Cognition in Late Life Depression: Treatment Considerations.
Cognition in Late Life Depression: Treatment Considerations.
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晚年抑郁症的认知：治疗注意事项。
DOI：
10.1007/s40501-013-0001-2
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发表时间：
2014
影响因子：
--
通讯作者：
Butters,MerylA
中科院分区：
文献类型：
--
作者：
Koenig,AaronM;Butters,MerylA
观点陈述晚年抑郁症(LLD)经常表现为认知障碍，越来越多的证据表明，这些疾病过程以多种方式“联系”。对于一些人来说，LLD可能是长期抑郁疾病的复发，而对另一些人来说，它可能是正在发展的神经病理疾病的主要症状。总体而言，研究LLD的治疗与认知功能改善之间的关系的研究结果喜忧参半。研究表明，部分患有LLD和认知功能障碍的患者在接受抗抑郁药物治疗后，认知功能将得到改善，尽管有相当一部分人将在抑郁症状缓解后继续表现出认知障碍。从治疗的角度来看，确保个人的抑郁症状得到缓解是至关重要的，这是通过标准化的评级标准，如老年抑郁量表(GDS)来衡量的。选择性5-羟色胺再摄取抑制剂(SSRI)或5-羟色胺-去甲肾上腺素再摄取抑制剂(SNRI)单一疗法通常是有效的，并可通过采用循证心理疗法(如问题解决疗法(PST)或人际关系疗法(IPT))来增强，经修改以适应可能存在的认知障碍。对于认知功能障碍的具体治疗，认知增强或训练策略可能对某些患者有帮助，并可能与原发性抑郁发作的治疗结合起来探索。虽然可以考虑引入胆碱酯酶抑制剂(例如多奈哌齐)，但必须权衡潜在的益处(认知和功能的适度改善)和恶化或复发抑郁症的风险增加。最后，生活方式因素--如有氧运动、与初级保健医生的跟进以管理共病的内科疾病，以及定期参加刺激活动(如通过老年中心)--是重要的，应作为整体治疗计划的一部分。
Opinion statementLate-life depression (LLD) frequently presents with cognitive impairment, and growing evidence suggests that these disease processes are “linked” in multiple ways. For some individuals, LLD may be a recurrence of a long-standing depressive illness, while for others it may be the leading symptom of a developing neuropathological disorder. Overall, studies investigating the relationship between the treatment of LLD and improvement in cognitive functioning have yielded mixed results. Research suggests that a subset of individuals with LLD and cognitive dysfunction will experience an improvement in cognitive function after antidepressant treatment, though a significant proportion will continue to exhibit cognitive impairment following resolution of their depressive symptoms. From a treatment standpoint, it is critical to ensure that an individual’s depressive symptoms have been treated to remission, measured by a standardized rating scale such as the Geriatric Depression Scale (GDS). Selective serotonin reuptake inhibitor (SSRI) or serotonin–norepinephrine reuptake inhibitor (SNRI) monotherapy is often effective, and may be enhanced by employing an evidence-based psychotherapy such as Problem-Solving Therapy (PST) or Interpersonal Therapy (IPT), modified to accommodate cognitive impairments that may be present. With respect to specific treatment of cognitive dysfunction, cognitive augmentation or training strategies can be helpful for some patients, and may be explored in combination with treatment of the primary depressive episode. While the introduction of a cholinesterase inhibitor (e.g., donepezil) may be considered, the potential benefit (modest improvement in cognition and functioning) must be weighed against an increased risk for worsening or recurrent depression. Finally, lifestyle factors—such as aerobic exercise, follow-up with a primary care physician for management of co-morbid medical illnesses, and regular participation in stimulating activities (such as through a senior center)—are important and should be included as part of the overall treatment plan.