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Depression in Alzheimer’s disease and other dementias

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Abstract

Much of our current knowledge about depression in Alzheimer’s disease and other dementias is based on the 1991 National Instiute of Health Consensus Development Panel on the Diagnosis and Treatment of Depression in Late Life, and its subsequent 1997 update. However, much research has taken place since these reports. This article summarizes this research, particularly research that has taken place in the past year. Comorbid depression is common in all types of dementia. It may, however, appear to be different from classic depression. Unlike classic depression, the depression found in dementia may result from anatomic damage to the brain. This is most clearly demonstrated in vascular depression. The implications of this are many. Treatments for depression are designed for classic depression. For those with vascular depression (and other depressions associated with dementia) treatments may not be as efficacious. Newer strategies, including agents not commonly thought of as antidepressants, may be needed.

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References and Recommended Reading

  1. National Institutes of Health: Diagnosis and treatment of depression in late life. NIH Cons Statement 1991, 9:1–27.

    Google Scholar 

  2. Lebowitz BD, Pearson JL, Schneider LS, et al.: Diagnosis and treatment of depression in late life. Consensus statement update. JAMA 1997, 278:1186–1190.

    Article  PubMed  CAS  Google Scholar 

  3. Mast BT, MacNeill SE, Lichtenberg PA: Geropsychological problems in medical rehabilitation: dementia and depression among stroke and lower extremity fracture patients. J Gerontol A Biol Sci Med Sci 1999, 54:M607–612.

    PubMed  CAS  Google Scholar 

  4. Vilalta-Franch J, Llinas-Regla J, Lopez-Pousa S: Depression and dementia: case-control study [in Spanish]. Rev Neurol 1999, 29:599–603.

    PubMed  CAS  Google Scholar 

  5. Forsell Y, Winblad B: Major depression in a population of demented and nondemented older people: prevalence and correlates. J Am Geriatr Soc 1998, 46:27–30.

    PubMed  CAS  Google Scholar 

  6. Radloff LS: The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measure 1977, 1:385–401.

    Article  Google Scholar 

  7. Papassotiropoulos A, Heun R, Maier W: Age and cognitive impairment influence the performance of the General Health Questionnaire. Compr Psychiatry 1977, 38:335–340.

    Article  Google Scholar 

  8. Kunik ME, Snow-Turek AL, Iqbal N, et al.: Contribution of psychosis and depression to behavioral disturbances in geropsychiatric inpatients with dementia. J Gerontol A Biol Sci Med Sci 1999, 54:M157–161.

    PubMed  CAS  Google Scholar 

  9. Lyketsos CG, Steele C, Galik E, et al.: Physical aggression in dementia patients and its relationship to depression. Am J Psychiatry 1999, 156:66–71.

    PubMed  CAS  Google Scholar 

  10. Robinson RG, Price TR: Post-stroke depressive disorders: a follow-up study of 103 patients. Stroke 1982, 13:635–641.

    PubMed  CAS  Google Scholar 

  11. Alexopoulos GS, Meyers BS, Young RC, et al.: “Vascular Depression” hypothesis. Arch Gen Psychiatry 1997, 54:915–922.

    PubMed  CAS  Google Scholar 

  12. Simpson S, Allen H, Tomenson B, Burns A: Neurological correlates of depressive symptoms in Alzheimer’s disease and vascular dementia. J Affect Disord 1999, 53:129–36.

    Article  PubMed  CAS  Google Scholar 

  13. Hargrave R, Geck LC, Reed B, Mungas D: Affective behavioral disturbances in Alzheimer’s disease and ischaemic vascular disease. J Neurol Neurosurg Psychiatry 2000, 68:41–46.

    Article  PubMed  CAS  Google Scholar 

  14. Lyness JM, Caine ED, Cox C, et al.: Cerebrovascular risk factors and later-life major depression. Testing a small-vessel brain disease model. Am J Geriatr Psychiatry 1998, 6:5–13.

    PubMed  CAS  Google Scholar 

  15. Kramer-Ginsberg E, Greenwald BS, Krishnan KRR, et al.: Neuropsychological functioning and MRI signal hyperintensities in geriatric depression. Am J Psychiatry 1999, 156:438–444.

    PubMed  CAS  Google Scholar 

  16. Ritchie K, Gilham C, Ledesert B, et al.: Depressive illness, depressive symptomatology and regional cerebral blood flow in elderly people with sub-clinical cognitive impairment. Age Ageing 1999, 28:385–91.

    Article  PubMed  CAS  Google Scholar 

  17. Palsson, S, Aevarsson O, Skoog I: Depression, cerebral atrophy, cognitive performance and incidence of dementia: population study of 85-year-olds. Br J Psychiatry 1999, 174:249–253.

    Article  PubMed  CAS  Google Scholar 

  18. Gregory, CA: Frontal variant of frontotemporal dementia: a cross-sectional and longitudinal study of neuropsychiatric features. Psychol Med 1999, 29:1205–1217.

    Article  PubMed  CAS  Google Scholar 

  19. Sheline, YI: Hippocampal atrophy in major depression: a result of depression-induced neurotoxicity? Mol Psychiatry 1996, 1:298–299.

    PubMed  CAS  Google Scholar 

  20. Ashtari M, Greenwald BS, Kramer-Ginsberg E, et al.: Hippocampal/amygdala volumes in geriatric depression. Psychol Med 1999, 29:629–638.

    Article  PubMed  CAS  Google Scholar 

  21. Hoogendijk WJG, Sommer IEC, Pool CW, et al.: Lack of association between depression and loss of neurons in the locus coeruleus in Alzheimer Disease. Arch Gen Psychiatry 1999, 56:45–51.

