 10.1001/archpsyc.1997.01830220033006.
We propose that cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes. The "vascular depression" hypothesis is supported by the comorbidity of depression, vascular disease, and vascular risk factors and the association of ischemic lesions to distinctive behavioral symptoms. Disruption of prefrontal systems or their modulating pathways by single lesions or by an accumulation of lesions exceeding a threshold are hypothesized to be central mechanisms in vascular depression. The vascular depression concept can generate studies of clinical and heuristic value. Drugs used for the prevention and treatment of cerebrovascular disease may be shown to reduce the risk for vascular depression or improve its outcomes. The choice of antidepressants in vascular depression may depend on their effect on neurologic recovery from ischemic lesions. Research can clarify the pathways to vascular depression by focusing on the site of the lesion, the resultant brain dysfunction, the presentation of depression and time of onset, and the contribution of nonbiological factors.
我们提出，脑血管疾病可能使某些老年抑郁综合征易患、促发或持续存在。抑郁、血管疾病和血管危险因素的共病以及缺血性病变与独特行为症状的关联支持了“血管性抑郁”假说。前额叶系统或其调节通路因单个病变或超过阈值的病变累积而受到破坏被假定为血管性抑郁的核心机制。血管性抑郁概念可催生具有临床和启发价值的研究。用于预防和治疗脑血管疾病的药物可能会被证明可降低血管性抑郁的风险或改善其预后。血管性抑郁中抗抑郁药的选择可能取决于它们对缺血性病变神经恢复的影响。通过关注病变部位、由此导致的脑功能障碍、抑郁表现和发病时间以及非生物学因素的作用，研究可以阐明血管性抑郁的途径。
