Controversies in geriatric medicineDepression and dementia. A review
Introduction
Dementia is a brain disorder causing progressive change in cognitive functions, such as memory, language, rational thinking and social skills, as well as emotion and personality [1], [2], [3]. It presents a significant variability of clinical pictures. Many patients with Alzheimer's disease (AD) have depressed mood [1], and other behavioral symptoms [4], [5], [6], [7], [8]. Depression is also common in other types of degenerative dementias, including those that arise in frontotemporal dementia (FTD), Parkinson's disease dementia (PDD), Huntington's disease (HD), and in vascular dementia (VaD) [9].
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Disease outcomes
Depression, when present with dementia, can adversely affect multiple areas of functioning in patients as well as caregivers. It is most strongly associated with reduced patient quality of life [10], and has been shown to have a negative impact on patients’ activities of daily living, even after adjusting for degree of cognitive decline and medical conditions [11], [12]. There are increased chances of early institutionalization of dementia patients with comorbid depression [13], and greater
AD
Depression is often seen early in the course of AD. Studies have reported that the rates of depression in AD range anywhere from 1% to 90% although most estimates fall between 30% and 50% [23] (Table 1). A significant source of variability arises from differences in the tools used to assess for mood changes across studies [24]. Vilalta-Franch et al. [25] examined the prevalence rate of depression according to five different conceptualizations [diagnostic criteria of ICD-10 [26] and DSM–IV [27]
Depression as risk factor or prodrome of dementia?
Whereas depression earlier in life would not be confused with dementia, early symptoms of dementia in older adults could be misdiagnosed as depression. The relationship between depression and the risk for later development of dementia is yet unclear. A personal history of depression has been related to increased risk for developing AD later in life, although this finding has not been universal. One study found that the risk of dementia among members of an AD registry was approximately twice as
Aetiology and pathophysiology
The heterogeneity of late-life depression and its association with cerebrovascular risk factors [89], physiologic changes related to aging [90], serotonergic dysfunction [91], structural brain changes [92], suggest that clinical expression of dementia may be related to a confluence of brain insults and diminished cognitive reserve. Underlying mechanisms, which may be associated with both dementia and depression, are neurotransmitter changes. Reduced levels of brain serotonin (5-HT) and
Assessment
The diagnosis of depression is based on the presence of a set of signs and symptoms that make up a continuum from lesser to greater intensity and frequency. An issue under debate is how to diagnose depression in the context of a chronic neurological illness that involves cognitive decline and prominent behavioral changes. As the dementing illness progresses, the presentation of depression may alter, with non-verbal manifestations (e.g. demanding behavior, clinging) being more apparent than
Management
Common sense would suggest that the initial management of depression in dementia should first of all involve consideration of precipitating factors such as life events or concomitant medication and also the nature of the living situation, both physically and socially [130]. When treating depression in healthy adult population, the clinician can choose from a range of interventions, from pharmacological to cognitive behavioral therapies. Although there is a wide evidence base for the use of
Conclusions
The diagnosis of depression in dementia is not an easy task. Depression and dementia are common in older people and their association is very complex. They contribute to suffering in both patients and their caregivers. It is still unclear whether depression is an early sign, a reaction to cognitive decline, a threshold lowering or possibly even a causal factor in AD. The prevalence of depressive symptoms and syndromal depression in dementia, ranging from 0% to 87%, depends on the scales used
Ethical statement
Research consists basically of a review of the literature and then it does not need the approval of the Ethics Committee.
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
References (141)
- et al.
Neuropsychiatric symptoms and quality of life in Alzheimer disease
Am J Geriatr Psychiatry
(2005) - et al.
Rates of clinical depression diagnosis, functional impairment, and nursing home placement in coexisting dementia and depression
Am J Geriatr Psychiatry
(2005) - et al.
Provisional diagnostic criteria for depression of Alzheimer disease
Am J Geriatr Psychiatry
(2002) - et al.
Dementia and suicidal behavior. Aggression and violent behavior
(2013) - et al.
Depression in Alzheimer's disease: heterogeneity and related issues
Biol Psychiatry
(2003) - et al.
Detecting depression in Alzheimer's disease: evaluation of four different scales
Arch Clin Neuropsychol
(2005) - et al.