    Article  PubMed  CAS  Google Scholar 

  22. Ballard C, Holmes C, McKeith I, et al.: Psychiatric morbidity in dementia with Lewy bodies: a prospective clinical and neuropathological comparative study with Alzheimer’s disease. Am J Psychiatry 1999, 156:1039–1045.

    PubMed  CAS  Google Scholar 

  23. Meltzer CC, Price JC, Mathis CA, et al.: PET imaging of serotonin type 2A receptors in late-life neuropsychiatric disorders. Am J Psychiatry 1999, 156:1871–1878.

    PubMed  CAS  Google Scholar 

  24. Benedict RH, Dobraski M, Goldstein MZ: A preliminary study of the association between changes in mood and cognition in a mixed geriatric psychiatry sample. J Gerontol B Psychol Sci Soc Sci 1999, 54:P94–99.

    PubMed  CAS  Google Scholar 

  25. Geerlings MI, Deeg D, Penninx B, et al.: Cognitive reserve and mortality in dementia: the role of cognition, functional ability and depression. Psychol Med 1999, 29:1219–1226.

    Article  PubMed  CAS  Google Scholar 

  26. Janzing JGE, Bouwens JMP, Teunisse RJ, et al.: The relationship between depression and mortality in elderly subjects with less severe dementia. Psychol Med 1999, 29:979–983.

    Article  PubMed  CAS  Google Scholar 

  27. Reynolds CF, Frank E, Perel JM, et al.: Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years. JAMA 1999, 281:39–45. An important study targeting geriatric depression. Also notable as one of the few studies investigating psychotherapy in elderly patients with depression.

    Article  PubMed  CAS  Google Scholar 

  28. Tuma TA: Outcome of hospital-treated depression at 4.5 years. An elderly and a younger adult cohort compared. Br J Psychiatry 2000, 176:224–228.

    Article  PubMed  CAS  Google Scholar 

  29. Arfken CL, Lichtenberg PA, Tancer ME: Cognitive impairment and depression predict mortality in medically ill older adults. J Gerontol. A Biol Sci Med Sci 1999:54:M152–156.

    PubMed  CAS  Google Scholar 

  30. Kales HC, Blow FC, Copeland LA, et al.: Health care utilization by older patients with coexisting dementia and depression. Am J Psychiatry 1999, 156:550–556.

    PubMed  CAS  Google Scholar 

  31. Devanand DP, Sano M, Tang MX, et al.: Depressed mood and the incidence of Alzheimer’s disease in the elderly living in the community. Arch Gen Psychiatry 1996, 53:175–182.

    PubMed  CAS  Google Scholar 

  32. Berger AK, Fratiglioni L, Forsell Y, et al.: The occurrence of depressive symptoms in the preclinical phase of AD: a population-based study. Neurology 1999, 53:1998–2002.

    PubMed  CAS  Google Scholar 

  33. Henderson AS, Korten AE, Jacomb PA, et al.: The course of depression in the elderly: a longitudinal community-based study in Australia. Psychol Med 1997, 27:119–129.

    Article  PubMed  CAS  Google Scholar 

  34. Chen P, Ganguli M, Mulsant BH, DeKosky ST: The temporal relationship between depressive symptoms and dementia: a community-based prospective study. Arch Gen Psychiatry 1999, 56:261–266.

    Article  PubMed  CAS  Google Scholar 

  35. Donaldson C, Tarrier N, Burns A: Determinants of carer stress in Alzheimer’s disease. Int J Geriatr Psychiatry 1998, 13:248–256.

    Article  PubMed  CAS  Google Scholar 

  36. Brodaty H, Luscombe G: Psychological morbidity in caregivers is associated with depression in patients with dementia. Alzheimer Dis Assoc Disord 1998, 12:62–70.

    Article  PubMed  CAS  Google Scholar 

  37. Dyer CB, Pavlik VN, Murphy KP, Hyman DJ: The high prevalence of depression and dementia in elder abuse or neglect. J Am Geriatr Soc 2000, 48:205–208.

    PubMed  CAS  Google Scholar 

  38. Simpson S, Baldwin RC, Jackson A. Burns AS: Is subcortical disease associated with a poor response to antidepressants? Neurological, neuropsychological and neuroradiological findings in late-life depression. Psychol Med 1998, 28:1015–1026.

    Article  PubMed  CAS  Google Scholar 

  39. Amrein R, Martin JR, Cameron AM: Moclobemide in patients with dementia and depression. Adv Neurol 1999, 80:509–519.

    PubMed  CAS  Google Scholar 

  40. Katona CL, Hunter BN, Bray J: A double-blind comparison of the efficacy and safely of paroxetine and imipramine in the treatment of depression with dementia. Int J Geriatr Psychiatry 1998, 13:100–108. One of the few rigorous trials of antidepressants in patients with dementia.

    Article  PubMed  CAS  Google Scholar 

  41. Mega MS, Masterman DM, O’Connor SM, et al.: The spectrum of behavioral responses to cholinesterase inhibitor therapy in Alzheimer disease. Arch Neurol 1999, 56:1388–1393. This important study posits a psychotropic role for cholinesterase inhibitors. Important not only clinically, but in suggesting novel approaches to the depression associated with dementia.

    Article  PubMed  CAS  Google Scholar 

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  1. Center for Behavioral and Preventive Medicine, Miriam Hospital/LifeSpan, 164 Summit Avenue, 02906, Providence, RI, USA

    Robert J. Boland MD

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  1. Robert J. Boland MD
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Boland, R.J. Depression in Alzheimer’s disease and other dementias. Curr Psychiatry Rep 2, 427–433 (2000). https://doi.org/10.1007/s11920-000-0028-0

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  • DOI: https://doi.org/10.1007/s11920-000-0028-0

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