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Originalia

Leichte kognitive Beeinträchtigung bei älteren depressiven Patienten

Mild Cognitive Impairment in Elderly Depressed Patients

Published Online:September 01, 2006https://doi.org/10.1024//1011-6877.12.2.97

Abstract

Zusammenfassung: Bei älteren depressiven Patienten bestehen gelegentlich kognitive Beeinträchtigungen vom Ausmaß einer Demenz. Dieses dementielle Syndrom bildet sich bei einem Teil der Patienten mit dem Abklingen der Depression zurück, stellt aber einen Risikofaktor für die Entwicklung einer irreversiblen Demenz dar. Unklar ist bislang die prognostische Bedeutung leichter kognitiver Einschränkungen, die nicht das Ausmaß einer Demenz erreichen. Wir untersuchten bei 24 älteren depressiven Patienten (mittleres Alter: 72,2 Jahre) die Schwere der depressiven Symptomatik und das Ausmaß kognitiver Beeinträchtigungen vor und nach einer sechswöchigen antidepressiven Behandlung. Ausschlußkriterium war ein Mini-Mental-State Wert unter 24. 16 von 24 Patienten litten vor Behandlung an einer leichten kognitiven Beeinträchtigung. Bei der Nachuntersuchung von 14 dieser Patienten zeigte sich bei 10 ein Fortbestehen leichter kognitiver Beeinträchtigungen. Prädiktiv für das Weiterbestehen der Beeinträchtigungen war das Ausmaß der Einschränkungen im Kurzzeitgedächtnis vor Behandlung. Kein Zusammenhang bestand zwischen dem Ausmaß kognitiver Einschränkungen und der Schwere der Depression. Diese Befunde weisen auf eine eigenständige Bedeutung leichter kognitiver Beeinträchtigungen bei älteren depressiven Patienten hin. Eine engmaschige Betreuung dieser Patienten erscheint vor diesem Hintergrund angebracht, um bei einer weiteren Verschlechterung des kognitiven Leistungsvermögens frühzeitig intervenieren zu können.


Summary: Cognitive impairment classifying for dementia syndrome is occasionally detected in patients suffering from old-age depression. When depression improves, cognitive function also may reverse to normal, but these patients are at greater risk for developing irreversible dementia in the further course. The prognostic significance of mild cognitive impairment in old-age depression is not known yet. We examined the severity of depressive symptoms and of cognitive impairment in 24 elderly depressed patients (mean age: 72.2 years) before and after a 6 week antidepressant treatment. Patients scoring lower than 24 in the Mini Mental State Examination were excluded from the study. 16 patients suffered from mild cognitive impairment. Reexamination of 14 of them after treatment confirmed the persistence of mild cognitive impairment in 10. The extent of impairment in short-term memory before treatment predicted the persistence of cognitive impairment. There was no correlation between the extent of cognitive impairment and the severity of depression. These findings point to an independent significance of mild cognitive impairment in old-age depression. It is suggested that patients with old-age depression suffering from mild cognitive impairment need close follow up in order to detect further cognitive decline and start intervention early.

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