Blagi kognitivni poremećaj (BKP) je klinički koncept koji se smatra stanjem izmeĎu zdravog starenja i demencije. BKP je heterogeni sindrom, obilježen različitim kliničkim prezentacijama, različitom progresivnosti profila i različitim etiološkim čimbenicima. Depresija je naziv za niz depresivnih poremećaja koji uključuju poremećaj disregulacije raspoloženja. Koegzistiranje depresije i BKP prepoznato je u brojnim epidemiološkim istraživanjima, ali mehanizmi koji leže u podlozi njihova meĎuodnosa nedovoljno su razjašnjeni. Cilj rada bio je dati cjelovit pregled spoznaja o ulozi depresije u razvoju BKP; te o mogućnostima neuropsihologijske diferencijalno-dijagnostičke procjene rizika za razvoj BKP u osoba s depresijom. Značajna povezanost depresije s incidencijom BKP potvrĎena je u većini istraživanja. Depresija može biti rizični čimbenik za razvoj BKP. Osim toga, povezanost depresije i BKP ostvaruje se i zajedničkim čimbenicima- vaskularnim lezijama, AD patologijom, genetskom vezom. Moguće je da depresivni simptomi i promjene bijele tvari imaju aditivni ili sinergistički učinak za razvoj BKP i demencije. Depresija povećava rizik za vaskularne bolesti, a neuronskom štetom može umanjiti učinak kognitivne rezerve i ubrzati javljanje BKP. Rizični čimbenici za incidenciju BKP u depresivnih osoba su starija životna dob, kumulativni depresivni simptomi, dulje razdoblje trajanja depresije, veći intenzitet depresivnih simptoma, niska, ali i visoka zastupljenost patologije AD, sinergistička aditivna interakcija nedostatka tjelesne aktivnosti i poteškoća spavanja, kliničke depresije i klinički značajne anksioznosti, niža interpersonalna podrška, muški rod, niži stupanj formalnog obrazovanja, aktualno posjedovanje recepta za korištenje antidepresiva. Istovremeno, korištenje antidepresiva definirano na temelju ikada prijavljene upotrebe pokazuje se zaštitnim čimbenikom smanjujući vjerojatnost BKP. Zaštitni čimbenici koji utječu na povećanu vjerojatnost reverzije BKP u uredno kognitivno funkcioniranje u depresivnih osoba su mlaĎa dob, neamnestički podtip BKP, niži intenzitet depresivnih simptoma ili pak smanjenje depresivnih simptoma od prve do naredne točke mjerenja. Pregled dosadašnjih spoznaja ukazuje na važnu ulogu kliničke neuropsihologijske procjene u diferencijaciji depresije i BKP. Od probirnih testova ističe se digitalna baterija THINC-it. Predložene neuropsihologijske baterije sadrže testove za mjerenje pamćenja, brzine procesiranja, izvršnih funkcija, jezika, te rjeĎe vizuokonstruktivnih sposobnosti. Istaknuti su i psihologijski mjerni instrumenti kao potencijalni markeri BKP u skupini depresivnih. Identifikacija rizičnih čimbenika za razvoj BKP u depresivnih osoba može pomoći prevenciji.
|Abstract (english)|| |
Mild cognitive impairment (MCI) is a clinical concept, considered as a transitional stage of cognitive function between that seen in normal aging and dementia, affects 15% - 20% of the population 60 years and older (Petersen, 2016). Dementia is a growing public health problem. The annual rate of progression of MCI to dementia varies between 8 and 15%, compared to the annual rate of progression in the general population, 1-2% (Petersen et al., 2001). The pathological process in Alzheimer's dementia begins much earlier than the initial symptoms, which is why early recognition is important. Diagnosing MCI reveals the early signs of the initial phase of Alzheimer's disease and other dementias and enables the potential delay of progression, which has become an increasingly prominent imperative for research into its treatment in the last twenty years. A significant part of MCI cases occur due to non-neurodegenerative processes, caused by many other underlying conditions. Significant numbers of patients diagnosed with MCI do not progress to dementia, and significant part reverse from MCI to normal cognitive functioning. Studies have provided unambiguous evidence that depression increase the risk of progression to dementia in subjects with MCI. Depression is the name for a number of depressive disorders. Data on the prevalence of depression in the general population vary from 0.6 - 25% (Mimica et al., 2004), with depression being two to three times more common in women than in men (American Psychiatric Association, 2004). Although it can appear at any age, it most often appears between the ages of twenty-five and forty (Karlović, 2017). The public health consequences of depression are great. Research by the World Health Organization states that depression is the most severe disease in the world in terms of disability among middle-aged people (Murray & Lopez, 1996). Longitudinal comorbidity of depression and cognitive impairment has been reported by number of epidemiological studies but the underlying mechanisms explaining the link between are not very well understood. Little is known about the associations of specific depressive disorders to mild cognitive impairment. Recent research indicates that, apart from the fact that depression and MCI often coexist, even after cognitive recovery and remission of depression, patients with comorbid depression and MCI in the anamnesis are at greater risk for developing dementia than depressed patients with normal cognitive functioning. People with MCI have an increased probability of developing dementia than people with normal cognitive