老年期抑郁症与阿尔茨海默病的相关性

Correlation between senile depression and Alzheimer disease

目的:探讨老年期抑郁症与阿尔茨海默病在流行病学、临床表现、病因学等方面的相似性,为两者的鉴别诊断和防治提供依据。资料来源:应用计算机检素Medline 1993-01／2004-12的有关老年期抑郁症与阿尔茨海默病的文章,检索词“depression,senile,Alzheimer disease”, 并限定文章语言种类为English。同时计算机检索中国期刊全文数据库 2000-01／2004-12期间的相关文章,限定文章语言种类为中文,检索词“抑郁症,阿尔茨海默病”。资料选择:对资料进行初审,选取有关老年期抑郁症和阿尔茨海默病相关的文章,并对之查找全文、分析总结。排除重复性研究。资料提炼:共收集到英文文献369篇,其中25篇符合纳入标准;共收集到中文文献25篇,其中3篇符合纳入标准。资料综合:老年期痴呆与老年抑郁症(大多为晚发抑郁症)的患病率分别在1％和20%-3％左右。大约35%老年抑郁症患者具有认知损害,17％- 29％阿尔茨海默病患者患有抑郁症。抑郁症以抑郁为首发症状,通常有情感性精神障碍病史,起病较快,发展迅速,病程不超过6个月．认知水平呈现波动性,对于愉快的环境或气氛,不能作出相应的积极反应;阿尔茨海默病患者首先出现记忆力减退,有痴呆家族史。起病缓慢,呈进行性发展。精神检查比较合作,尽量掩饰自己认知功能下降,对愉快环境作出积极的反应。阿尔茨海默病与抑郁症具有共同的危险因素。结论:阿尔茨海默病与抑郁症具有共同的危险因素,如高血压、糖尿病、吸烟、携带载脂蛋白Ea4等位基因、高胆固醇血症、高同型半胱氨酸血症等,积极治疗抑郁症,将有助于减少阿尔茨海默病的发生。

OBJECTIVE：To explore the similarity between senile depression Alzheimer disease in the aspects of epidemiology,clinical situation etiology, etc., to offer the evidences of differential diagnosis, prevention cure between them. and and and DATA SOURCES：We searched Medline database for articles about the relationship between senile depression and Alzheimer disease published in English from January 1993 to December 2004 by using the key words of “depression, senile, Alzheimer disease”. Meanwhile, related articles were searched in China Journal Full-text Database published from January 2000 to December 2004 in Chinese,with the key words of “depression and Alzheimer disease”. STUDY SELECTION：Preliminary check was implemented.The articles about the relationship between senile depression and Alzheimer disease were selected.The full-texts of the rest articles were scanned,and the contents were analyzed and summarized. Articles on repetitive researches were excluded. DATA EXTRACTION：Totally 369 English literatures were collected, 25 of them accorded with the inclusive criteria. Three articles of the included Chinese literatures accorded with the inclusive criteria. DATA SYNTHESIS：The prevalence rate of senile depression and Alzheimer disease （late depression mostly） were 1% and around 2%-3%, respectively.About 35% patients with senile depression had cognitive impairment,and 17%-29% patients with Alzheimer disease had depression. Major symptom of depression was depressed, generally with history of affective disonters,rapid episode and development,and the course was less than 6 months, fluctuation showed in cognitive level. Patients with depression could not made relatively active reaction on happy environment or atmosphere.Anamnesis of Alzheimer disease patients decreased firstly, with family history of amentia,slow episode,showing proceeding development.They were cooperative on interview, and tried to cover up their decrease of cognitive function, could make active reaction on happy environment.Alzheimer disease had congenerous risk factors with depression. CONCLUSION：Alzheimer disease and depression have common risk factors, for example： hypertension, diabetes, smoking, carrying with ApoEε4, hypercholesteremia, homocysteine, and so on. If major depression is treated actively, it conduces to decrease the incidence of Alzheimer disease.