Demenz und Suizid

 

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Zusammenfassung:

Obwohl sowohl dementielle Erkrankungen als auch Suizide mit zunehmendem Alter häufiger vorkommen, ist bisher der Zusammenhang zwischen Demenz und suizidalem Verhalten kaum systematisch untersucht worden. In den Studien zur Mortalität bei Demenzen findet sich - im Gegensatz zu den meisten psychiatrischen Erkrankungen - kein erhöhtes Suizidrisiko gegenüber der Allgemeinbevölkerung (SMR =0). Somit ist eine Erhöhung des Suizidrisikos im Alter durch dementielle Erkrankungen nicht gegeben. Auch in Untersuchungen mit der Methode der „psychological autopsy” wurden kaum dementielle Erkrankungen bei Suizidopfern diagnostiziert. In Verlaufsstudien werden bei weniger als 1 % aller Patienten mit Demenz Suizidversuche beobachtet. Depression als wichtiger gemeinsamer Risikofaktor für Suizid und Demenz kommt häufig zusammen mit Demenz vom Alzheimer Typ (Prävalenz zwischen 0 % und 86 %) als auch zusammen mit Multiinfarktdemenz vor (20 % bis 45 %), wobei jedoch Major Depression signifikant häufiger bei vaskulärer Demenz als bei Alzheimer Demenz auftreten soll. Suizidabsichten und -gedanken, Todeswünsche und lebensüberdrüssige Gedanken wurden bei 1 % bis 42 % aller Patienten mit dementiellen Erkrankungen berichtet und kommen vor allem bei gleichzeitigem Vorhandensein einer Depression vor. Bisher nicht systematisch untersuchte Zusammenhänge zwischen kognitiven Defiziten, Einsicht in die Erkrankung bei beginnender Demenz und Suizidalität sowie mögliche Interaktionseffekte werden in dieser Übersichtsarbeit umfassend diskutiert.

Dementia und Suicide:

The relationship between suicide and dementia has not systematically been investigated, although the prevalence of both, dementia and suicide, increases with age. In contrast to patients with other psychiatric disorders, patients with dementia were not found to die from suicide more often than expected (SMR, 0). Thus the diagnosis of dementia does not contribute to the elevated suicide risk in old age. In studies using the psychological autopsy method, dementia was rarely diagnosed in suicide victims. Suicide attempts were observed in less than 1 % of all patients with dementia. Depression as an important common risk factor of suicide and dementia is often found in patients with Alzheimer's disease (0 % to 86 %) as well as in patients with multi-infarct dementia (20 % to 45 %). However major depression was found significantly more often in vascular dementia than in dementia of Alzheimer type. Suicidal thoughts and intents, wishes to die and feelings that life is not worth living were reported in 1 % to 42 % of all patients with dementia, especially if these patients also suffered from depression. This review comprehensively presents the association between cognitive deficits, insight in early stages of dementia and suicidality and possible confounders which have not systematically been investigated up to now.

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Dr B Schneider

Zentrum der Psychiatrie, Klinik für Psychiatrie
und Psychotherapie I
Johann Wolfgang Goethe-Universität

Heinrich-Hoffmann-Str. 10
60528 Frankfurt/Main

Email: E-mail: B.Schneider@em.uni-frankfurt.de