Comparison of different clinical diagnostic criteria for depression in Alzheimer disease
Am J Geriatr Psychiatry
(2006) - et al.
Provisional diagnostic criteria for depression of Alzheimer disease: rationale and background
Am J Geriatr Psychiatry
(2002) - et al.
Depression in frontotemporal dementia
Psychosomatics
(2009) Vascular dementia revisited: diagnosis, pathogenesis, treatment, and prevention
Med Clin N Am
(2002)
Anxiety, depression and psychosis in vascular dementia: prevalence and associations
J Affect Disord
Greymatter lesions and dementia
Lancet
The vascular depression hypothesis: an update
Am J Geriatr Psychiatry
Increased neurofibrillary tangles in patients with Alzheimer disease with comorbid depression
Am J Geriatr Psychiatry
The stress system in the human brain indepression and neurodegeneration
Ageing Res Rev
Behavioral and psychological symptoms of dementia: factor analysis and relationship with cognitive impairment
Eur Neurol
Sociopathic behavior and dementia
Acta Neurol Belg
Personality and dementia
J Nerv Ment Dis
Understanding delusion in dementia: a review
Geriatr Gerontol Int
Delusional misidentification syndromes and dementia: a border zone between neurology and psychiatry
Am J Alzheimers Dis Other Demen
Repetitive stereotypic phenomena dementia
Am J Alzheimers Dis Other Demen
Aggressive behavior in patients with dementia: correlates and management
Geriatr Gerontol Int
Uncommon and/or bizarre features of dementia
Acta Neurol Belg
Major depression in primary dementia: clinical and neuropathologic correlates
Arch Neurol
Major and minor depression in Alzheimer's disease: prevalence and impact
J Neuropsychiatry Clin Neurosci
Cognitive impairment and depression in the early 1960s: which is more problematic in terms of instrumental activities of daily living?
Geriatr Gerontol Int
Health care utilization in dementia patients within psychiatric comorbidity
Gerontologist
Major depression as a risk factor for early institutionalization of dementia patients living in the community
Int J Geriatr Psychiatry
Mortality in Alzheimer's disease: a comparative prospective Korean study in the community and nursing homes
Int J Geriatr Psychiatry
Quality of life of patients with dementia in long-term care
Int J Geriatr Psychiatry
Physical aggression in dementia patients and its relationship to depression
Am J Psychiatry
Wandering and dementia
Psychogeriatrics
The construct of minor and major depression in Alzheimer's disease
Am J Psychiatry
The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines
Diagnostic and statistical manual of mental disorders (DSM)
CAMDEX: the Cambridge examination for mental disorders for the elderly
The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia
Neurology
Prospective longitudinal study of depression and anosognosia in Alzheimer's disease
Br J Psychiatry
The specificity of depressive symptoms in patients with Alzheimer's disease
Am J Psychiatry
Variation in psychiatric and behavioural symptoms at different stages of dementia: data from physicians’ examinations and informants’ reports
Dementia
Diagnosis and treatment of depression in Alzheimer's disease: a practical update for the clinician
Dement Geriatr Cogn Disord
The neuropathology of aminergic nuclei in Alzheimer's disease
Ann Neurol
Consortium on DLB
Neurology
Psychiatric morbidity in dementia with Lewy bodies: a prospective clinical and neuropathological comparative study with Alzheimer's disease
Am J Psychiatry
Psychiatric features in diffuse Lewy body disease: a clinicopathologic study using Alzheimer's disease and Parkinson's disease comparison groups
Neurology
A review of Lewy body disease, an emerging concept of cortical dementia
J Neuropsychiatry Clin Neurosci
Dementia with Lewy bodies is associated with higher scores on the Geriatric Depression Scale than is Alzheimer's disease
Psychogeriatrics
Psychopathology at initial diagnosis in dementia with Lewy bodies versus Alzheimer disease: comparison
Int J Geriatr Psychiatry
Depression in autopsy-confirmed dementia with Lewy bodies and Alzheimer's disease
Mt Sinai J Med
Severity of neuropsychiatric symptoms and dopamine transporter levels in dementia with Lewy bodies; a 123I-FP-CIT SPECT study
Mov Disord
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