老年卒中后抑郁与非抑郁患者人格特征分析

目的调查卒中后抑郁的影响因素、临床结局及采用明尼苏达多相人格测验研究老年卒中后抑郁患者的心理特征。方法对160例老年卒中患者进行回顾性病例对照研究,根据有无卒中后抑郁分为2组,采用logistic回归分析卒中后抑郁的影响因素,并统计分析卒中后抑郁患者的人格特征。结果抑郁人格、疑病人格、精神衰弱人格量表分值差异显著(P0.05);疑病分值、抑郁分值与老年卒中后抑郁呈正相关;配偶支持、卒中部位、简易智能评分量表分值和美国国立卫生研究院卒中评分量表分值与老年卒中后抑郁发生相关。老年卒中后抑郁组卒中后30 d Bathel生活能力评分比对照组显著降低(P0.05),30 dRankin评分0-1级抑郁组人数显著减少(P0.001)。结论老年卒中后抑郁患者人格以抑郁人格、疑病人格、精神衰弱人格为主;缺乏配偶支持、前循环病变、认知障碍和卒中严重的患者更易发生老年卒中后抑郁;老年卒中后抑郁的发生延长平均住院时间、影响卒中的临床康复。     

缺血性卒中后认知功能障碍的患病率和危险因素

目的 明确卒中后认知功能障碍(PSCI)的患病率和危险因素.方法 526例缺血性卒中患者被分为无认知障碍、认知障碍非痴呆(CIND)和血管性痴呆(VaD),根据影像学表现,患者分为皮质下缺血性血管病、皮质型缺血性血管病和其他类型,登记患者人口学、血管危险凶素和卒中病情等.结果 PSCI患病率36.7%.与无认知障碍相比,PSCI患者年龄大、女性比例高、教育程度低、彳T侧瘫痪多、抑郁评分高,但血管危险因素无差别.与无认知障碍者相比,VaD者经济水平低、配偶照料少、失语多、尿失禁多、皮质型缺血性血管病多;CIND者则有较多的皮质下缺血性血管病.VaD者较CIND者皮质型缺血性血管病多、抑郁评分低.高龄、女性、低社会经济水平、失语、皮质下缺血性血管病、皮质型缺血性血管病和抑郁评分高为PSCI的独立危险因素.结论 PSCI常见于缺血性卒中患者,与人口学因素、卒中类型及抑郁有关.     

脑卒中后认知障碍与抑郁相关性的研究进展

脑卒中已被列为全世界第三大致命疾病,根据世界卫生组织的报告,每年有1500万人患病,而脑卒中后认知障碍及脑卒中后抑郁作为其最常见的并发症常常相伴出现,严重影响脑卒中患者功能恢复和生活质量。因此,临床上对脑卒中后认知障碍与抑郁的相关性进行研究,对于优化康复治疗方案、改善预后、提高患者生活质量有重要意义。     

卒中后抑郁的危险因素

卒中后抑郁(post-stroke depression,PSD)是卒中的一种常见并发症,患病率在23%～60%之间.文章对PSD的危险因素,包括性别、年龄、病前个性、文化程度、卒中和抑郁病史、卒中类型、卒中部位、神经功能障碍、认知障碍、失语以及社会支持等进行了综述.     

卒中后抑郁的危险因素和机制

抑郁症是卒中后常见的一种并发症,常与残疾、认知障碍和病死率增高相关.文章就卒中后抑郁的流行病学、危险因素、预测因素和病理生理学机制进行了综述.     

卒中后认知障碍

卒中后认知障碍包括卒中后非痴呆认知障碍和卒中后痴呆,是卒中后由血管因素、神经变性或混合因素导致的认知功能障碍.卒中后认知障碍的慨念虽未被普遍接受,但值得进一步探讨.文章介绍了卒中后认知障碍的流行病学、危险因素、发病机制、临床表现和防治措施.     

卒中后认知障碍

卒中后认知障碍包括卒中后非痴呆认知障碍和卒中后痴呆,是卒中后由血管因素、神经变性或混合因素导致的认知功能障碍.卒中后认知障碍的慨念虽未被普遍接受,但值得进一步探讨.文章介绍了卒中后认知障碍的流行病学、危险因素、发病机制、临床表现和防治措施.     

