老人憂鬱與認知功能障礙

Geriatric Depression and Cognitive Impairment

翁菁甫(Ching-Fu Weng) ； 林坤霈(Kun-Pei Lin) ； 詹鼎正(Ding-Cheng Chan)

《內科學誌》 25卷3期 (2014/06) Pp. 158-164

https://doi.org/10.6314/JIMT.2014.25(3).05

摘要

如何正確區分老年人憂鬱症與認知功能障礙，往往是臨床醫師所面臨極大的挑戰，尤其在高齡化社會越趨明顯的今日，老年人常見心智障礙如失智（Dementia）、憂鬱（Depression）、譫妄（Delirium）等問題，越來越受到關注。許多老年人已罹患憂鬱症，但在環境及心理因素影響下，普遍不願表達或否認自我低落情緒，最後以各式身體症狀為主要抱怨，此情形常被照顧者或臨床醫師誤認為內科疾病，因而安排過多檢查，造成醫療資源浪費，延誤治療時機。此外，老年人輕度認知功能障礙（mild cognitive impairment, MCI ）常與憂鬱症有類似表現，但在病程特徵上仍然有所不同，若能早期發現並加以治療，將有助於延緩發展成失智症（dementia）。憂鬱及認知功能障礙等問題，在老年族群盛行率越來越高，能夠正確診斷並區 分並不容易。若能適當運用老年周全性評估（Comprehensive Geriatric Assessment）介入，將可提高診斷率，並予以藥物及行為治療，最終達到改善老年人日常生活功能（Activities of Daily Living, ADL）、減少老年功能退化（functional decline），並協助老年人達到良好生活品質的目的。了解老年憂鬱與失智不只是老年醫學相關科別醫師的工作，臨床護理人員、主要照顧者或長照機構照服人員等，皆應主動查覺老年人情緒及認知功能改變，進而尋求醫療協助，避免增加日後治療上的困難。

關鍵字

老年（Geriatric, Elderly） ； 認知功能障礙（Cognitive impairment） ； 失智（Dementia） ； 憂鬱（Depression）

並列摘要

Increases in the number of elder population will have a profound impact on the old age associated problem. Common psychiatric disorder and cognitive dysfunction seen in aging persons are depression and dementia, that also the great challenge for clinician to accurately differentiate and diagnose. Elder people may not express low mood by themselves even though depression had persisted for a period of time. Multiple physical complaint may mask the true psychiatric illness as depression, leading to confusion or misdiagnosis as internal medical program by clinician, thus delay the appropriate treatment. On the other hand, mild cognitive impairment share many similar clinical presentation as depression. The accurate differential diagnosis is based on distinct characters of different disease course, and earlier intervention could refrain from mild cognitive impairment entering into dementia. We highlight that clinical practitioner, nursing staff, main care giver and geriatric doctor all have to learn more about this issue. The role of comprehensive geriatric assessment (CGA) for elder people help increasing correct diagnosis of depression or cognitive dysfunction, and benefit maintaining activities of daily living, also prevent from functional decline and improve quality of life.