Advertisement

Depression, Dementia, and Pseudodementia

  • Sara Pozzoli
  • Vera De Carlo
  • Domenico Madonna
Chapter

Abstract

Depression and dementia represent frequent clinical presentations in the elderly population. Both diseases are interlinked. Indeed, depression in the elderly may reflect an increased risk for the later development of dementia. Worldwide, about 47 million people are affected by dementia, which represents about 10% of the general population over 65 years of age. On the other hand, among elderly people, the prevalence of depressive symptoms and major depressive disorder (MDD) is 15% and 1–3%, respectively. Female gender, alcohol and substance or drug abuse, family history, and medical conditions are factors associated with depression in the elderly.

In the present chapter we specifically focus on discrimination between elderly MDD and major neurocognitive disorder. Concerning this point, two steps have to be performed: (1) observation of clinical response to antidepressants’ treatment, taking into consideration a possible longer latency of antidepressants’ efficacy in elderly/lower response to antidepressants in older age, and (2) cross-clinical assessments with neuropsychological evaluation, imaging, and laboratory tests.

Considering the background of the present literature, we pointed out the case of a woman, 72 years old, with a long history of MDD and a recent diagnosis of mild cognitive impairment (MCI). She was referred to our outpatient clinic for a relapsing depressive episode. In the present case presentation, we investigated the differential diagnostic process, observing clinical course, using neuropsychological evaluation, blood and urine laboratory exams, computed tomography, magnetic resonance imaging, positron emission tomography, cerebrospinal fluid analysis, and electroencephalogram.