抗抑郁联合心理治疗对卒中后抑郁患者认知功能的影响

目的研究抗抑郁药物联合心理治疗对卒中后抑郁患者情感障碍、神经功能康复及认知障碍的影响。方法将120例PSD患者随机分为两组,两组均给予脑血管病常规治疗,治疗组同时加用盐酸氟西汀联合心理治疗,治疗12周后,采用神经功能缺损评分判断临床疗效,采用汉密尔顿抑郁量表（HAMD）、简易精神状态检查表（MMSE）及听觉Oddball刺激序列事件相关电位（P300）潜伏期与波幅的变化判断抗抑郁疗效及对认知功能的影响。结果治疗组临床疗效较对照组明显提高,治疗12周后治疗组较对照组HAMD评分显著降低,MMSE评分显著提高,P300潜伏期显著缩短,波幅显著增高（P〈0．05或〈0．01）。结论卒中后的神经功能障碍、抑郁和认知障碍可同时存在并相互影响,抗抑郁药物联合心理治疗可改善PSD患者的抑郁情绪、认知能力和预后。     

老年冠心病抑郁与卒中后抑郁的心血管危险因子临床对比研究

目的对比分析老年冠心病抑郁和卒中后抑郁的心血管危险因子。方法选取某医院收治的冠心病伴抑郁症以及卒中后抑郁患者60例作为研究对象,其中冠心病版抑郁症患者30例,卒中后抑郁患者30例,通过临床检查对于患者心血管危险因子进行对比分析,以为临床提供参考和借鉴。结果临床检查与对比显示,老年冠心病抑郁与卒中后抑郁患者在高血压以及高同型半胱氨酸、高血脂、糖尿病、心血管危险基因等发生率对比,差异无统计学意义(P0.05),而卒中后抑郁的老年患者临床中高血压及心血管危险因子发生率要比卒中后不伴抑郁的患者高。结论高血压是导致老年冠心病伴抑郁症以及卒中后抑郁发生的危险因子,患者对于心血管危险因子与抑郁发生之间关系的认识直接影响着患者病症的变化。     

从“卒中后抑郁”到“卒中伴抑郁”——谈卒中防控的新思路

卒中肆虐全球,已上升为我国成人致死、致残的首位病因。抑郁不仅是卒中的危险因素和并发症状,更是加重卒中病情并危及患者生命的重要致病因素。抑郁可能发生在卒中前或卒中后。病程中卒中和抑郁常常交互影响,但抑郁对卒中的次生损害却多被忽略,常导致卒中患者瘫痪加重和病死率增高,并使卒中复发增多而加大了卒中二级预防的难度。既往"卒中后抑郁"的概念中,卒中和抑郁被认为是两种独立的疾病,该概念临床应用受限并常延误患者的诊治。因此,我们提出"卒中伴抑郁"的新观念,更加强调治疗抑郁对紧急救治卒中损害所带来的更多获益,从而使急性卒中的防治步入崭新的时代。     

Functional status and cognitive impairment in Alzheimer's patients with and without depression

Cognitive impairment and depression each compromise functional status in the elderly, but it is not known whether their coexistence is associated with additive functional impairment. The effect of the presence or absence of a diagnosis of major depression on functional status was examined in a group of 50 community-residing patients with dementia of the Alzheimer's type (DAT). Patients were diagnosed as depressed (N = 20) or not (N = 30) according to DSM-III criteria. Cognitive status was assessed with the Mini-Mental State Exam (MMSE), and functional status was assessed by family report of Instrumental Activities of Daily Living (IADLs). Consistent with previous reports, patients with a depression diagnosis were less cognitively impaired than their nondepressed counterparts. When cognitive status was controlled for, depression diagnosis was found to have a main effect on functional impairment. Although the direction of effects between depression and functional limitations was not determined here, these results suggest that alleviating depression may decrease functional limitations in DAT patients.     

