nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2020-4-100-106nnp-1421Research ArticleREVIEWSОБЗОРЫDepression and dementia: differentiation and comorbidityДепрессия и деменция: дифференциация и коморбидностьЛобзинВ. Ю.LobzinV. Yu.

Владимир Юрьевич Лобзин

194044, Санкт-Петербург, ул. Академика Лебедева, 6191015, Санкт-Петербург, ул. Кирочная, 41 

Vladimir Yuryevich Lobzin

6, Academician Lebedev St., Saint Petersburg 19404441, Kirochnaya St., Saint Petersburg 191015 

vladimirlobzin@mail.ruЕмелинА. Ю.EmelinA. Yu.

Кафедра нервных болезней

194044, Санкт-Петербург, ул. Академика Лебедева, 6

Department of Nervous System Diseases

6, Academician Lebedev St., Saint Petersburg 194044

Кафедра нервных болезней ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны России; кафедра неврологии им. акад. С.Н. Давиденкова ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииРоссияDepartment of Nervous System Diseases, S.M. Kirov Military Medical Academy, Ministry of Defense of Russia; Acad. S.N. Davidenkov Department of Neurology, I.I. Mechnikov North-Western State Medical University, Ministry of Health of RussiaRussian FederationФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны РоссииРоссияS.M. Kirov Military Medical Academy, Ministry of Defense of RussiaRussian Federation202027082020124100106Copyright © Lobzin V.Y., Emelin A.Y., 20202020Лобзин В.Ю., Емелин А.Ю.Lobzin V.Y., Emelin A.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/1421

The relationship between cognitive impairment (CI) and depression is complicated: h\the latter can be one of the symptoms of Alzheimer’s disease or may precede the onset of CI. Depression also has cognitive symptoms that alter the clinical presentation of the disease. Patients with depressive pseudodementia experience difficulties concentrating, confusion concurrent with impaired memory and thinking, whereas the patient’s answers to certain questions often resemble the vague pseudoamnestic pattern of the impairment. Mnestic disorders occur in at least 40% of patients with depression, and if the latter is diagnosed in the patient who already has dementia, the rate of cognitive decline may be faster. The mechanisms underlying the development of CI can also affect the development of depression. When assessing the risk of dementia in depression, it is necessary to take into account the time from the onset of a major depressive episode until moderate CI appears, to carry out a detailed analysis of neuropsychological testing for Alzheimer’s disease and to use the current lifetime markers for amyloidosis and neurodegeneration. Serotonergic antidepressants and non-pharmacological cognitive behavioral and psychotherapeutic procedures play the most important role in the treatment of depression and dementia.

Взаимосвязь когнитивных нарушений (КН) и депрессии сложна: депрессия может быть одним из симптомов болезни Альцгеймера, а может предшествовать появлению КН. При депрессии также наблюдаются когнитивные симптомы, которые меняют клиническую картину заболевания. При депрессивной псевдодеменции больные испытывают трудности сосредоточения, растерянность в сочетании с нарушениями памяти и мышления, а ответы пациента на те или иные вопросы часто заставляют думать о неопределенном псевдоамнестическом характере нарушений. Мнестические расстройства у больных с депрессией встречаются не менее чем в 40% случаев, а если депрессия диагностируется у пациента, уже имеющего деменцию, то темп когнитивного снижения может ускоряться. Механизмы, лежащие в основе формирования КН, способны оказывать влияние и на развитие депрессии. При оценке риска развития деменции при депрессии необходимо учитывать время, прошедшее от начала большого депрессивного эпизода до появления умеренных КН, проводить тщательный анализ нейропсихологического тестирования, направленного на выявление болезни Альцгеймера, и использовать современные прижизненные маркеры амилоидоза и нейродегенерации. В лечении депрессии и деменции важнейшую роль играют серотонинергические антидепрессанты, а также немедикаментозные когнитивно-поведенческие и психотерапевтические методики.

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The authors declare that there are no conflicts of interest present.