Treatment of late-life depression: A role of non-invasive brain stimulation techniques
Treatment of late-life depression: A role of non-invasive brain stimulation techniques
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DOI：
10.3109/09540261.2011.633501
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发表时间：
2011-01-01
影响因子：
2.8
通讯作者：
Robinson, Robert G.
中科院分区：
文献类型：
--
作者：
Jorge, Ricardo E.;Robinson, Robert G.
晚年抑郁症 (LLD) 是衰老过程中常见的并发症，在社区居住的老年人中发生率高达 5%，在患有并存疾病的受试者中发生率更高。它的存在一直与认知障碍、更大的残疾和更高的死亡率相关。 MRI 显示，大约一半的 LLD 患者有前额叶回路皮质下缺血性损伤的证据。这可能构成抑郁症和执行功能障碍主要症状的生物学基础。尽管接受了充分的药物和心理治疗，但很大一部分 LLD 患者的抑郁症状仍未得到缓解。此外，一组 LLD 患者会进一步发展为痴呆症形式的损伤和残疾。迫切需要开发新的 LLD 治疗策略。重复经颅磁刺激（rTMS）和经颅直流电刺激（tDCS）等非侵入性脑刺激技术是安全有效的干预措施，可以与其他治疗方案结合使用以改善治疗结果。然而，关于 rTMS 和 dTCS 的最佳实施方式以及我们如何确定从这些干预措施中受益最大的受试者的方式仍然存在疑问。
Late-life depression (LLD) is a frequent complication of the ageing process, occurring in up to 5% of community-dwelling elderly and in a higher proportion of subjects with coexistent medical illnesses. Its presence has been consistently associated with cognitive impairment, greater disability and increased mortality. Approximately half of patients with LLD have evidence of subcortical ischaemic damage in prefrontal circuits revealed by MRI. This might constitute the biological substrate of the cardinal symptoms of depression and of executive dysfunction. An important proportion of patients with LLD do not achieve remission of their depressive symptoms in spite of adequate pharmacological and psychotherapeutic treatment. In addition, a group of LLD patients progress to further impairment and disability in the form of a dementing disorder. There is an imperative need to develop new treatment strategies for LLD. Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are safe and efficacious interventions that might be used in combination with other therapeutic options to improve treatment outcomes. However, there are still questions regarding the optimal way in which rTMS and dTCS should be delivered as well as to the way in which we may identify the subjects who will benefit the most from these interventions.