Managing depression in patients with vision impairment: A descriptive study of practitioners' beliefs and confidence

Aim: Depression is common in older adults with vision impairment yet it often remains unidentified and untreated. Eye health professionals (EHPs) and rehabilitation workers (RWs) may be able to assist in detecting depression. This study identified EHPs' and RWs' beliefs about depression and confidence in working with patients with vision impairment and depression. Methods: A self‐administered cross‐sectional survey of 94 EHPs and RWs assessed beliefs about the symptoms and treatment for depression, and confidence in working with depressed people with vision impairment. Results: Participants showed awareness of both the symptoms and treatment options for depression. However, some important misconceptions were identified and many symptoms of depression were commonly attributed to vision loss. Participants lacked confidence in communicating about depression with patients and their families. Conclusions: Training programs are needed to enable EHPs and RWs to confidently identify depression and discuss appropriate treatment and referral options with their patients.     

Depression associated with dementia

Depression and cognitive disorders, including dementia and mild cognitive impairment, are common disorders in old age. Depression is frequent in dementia, causing distress, reducing the quality of life, exacerbating cognitive and functional impairment and increasing caregiver stress. Even mild levels of depression can significantly add to the functional impairment of dementia patients and the severity of psychopathological and neurological impairments increases with increasing severity of depression. Depressive symptoms may be both a risk factor for, as well as a prodrome of dementia. Major depressive syndrome of Alzheimer’s disease may be among the most common mood disorders of older adults. Treating depression is therefore a key clinical priority to improve the quality of life both of people with dementia as well as their carergivers. Nonpharmacological approaches and watchful waiting should be attempted first in patients who present with mild to moderate depression and dementia. In cases of severe depression or depression not able to be managed through nonpharmacological means, antidepressant therapy should be considered.     

Depression and cognitive impairment following recovery from thrombotic thrombocytopenic purpura

After recovery from an acute episode of acquired thrombotic thrombocytopenic purpura (TTP), patients often describe problems with memory, concentration, and endurance. We have previously reported the occurrence of depression and cognitive impairment in these patients. In this study, we describe the frequency, severity, and clinical course of depression and cognitive impairment. Fifty‐two (85%) out of 61 eligible Oklahoma Registry patients who had recovered from TTP, documented by ADAMTS13 activity <10%, have had at least one (median, four) evaluation for depression over 11 years using the Beck Depression Inventory‐II; 31 (59%) patients screened positive for depression at least once; in 15 (29%), the results suggested severe depression at least once. Nine of these 15 patients had a psychiatric interview, the definitive diagnostic evaluation; the diagnosis of major depressive disorder was established in eight (89%) patients. In 2014, cognitive ability was evaluated in 33 patients by the Montreal Cognitive Assessment and the Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Both tests detected significant cognitive impairment in the patients as a group. Fifteen out of the 33 patients had been evaluated by extensive cognitive tests in 2006. The 2014 RBANS results were significantly worse than the 2006 results for the overall score and two out of the five RBANS domains (immediate and delayed memory). Neither depression nor cognitive impairment was significantly associated with the occurrence of relapses or ADAMTS13 activity <10% during remission. These observations emphasize the importance of screening evaluations for depression and cognitive impairment after recovery from acquired TTP. Am. J. Hematol. 90:709–714, 2015. © 2015 Wiley Periodicals, Inc.     

Atrial fibrillation (AF) and cognitive impairment in the elderly: a case-control study

AF is able not only to increase the risk of cognitive decline due to acute cerebrovascular events, but also to reduce cardiac output, with the consequence of impaired cerebral perfusion. The aim of this study was to evaluate the association between AF, dementia and depression in patients with negative anamnesis for past strokes. Our sample included 26 patients with a diagnosis of AF (paroxystic, persistent, permanent) and 31 patients with sinus rhythm, enrolled as controls. All selected patients underwent a Multidimensional Geriatric Assessment in order to investigate cognitive and behavioral functions. Statistical analysis of results showed a greater frequency of latent cognitive impairment in patients with AF, even in the absence of memory disorders. As a matter of facts, AF patients showed Mini Mental State Examination (MMSE) scores significantly lower than those with sinus rhythm (p<0.05) and Geriatric Depression Scale (GDS) scores higher than those without AF, evidencing a greater risk of depression too (p<0.02). Results showed a statistically significant association between AF, depression and cognitive impairment in early stage. In conclusion, AF is not only associated with the risk of developing cognitive impairment, but it can also be considered as a risk factor for dementia and depression, even in the absence of medical history of past stroke.     