Keywords

Depression Dementia Pseudodementia Elderly 

References

  1. 1.
    Steffens DC, Otey E, Alexopoulos GS, Butters MA, Cuthbert B, Ganguli M, et al. Perspectives on depression, mild cognitive impairment, and cognitive decline. Arch Gen Psychiatry. 2006;63(2):130.  https://doi.org/10.1001/archpsyc.63.2.130.CrossRefPubMedGoogle Scholar
  2. 2.
    Heser K, Tebarth F, Wiese B, Eisele M, Bickel H, Köhler M, et al. Age of major depression onset, depressive symptoms, and risk for subsequent dementia: results of the German study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe). Psychol Med. 2013;43(8):1597–610.  https://doi.org/10.1017/S0033291712002449.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ownby RL, Crocco E, Acevedo A, John V, Loewenstein D. Depression and risk for Alzheimer disease: systematic review, meta-analysis, and meta-regression analysis. Arch Gen Psychiatry. 2006;63(5):530–8.  https://doi.org/10.1001/archpsyc.63.5.530.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Diniz BS, Butters MA, Albert SM, Dew MA, Reynolds CF. Late-life depression and risk of vascular dementia and Alzheimer’s disease: systematic review and meta-analysis of community-based cohort studies. Br J Psychiatry. 2013;202(5):329–35.  https://doi.org/10.1192/bjp.bp.112.118307.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Mintzer J, Targum SD. Psychosis in elderly patients: classification and pharmacotherapy. J Geriatr Psychiatry Neurol. 2003;16(4):199–206.  https://doi.org/10.1177/0891988703258658.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    WHO-Dementia. World Health Organization endorses global action plan on rising incidence of dementia. Nurs Older People. 2017;29(6):7–7.  https://doi.org/10.7748/nop.29.6.7.s6.CrossRefGoogle Scholar
  7. 7.
    Espinoza RT. Improving the recognition and management of dementia in long-term care: obstacles and opportunities. J Am Med Dir Assoc. 2006;7(2):128–30.  https://doi.org/10.1016/j.jamda.2005.10.002.CrossRefPubMedGoogle Scholar
  8. 8.
    Fillit HM, Doody RS, Binaso K, Crooks GM, Ferris SH, Farlow MR, et al. Recommendations for best practices in the treatment of Alzheimer’s disease in managed care. Am J Geriatr Pharmacother. 2006;4(Suppl A):S9–S28.  https://doi.org/10.1016/j.amjopharm.2006.10.001.CrossRefGoogle Scholar
  9. 9.
    Pazzaglia P. Clinica Neurologica. 7 edizione. Capitolo “Demenze”; 2012.Google Scholar
  10. 10.
    Roberson ED, Hesse JH, Rose KD, Slama H, Johnson JK, Yaffe K, et al. Frontotemporal dementia progresses to death faster than Alzheimer disease. Neurology. 2005;65(5):719–25.  https://doi.org/10.1212/01.wnl.0000173837.82820.9f.CrossRefPubMedGoogle Scholar
  11. 11.
    Rosso SM, Donker Kaat L, Baks T, Joosse M, de Koning I, Pijnenburg Y, et al. Frontotemporal dementia in The Netherlands: patient characteristics and prevalence estimates from a population-based study. Brain J Neurol. 2003;126(Pt 9):2016–22.  https://doi.org/10.1093/brain/awg204.CrossRefGoogle Scholar
  12. 12.
    Brown GM, McIntyre RS, Rosenblat J, Hardeland R. Depressive disorders: processes leading to neurogeneration and potential novel treatments. Prog Neuro-Psychopharmacol Biol Psychiatry. 2017;80(Pt C):189–204.  https://doi.org/10.1016/j.pnpbp.2017.04.023.CrossRefGoogle Scholar
  13. 13.
    Mulsant BH, Ganguli M. Epidemiology and diagnosis of depression in late life. J Clin Psychiatry. 1999;60(Suppl 20):9–15. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10513852
  14. 14.
    CADTH-Depression. Diagnosing, screening, and monitoring depression in the elderly: a review of guidelines – PubMed – NCBI. Canadian Agency for Drugs and Technologies in Health; 2015. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26468558.
  15. 15.
    Copeland JRM, Beekman ATF, Braam AW, Dewey ME, Delespaul P, Fuhrer R, … Wilson KCM. Depression among older people in Europe: the EURODEP studies. World Psychiatry. 2004;3(1):45–9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16633454.
  16. 16.
    Fereshtehnejad S-M, Johannsen P, Waldemar G, Eriksdotter M. Dementia diagnosis, treatment, and care in specialist clinics in two Scandinavian countries: a data comparison between the Swedish Dementia Registry (SveDem) and the Danish Dementia Registry. J Alzheimers Dis. 2015;48(1):229–39.  https://doi.org/10.3233/JAD-150144.CrossRefPubMedGoogle Scholar
  17. 17.
    Miller AM, Begley E, Coen R, Doyle M, Dunne J, Hutchinson S, … Lawlor BA. Clinical consensus guidelines on the application of cerebrospinal fluid biomarkers for Alzheimer’s disease diagnosis: recommendations of the Irish network for biomarkers in neurodegeneration. Ir Med J. 2016;109(10):483. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/28644588.
  18. 18.
    Hofmann W. Guideline-based diagnosis of dementia etiology. Zeitschrift Fur Gerontologie Und Geriatrie. 2012;45(8):761–71–3.  https://doi.org/10.1007/s00391-012-0399-yCrossRefGoogle Scholar
  19. 19.
    APA American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-V; 2013.Google Scholar
  20. 20.
    APA American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV; 1994.Google Scholar
  21. 21.
    Gold DA. An examination of instrumental activities of daily living assessment in older adults and mild cognitive impairment. J Clin Exp Neuropsychol. 2012;34(1):11–34.  https://doi.org/10.1080/13803395.2011.614598.CrossRefPubMedGoogle Scholar
  22. 22.
    Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist. 1969;9(3):179–86. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/5349366.CrossRefGoogle Scholar
  23. 23.
    Ozer S, Young J, Champ C, Burke M. A systematic review of the diagnostic test accuracy of brief cognitive tests to detect amnestic mild cognitive impairment. Int J Geriatr Psychiatry. 2016;31(11):1139–50.  https://doi.org/10.1002/gps.4444.CrossRefPubMedGoogle Scholar
