Is depression a risk factor for dementia or cognitive decline? A review
Is depression a risk factor for dementia or cognitive decline? A review
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DOI：
10.1159/000022163
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发表时间：
2000-07-01
期刊：
影响因子：
3.5
通讯作者：
Jorm, AF
中科院分区：
文献类型：
--
作者：
Jorm, AF
背景资料：人们普遍认为抑郁症可能与严重的认知缺陷有关，抑郁症可能与痴呆症共病。目的：这篇综述试图更进一步，询问生命早期的抑郁是否会成为随后痴呆或认知能力下降的风险因素。方法：回顾病例对照和前瞻性研究中抑郁症是一个危险因素的流行病学证据。还对可能解释相关性的六种假设进行了文献综述：（1）抑郁症治疗是痴呆症的危险因素，（2）痴呆症和抑郁症具有共同的危险因素，（3）抑郁症是痴呆症的前驱症状，（4）抑郁症是认知能力下降的早期反应，（5）抑郁症影响表现痴呆症的阈值，（6）抑郁症是痴呆的一个致病因素。结果如下：一项荟萃分析发现，在病例对照研究（相对风险的95%CI：1.16-3.50）和前瞻性研究（95%CI：1.08-3.20）中，抑郁症与随后痴呆的风险增加相关。假设1和假设2几乎没有得到支持。其他假设的支持有限，但值得进一步研究。结论：有足够的证据表明，抑郁症是痴呆和认知能力下降的危险因素。需要进一步的工作来研究抑郁症作为血管性痴呆的前驱症状，抑郁症作为认知能力下降的早期反应，抑郁症对表现痴呆的阈值的影响，以及抑郁症作为海马损伤的来源，通过糖皮质激素级联反应。版权所有（C）2000 S.Karger AG，巴塞尔。
Background: It is generally accepted that depression can be associated with significant cognitive deficits and that depression can be comorbid with dementia. Objective: This review seeks to go further and ask whether depression earlier in life can be a risk factor for subsequent dementia or for cognitive decline. Methods: A review was made of the epidemiological evidence from casecontrol and prospective studies that depression is a risk factor. The literature was also reviewed in relation to six hypotheses that might explain an association: (1) depression treatments are a risk factor for dementia, (2) dementia and depression share common risk factors, (3) depression is a prodrome of dementia, (4) depression is an early reaction to cognitive decline, (5) depression affects the threshold for manifesting dementia, and (6) depression is a causal factor in dementia. Results: A meta-analysis found that depression was associated with an increased risk of subsequent dementia in both case-control studies (95% Cl for relative risk: 1.16-3.50) and prospective studies (95% Cl: 1.08-3.20). There was little support for hypotheses 1 and 2. The other hypotheses have limited support, but warrant further research. Conclusion: There is sufficient evidence to take seriously the possibility that depression is a risk factor for dementia and cognitive decline. Further work is needed to examine depression as a prodrome of vascular dementia, depression as an early reaction to perceived cognitive decline, the effects of depression on the threshold for manifesting dementia, and depression as a source of hippocampal damage through a glucocorticoid cascade. Copyright (C) 2000 S.Karger AG,Basel.