Depressive Störungen bei Demenzen und milder kognitiver Beeinträchtigung: Komorbidität, Ursache oder Risikofaktor?

Zusammenfassung

Depressive Störungen und demenzielle Erkrankungen treten ab dem 65. Lebensjahr einzeln und zusammen gehäuft auf. Ziel dieser Übersicht ist es, anhand einer systematischen Literaturrecherche eine Reihe von Hypothesen zu diskutieren, die dieses überzufällig häufige, gemeinsame Auftreten erklären sollen. Eine Anzahl von Untersuchungen weist auf biologische Gemeinsamkeiten zwischen Depression und Demenz hin, ohne dass diese in allen Studien untermauert werden können. Die Vorgeschichte einer Depression kann als distaler Risikofaktor für demenzielle Erkrankungen angesehen werden. Besonders nach Ausbruch demenzieller Erkrankungen sind depressive Störungen häufig und der Zusammenhang zwischen beiden wahrscheinlich am stärksten. Bei Patienten mit großer kognitiver Reserve kann eine Depression als Reaktion auf die Wahrnehmung der beginnenden kognitiven Defizite gedeutet werden. Sicherlich können Depressionen bei der Alzheimer-Demenz und anderen Demenzformen als eigene Krankheitsentität angesehen werden, zumal sich die klinischen Syndrome von denen anderer Depressionen in früheren Lebensabschnitten etwas unterscheiden. Studien über die Therapie von Depressionen bei Demenzen haben in den letzten Jahren ein steigendes Interesse gefunden. Dabei müssen jedoch bei der Behandlung älterer Patienten mit Antidepressiva einige Regeln beachtet werden, besonders kardiologische und vegetative Nebenwirkungen.

Abstract

Both depression and dementia occur by themselves or together in elderly subjects aged 65 and above. The aim of this review is to discuss several hypotheses which try to explain the frequent co-occurrence exceeding chance alone, based on a systematic literature search. A series of studies revealed potential biological similarities between both disorders which, however, were not found in all investigations. Lifetime history of depression can be considered as a distant risk factor for dementias. Depression occurs most frequently within one year before and after the onset of dementia, in which the association between both disorders is probably strongest. In a subgroup of subjects with more ”cognitive reserve”, depression was found to be a consequence of patient’s realisation of beginning cognitive deficits. Several studies indicate that depression in Alzheimer and other dementia forms can be considered as a separate disease entity, as the clinical syndrome differs from depression in earlier periods of life. Studies on the therapy of depression in dementia have aroused increasing interest in recent years. Herewith, certain guidelines in the treatment of older patients with antidepressants must be followed.

Schlüsselwörter

depressive Störungen - Demenz vom Alzheimer-Typ - vaskuläre Demenz - milde kognitive Beeinträchtigung

Key words

depressive disorder - Alzheimer dementia - vascular dementia - mild cognitive impairment

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