functioning, and this probability increases if MCI occurs in comorbidity with depression. Predictors of increased risk for the development of MCI in persons with depressive disorders have been little investigated. In addition to them, it is important to examine the stability of MCI over time and whether there are any protective factors predictive of the transformation of MCI into regular cognitive functioning in the group of depressed. The purpose of this scoping review is to give a comprehensive overview of previous research that has examined which clinical features in the group of depressed is associated with greater risk of mild cognitive impairment development, identified the clinical depressive symptoms associated with mild cognitive impairment, and examined whether these associations differ depending on gender, age and other sociodemographic characteristics; in order to better understand the phenomenology of MCI. Identification of risk factors could facilitate prevention of MCI development among depressed. Likewise, the aim of this scoping review is to comprehend knowledge about the role of neuropsychological assessment in the differential diagnosis of possibilities of differential diagnostic neuropsychological assessment of the risk for the development of mild cognitive impairment among depressed. To our knowledge, no scoping review has been conducted on this topic up to date. The paper has been written based on a literature review in the field of mild cognitive impairment. By searching electronic scientific databases Pubmed, Web of Science, Science direct, PsychInfo, Scopus and OVID, scientific papers were collected that had been published before the final date of the search, May 9, 2022. Due to clinical and methodological heterogeneity, no meta-analysis was performed, but the paper is presented as a review article using a narrative form. The significant connection between depression and the incidence of MCI has been confirmed in most studies. Depression can be a risk factor for the development of MCI. In addition, the connection between depression and MCI is realized by common factors - vascular lesions, pathology related to Alzheimer's dementia, genetic link. It is possible that depressive symptoms and white matter changes have an additive or synergistic effect on the development of MCI and dementia. Depression increases the risk for vascular diseases, and neuronal damage can reduce the effect of cognitive reserve and accelerate the occurrence of MCI. Risk factors for the incidence of MCI in depressed people are older age, cumulative depressive symptoms, longer period of depression, greater intensity of depressive symptoms, low but also high prevalence of AD pathology, synergistic additive interaction of lack of physical activity and sleep difficulties, clinical depression and clinically significant anxiety, lower interpersonal support, male gender, lower level of formal education, current possession of a prescription for the use of antidepressants. At the same time, the use of antidepressants defined on the basis of ever reported use appears to be a protective factor reducing the likelihood of MCI.Protective factors that affect the increased likelihood of MCI reversion to normal cognitive functioning in depressed individuals are younger age, non-amnestic subtype of MCI, lower intensity of depressive symptoms or a decrease in depressive symptoms from the first to the next measurement point. An overview of current findings indicates the important role of clinical neuropsychological assessment in the differentiation of depression and MCI. A clinical neuropsychological assessment, rather than the results of neuropsychological tests alone, is necessary to establish a diagnosis of MCI, given that the neuropsychological profiles of different disorders overlap, and that test scores depend on a number of factors that the clinician takes into account when interpreting. The proposed neuropsychological batteries that distinguish depressed groups with normal cognitive functioning from those with MCI contain tests for measuring memory, attention/processing speed, executive functions, language, and less often visual constructive abilities, considering them the core of neuropsychological deficits of people with depression in adulthood. Psychological measuring instruments have also been highlighted as potential markers of MCI in the group of depressed. Identification of risk factors for the development of MCI in depressed individuals may help in prevention. The greatest practical implication of this work is professional, as it helps to identify risk factors that should be kept in mind during assessment. Also, identifying patients at risk for developing MCI in the depressed group is important because they are potential candidates for providing interventions. The listed risk and protective factors of MCI incidence in depressed individuals indicate the potential of therapies aimed at treating depression. Data from intervention studies on the reduction of the risk of MCI in the general population, and especially in depressed groups, are still rare. The potential effect of psychotherapy and cognitively stimulating activities on the prevention of MCI, or the return of MCI to the normal cognitive functioning of depressed people, as emphasized by some authors, has not been sufficiently examined.