遷延性抑うつ状態が先行したCreutzfeldt-Jakob病の1剖検例

An Autopsied Case of Creutzfeldt-Jakob Disease Preceded by a Prolonged Depressive State

　【抄録】2年間という長期にわたる抑うつ状態の後に発症したCreutzfeldt-Jakob病（CJD）の症例を報告した。本例は，2年間にわたって軽うつ状態が持続し，遷延性うつ病の診断で，入院となった。入院治療により3か月ほどで軽快し，退院を考えた矢先，痴呆様の症状が現れ，以後，急速に意識障害が進み，ミオクローヌス・周期性同期性放電がみられ，無動無言状態となった。神経病理学的にもCJDと診断された。CJDの初発精神症状として，抑うつはまれではないが，通常，初期症状は数週間とされている。本例の抑うつ状態は，CJDの初期症状である可能性も否定はできないが，内因性うつ病との合併の可能性が高いと考えられた。

　Depressive state is often observed as an early symptom of Creutzfeldt-Jakob disease, but it usually lasts for a few weeks. We present a 70-year-old woman with Creutzfeldt-Jakob disease which was preceded by a depressive state for two years.

　She had been suffering from a subdepressive state for two years, and then was admitted to our hospital with a diagnosis of prolonged depression. Although she was getting better throughout three months of her hospitalization, she started to develop dementia, and soon myoclonus, and later akinetic mutism. The electroencephalogram revealed periodic synchronous discharge. She was diagnosed as having Creutzfeldt-Jakob disease, and died about a year after her admission. The neuropathological examination showed spongiform encephalopathy compatible with the disease.

　Because the period of her depression seems to have been too long to be regarded as an early symptom of Creutzfeldt-Jakob disease, and because, by overall observation of her case, we can detect characteristics of endogenous depression in her depressive state, we suspect that her depression was endogenous.