运动神经元病患者认知功能筛查

目的 调查中国运动神经元病患者认知功能异常及额颞叶功能异常的发生情况.方法 对100例运动神经元病的患者行简易智能状态量表(MMSE),神经精神科问卷,汉密尔顿抑郁量表及汉密尔顿焦虑量表检查.并调查患者一般资料及功能等级评分(FRS)等情况.结果 MMSE结果示轻度认知障碍者占24.2%,MMSE正常与异常之间比较FRS总分及抑郁情况,两者差异有统计学意义.抗抑郁治疗3个月后随访,发现2例患者可能存在额颞叶功能受损.结论 运动神经元病患者认知功能可能轻度受损,部分存在精神行为表现异常,2例患者可能有额颞叶功能受损.     

Assessment of comorbid mild cognitive impairment and depression in patients with type 2 diabetes mellitus

ContextDepression, mild cognitive impairment, and dementia are highly prevalent chronic conditions associated with social, medical, and economic burdens. Although there are several epidemiological studies that have reported the prevalence of mild cognitive impairment or depressive syndrome in elderly diabetic population little is known about the comorbidity of these conditions. We aimed to study the prevalence of comorbid mild cognitive impairment (MCI) and depression in patients with Type 2 diabetes mellitus and its relation to glycemic control.Materials and methodsthe present work was carried on 400 patients with T2DM. History taking, physical examination, laboratory investigations (with special emphasis on glycemic profile and lipid profile parameters) were done for every patient. Assessment of anxiety and depression using the HADS score and assessment of mild cognitive impairment using MoCA score were done.Results76% of studied patients had depression of varying degrees while 56.8% of studied patients had MCI. Decreased level of HDL-cholesterol and increased HADS anxiety score were significant predictors of depression. On the other hand, increased level of total cholesterol, decreased level of HDL-cholesterol, increased HADS depression score and decreased MoCA score were significant predictors of anxiety. HDL-cholesterol HADS anxiety score, FBG, and duration of DM were the significant predictors of MCI.ConclusionIncreased level of total cholesterol, decreased level of HDL-cholesterol, increased HADS depression score and decreased MoCA score were significant predictors of anxiety. HDL-cholesterol, HADS anxiety score, FBG, and duration of DM were the significant predictors of MCI.     

Anxiety and depression in COPD patients: The roles of gender and disease severity

BACKGROUND: The aim of our study was to assess the prevalence of anxiety and depression in the whole chronic obstructive pulmonary disease (COPD) population and in subgroups according to sex and severity classification. A secondary objective was to evaluate the possible differences between patients with and without a significant high level of anxiety, depression, or both, and finally to find out a correlation between psychological aspects, symptoms, functional parameters, and quality of life (QoL). METHODS: Two hundred and two COPD patients were enrolled. Their levels of anxiety, depression, dyspnea, and QoL were assessed using specific questionnaires. One hundred and fourteen sex- and age-matched healthy subjects were used as the control population. RESULTS: The prevalences of anxiety and depression were high (28.2% and 18.8%) in COPD even when it was of mild degree, compared to the control group, in which the prevalence of anxiety and depression were 6.1% and 3.5%, respectively. Female patients had higher levels of anxiety and depression and worse symptom-related QoL. Female patients reported a higher level of dyspnea than males for the same level of ventilatory impairment. Dyspnea was more strongly correlated with depression in women than in men. CONCLUSIONS: Anxiety and depressive symptoms are common in patients affected by COPD, even when their disease is mild in terms of FEV1 and respiratory symptoms. Female patients appear to be more exposed to psychological impairment, which correlates well with some specific symptomatic aspects of the disease, such as dyspnea. Psychological aspects need to be carefully assessed in COPD patients, particularly in females.     

上海社区老年人抑郁与认知状况的相关性研究

目的 研究社区居家养老老年人抑郁状况及其与认知障碍的关系.方法 本研究于2020年4月9日-6月15日间,选取842例上海某社区健康体检老年人为研究对象,用老年抑郁量表(GDS)评估其抑郁状态,用简易智力状态检查量表(MMSE)评估其认知功能.结果 分析发现,抑郁组的MMSE得分下降(P=0.005),表明抑郁与认知功...