社区老年期痴呆和老年抑郁症的两年随访研究

2 Years Follow-up of the Elderly with Dementia or Depression

目的 :了解老年期痴呆和老年抑郁症的疾病过程和转归 ;动态观察老年人的认知功能变化和情绪改变。方法 :以 1997年患病率调查时确诊的 40例痴呆和 2 5例抑郁症病人以及 15 2 8名非病例老人作为随访对象。使用随访问卷进行访谈 ,诊断流程和标准同 1997年。结果 :40例痴呆中死亡 17例 ,其标准化死亡比 (SMR)为 3 42。在 2 3例存活的病人中 ,8例加重 ,13例病情不变 ,1例病情波动 ,1例诊断为“假性痴呆” ;2 5例老年抑郁症中 40 %仍为抑郁病例 ,40 %痊愈 ,2 0 %死亡 (其中 1例发展为痴呆 ) ;非病例老人 97年简短心理状况检查(MMSE)低分值组发生痴呆的比率高于 97年MMSE分值正常组 ,97年GDS高分组发生抑郁的比率高于 97年整体恶化量表 (GDS)分值正常组。结论 :老年期痴呆和老年抑郁症的预后差 ,死亡率高 ,老年人的认知功能损害与痴呆和抑郁症的发生存在一定的关联 ,抑郁情绪影响老人的认知功能。

Objective:To follow up the elderly with dementia or depression, and follow up normal elderly to observe the change of their cognitive function.Method:40 cases of dementia, 25 with depression identified in the 1997 survey were followed up with self-made questionnaire in 1999, other 1528 normal elderly in that survey were also followed up with the same questionnaire and same instruments (MMSE and GDS) used in 1997.Result:17 of the 40 demented patients died, the standard mortality ratio (SMR) was 3.42. Of the other 23 patients alive, 8 became worse, 13 stayed the same, one with fluctuated course, and the other one was re-diagnosed as'pseudo-dementia'. Of the 25 depressed patients, 10 were still depressed, 10 recovered, 5 died with one developed dementia before his death.(In the 1378 normal elderly of 1997)the incident rate of dementia was higher in those with lower MMSE scores than that in those with normal MMSE scores in 1997. Similarly, the incident rate of depression was higher in those with higher GDS scores in 1997 than in those with normal GDS scores at that time.Conclusion:The prognosis of dementia and depression in the elderly is poor. Cognitive dysfunction is associated with both dementia and depression.