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Expressions of depression in Alzheimer's disease. The current scientific debate

Published online by Cambridge University Press:  11 October 2011

Matteo Balestrieri
Matteo Balestrieri*
Affiliation:
Cattedra di Psichiatria, Dipartimento di Patologia e Medicina S.C., Università di Udine, Udine
*
Indirizzo per la corrispondenza: Professor M. Balestrieri, Clinica Psichiatrica, Policlinico Universitario, P.le S.M.Misericordia, 33100 Udine. Fax: +39-0432-545.526 E-mail: m.balestrieri@raed.uniud.it
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Summary

Scope – This overview analyses findings coming from researches that considered the interaction between depression and Alzheimer's disease (AD). Method – Information was collected from the Medline database and from a reasoned manual analysis of the published studies. Results – The prevalence of depressive symptoms in patients with AD is elevated (40-50%). The role of depression in the pathogenesis of AD (independent, prodromal symptom, factor of risk) still must be defined. Data on family history of depression suggest that AD could act as stimulus triggering depression from a basis of a genetic vulnerability. From a biological point of view the onset of depression could derive from an unbalance between cholinergic and noradrenergic systems. Psychological understanding sees depression as a reaction of mourning for the cognitive deficit. Current diagnostic instruments validated on patients with AD constitute a good aid for the clinician and the researcher. The identification of depression coexisting with AD is difficult, in absence of clear affective symptoms, since the cognitive, psychomotor and vegetative symptoms belong both to depression and to AD. The affective disorders most frequently reported are major depression and dysthymia. The use of antidepressant drugs with the lowest anticholinergic profile is strongly recommended. Good results have been obtained also using various psychoterapeutic interventions adapted for dementia sufferers. Conclusions – The current scientific debate is based on information still limited and sparse. Future analyses should consider a better definition of the hypotheses related to psychopathology in AD, a standardised definition of cases and selection procedures and a prospective longitudinal design.

Riassunto

Scopo – In questa rassegna sono stati raccolti ed analizzati i dati conoscitivi provenienti da ricerche che si occupano della relazione tra depressione e malattia di Alzheimer (Alzheimer's Disease, AD). Metodo – E' stata analizzata in modo sistematico la letteratura, attingendo sia alle segnalazione presenti nella banca-dati Medline che alle informazioni ricavabili da una analisi ragionata degli studi pubblicati. Risultati – La prevalenza di segni e sintomi depressivi nei pazienti con AD è piuttosto elevata (40-50%). II ruolo della depressione all'interno dell'AD (indipendente, prodromo, fattore di rischio) deve in realtà essere ancora definito. I dati sulla familiarità per la depressione suggeriscono che l'AD agisca come stimolo scatenante la depressione su una base di vulnerabilità genetica. Su un versante biologico l'insorgenza di depressione nell'AD potrebbe derivare da uno sbilanciamento tra sistema colinergico e noradrenergico, mentre sul versante della comprensione psicologica la depressione costituirebbe una reazione di lutto per il decadimento cognitivo. Gli attuali strumenti diagnostici validati in pazienti con AD costituiscono un buon ausilio nella clinica e nella ricerca. L'individuazione di una depressione nel corso di un AD rimane in realtà sempre difficoltosa se non sono presenti sintomi affettivi franchi, poichè i sintomi cognitivi, psicomotori e vegetativi appartengono sia alia depressione che all'AD. I disturbi affettivi più frequentemente riportati sono la depressione maggiore e la distimia. Nel trattamento farmacologico si suggerisce l'utilizzo dei farmaci antidepressivi con minori effetti anticolinergici. Buoni risultati sono stati ottenuti anche adattando diversi tipi di psicoterapia alle particolari esigenze del paziente demente. Conclusioni – L'attuale dibattito scientifico si basa su conoscenze ancora limitate e parcellizzate. La futura ricerca in questo campo dovrà produrre studi che siano in grado di soddisfare criteri di indagine più rigidi, con una migliore definizione dei casi, una stratificazione per fattori di rischio ed una prospettiva longitudinale.

Keywords

depressionAlzheimer's diseaserisk factorsepidemiologygeneticstreatmentdepressionemalattia di Alzheimerfattori di rischioepidemiologiageneticatrattamento.
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 9 , Issue 2 , June 2000 , pp. 126 - 139
Copyright
Copyright © Cambridge University Press 2000

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