图文好读版：http://pharmawind.pixnet.net/blog/post/36103675 忧郁与失智症之间的存在着许多纠葛、纠缠与纠结：据研究指出，忧郁可能是 Alzheimer's disease 与失智症的风险因子与前驱症状 (prodrome)，而在失智症的每 个阶段中，都有可能会发并发忧郁的情形。 The relationship between depression and dementia is complex: depression has been reported to be both a risk factor and a prodrome for Alzheimer’s disease and dementia, and is a common complication of dementia at all stages. 目前在证据上，对於轻度认知障碍 (mild cognitive impairment, MCI) 病人是否会因 忧郁而使病程进程为失智症，仍是呈现不一致的看法。 There is inconsistent evidence that the presence of depression increases the conversion rate to dementia in patients with mild cognitive impairment. 约有 20-30% 的 Alzheimer's disease 患者会产生忧郁的状况，而且在血管型失智症 (vascular dementia, VoD) 和路易氏体失智症 (dementia with Lewy bodies, DLW) 的病人中发生忧郁的比例更高。 Depression occurs in 20–30% of patients with Alzheimer's disease, and is even higher in patients with vascular dementia and dementia with Lewy bodies. 有一收纳 1239 位高龄患者为对象之 Baltimore 纵向追踪研究，共追踪达 24.7 年， 并每隔 1-2 年便进行忧郁情形的评估，研究发现忧郁的发作次数是失智症的风险因子 ，每发作一次忧郁，便可能提高 14% 的失智症风险。 （Wind: 我这麽忧郁... 该不会到 40 岁之前就连回家的路都不认得了吧...so sad~） In Baltimore Longitudinal Study of Aging, 1239 elderly participants were followed for 24.7 years and depression was assessed at 1–2-year intervals. The risk for dementia was associated with number of depressive episodes, and increased by 14% for every episode of depression. 在老人的忧郁通常是复杂且多因性的，可能与心理、基因和大脑改变等状况有关。其中 潜在性大脑改变可能与末期忧郁有关，包括单胺异常、脑血管疾病、Alzheimer's disease 与路易士体病变、高类固醇血症之毒性物质压力、神经发炎、以及神经新生与 神经营养物质的改变等。 Depression in older patients is complex and multifactorial, and may be attributed to psychosocial, genetic and brain changes as well as medical conditions. Potential brain changes contributing to late-life depression include monoaminergic changes, cerebrovascular disease, Alzheimer's disease and Lewy body pathology, and toxic stress, with hypercortisolemia, neuroinflammation, and alterations of neurogenesis and neurotrophic factors. 目前虽然有数个研究试图探讨忧郁於失智症的机转，但目前并无一致的实验结果，因此 至今其病因学仍尚未完全明了。 The relatively few studies exploring the mechanisms underlying depression in dementia have yielded inconsistent findings, and thus the etiology is unknown. 在忧郁於失智症之治疗方面，目前也缺乏较佳的证据指出那些抗忧郁药物对於失智症患 者会是较有效的选择。 There is inconsistent evidence supporting the use of antidepressants for depression in people with dementia. Placebo-controlled studies of antidepressants for depression in AD -> http://pic.pimg.tw/pharmawind/1320724633-2643596667_l.png Reference: [1] Enache D, Winblad B, Aarsland D. Depression in dementia: epidemiology, mechanisms, and treatment. Curr Opin Psychiatry. 2011 Nov;24(6):461-72. [2] Teng E, Ringman JM, Ross LK, et al. Diagnosing depression in Alzheimer disease with the national institute of mental health provisional criteria. Am J Geriatr Psychiatry 2008; 16:469–477. [3] Dotson VM, Beydoun MA, Zonderman AB. Recurrent depressive symptoms and the incidence of dementia and mild cognitive impairment. Neurology 2010; 75:27–34. [4] Barnes DE, Yaffe K. The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol 2011; 10:819–828. [5] Richards E, Reitz C, Devanand D, et al. Relation of late life depression with MCI and dementia: early symptom or risk factor? Alzheimers Dement 2011;7 (Suppl 1):S597–S598; P593-263. [6] Wetzels RB, Zuidema SU, de Jonghe JF, et al. Course of neuropsychiatric symptoms in residents with dementia in nursing homes over 2-year period. Am J Geriatr Psychiatry 2010; 18:1054–1065. [7] Ballard CG, Jacoby R, Del Ser T, et al. Neuropathological substrates of psychiatric symptoms in prospectively studied patients with autopsy confirmed dementia with lewy bodies. Am J Psychiatry 2004; 161:843–849. [8] Casanova MF, Starkstein SE, Jellinger KA. Clinicopathological correlates of behavioral and psychological symptoms of dementia. Acta Neuropathol 2011; 122:117–135. [9] Bains J, Birks JS, Dening TR. The efficacy of antidepressants in the treatment of depression in dementia. Cochrane Database Syst Rev 2002; 4: CD003944. -- 隔壁的 在班上出风头 会打篮球 有汽车的人 有钱有车有房 大哥哥 的男生 又帅的学长 的主管 女生 女生 ─┬─────┼─────┼─────┼─────┼─────→ 是善变的 ♀ 喜 国小时 国中时 高中时 大学时 社会时 ♂ 欢 男生 男生 ─┴──年──┼──轻──┼──的──┼──正──┼──妹──→ 是专一的 --

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