  24. 24.
    Tsoi KKF, Chan JYC, Hirai HW, Wong SYS, Kwok TCY. Cognitive tests to detect dementia: a systematic review and meta-analysis. JAMA Intern Med. 2015;175(9):1450–8.  https://doi.org/10.1001/jamainternmed.2015.2152.CrossRefPubMedGoogle Scholar
  25. 25.
    Carlesimo GA, Caltagirone C, Gainotti G. The mental deterioration battery: normative data, diagnostic reliability and qualitative analyses of cognitive impairment. The group for the standardization of the mental deterioration battery. Eur Neurol. 1996;36(6):378–84. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8954307.CrossRefGoogle Scholar
  26. 26.
    Barthel H, Schroeter ML, Hoffmann K-T, Sabri O. PET/MR in dementia and other neurodegenerative diseases. Semin Nucl Med. 2015;45(3):224–33.  https://doi.org/10.1053/j.semnuclmed.2014.12.003.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Lista S, Toschi N, Baldacci F, Zetterberg H, Blennow K, Kilimann I, et al. Cerebrospinal fluid neurogranin as a biomarker of neurodegenerative diseases: a cross-sectional study. J Alzheimers Dis. 2017;59(4):1327–34.  https://doi.org/10.3233/JAD-170368.CrossRefPubMedGoogle Scholar
  28. 28.
    Società Italiana di Neuroscienze. Expert Panel Alzheimer. Malattia di Alzheimer. Documento di consenso, DSM-V, MMSE, RMN, Liquor, es. ematici per escludere infezioni disdratazione, squilibri elettrolitici, disfunzioni tiroidee; 1999.Google Scholar
  29. 29.
    Neto E, Biessmann F, Aurlien H, Nordby H, Eichele T. Regularized linear discriminant analysis of EEG features in dementia patients. Front Aging Neurosci. 2016;8:273.  https://doi.org/10.3389/fnagi.2016.00273.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    De Carlo V, Calati R, Serretti A (2016). Socio-demographic and clinical predictors of non-response/non-remission in treatment resistant depressed patients: a systematic review. Psychiatry Research. Elsevier Ireland Ltd.Google Scholar
  31. 31.
    Bennett S, Thomas AJ. Depression and dementia: cause, consequence or coincidence? Maturitas. 2014;79(2):184–90.  https://doi.org/10.1016/j.maturitas.2014.05.009.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Butters MA, Young JB, Lopez O, Aizenstein HJ, Mulsant BH, Reynolds CF, … Becker JT. Pathways linking late-life depression to persistent cognitive impairment and dementia. Dialogues Clin Neurosci. 2008;10(3):345–57. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18979948.
  33. 33.
    Sheline YI, Barch DM, Garcia K, Gersing K, Pieper C, Welsh-Bohmer K, et al. Cognitive function in late life depression: relationships to depression severity, cerebrovascular risk factors and processing speed. Biol Psychiatry. 2006;60(1):58–65.  https://doi.org/10.1016/j.biopsych.2005.09.019.CrossRefPubMedGoogle Scholar
  34. 34.
    Panza F, Frisardi V, Capurso C, D’Introno A, Colacicco AM, Imbimbo BP, et al. Late-life depression, mild cognitive impairment, and dementia: possible continuum? Am J Geriatr Psychiatry. 2010;18(2):98–116.  https://doi.org/10.1097/JGP.0b013e3181b0fa13.CrossRefPubMedGoogle Scholar
  35. 35.
    Huang C-Q, Wang Z-R, Li Y-H, Xie Y-Z, Liu Q-X. Cognitive function and risk for depression in old age: a meta-analysis of published literature. Int Psychogeriatr. 2011;23(4):516–25.  https://doi.org/10.1017/S1041610210000049.CrossRefPubMedGoogle Scholar
  36. 36.
    Djernes JK. Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatr Scand. 2006;113(5):372–87.  https://doi.org/10.1111/j.1600-0447.2006.00770.x.CrossRefPubMedGoogle Scholar
  37. 37.
    Enache D, Winblad B, Aarsland D. Depression in dementia: epidemiology, mechanisms, and treatment. Curr Opin Psychiatry. 2011;24(6):461–72.  https://doi.org/10.1097/YCO.0b013e32834bb9d4.CrossRefPubMedGoogle Scholar
  38. 38.
    Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, et al. Global prevalence of dementia: a Delphi consensus study. Lancet. 2005;366(9503):2112–7.  https://doi.org/10.1016/S0140-6736(05)67889-0.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. “Vascular depression” hypothesis. Arch Gen Psychiatry. 1997;54(10):915–22. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9337771CrossRefGoogle Scholar
  40. 40.
    Flicker L. Vascular factors in geriatric psychiatry: time to take a serious look. Curr Opin Psychiatry. 2008;21(6):551–4.  https://doi.org/10.1097/YCO.0b013e32830ef736.CrossRefPubMedGoogle Scholar
  41. 41.
    Teper E, O’Brien JT. Vascular factors and depression. Int J Geriatr Psychiatry. 2008;23(10):993–1000.  https://doi.org/10.1002/gps.2020.CrossRefPubMedGoogle Scholar
  42. 42.
    de Groot JC, de Leeuw FE, Oudkerk M, Hofman A, Jolles J, Breteler MM. Cerebral white matter lesions and depressive symptoms in elderly adults. Arch Gen Psychiatry. 2000;57(11):1071–6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11074873.CrossRefGoogle Scholar
  43. 43.
    Kiloh LG. Pseudo-dementia. Acta Psychiatr Scand. 1961;37:336–51.CrossRefGoogle Scholar
  44. 44.
    Coutinho G, Drummond C, Teldeschi A, Mattos P. Awareness of memory deficits is useful to distinguish between depression and mild cognitive impairment in the elderly. Rev Bras Psiquiatr. 2016;38(3):231-234. doi:  https://doi.org/10.1590/1516-4446-2015-1772. Epub 2016 May 17CrossRefGoogle Scholar
  45. 45.
    Kang H, Zhao F, You L, Giorgetta C, Venkatesh D, Sarkhel S, Prakash R. Pseudo-dementia: A neuropsychological review. Ann Indian Acad Neurol. 2014 Apr-Jun; 17(2):147–54. PMID: 25024563.Google Scholar
  46. 46.
    Lara E, Koyanagi A, Domènech-Abella J, Miret M, Ayuso-Mateos JL, Haro JM. The impact of depression on the development of mild cognitive impairment over 3 years of follow-up: a population-based study. Dement Geriatr Cogn Disord. 2017;43(3–4):155–69.  https://doi.org/10.1159/000455227.CrossRefPubMedGoogle Scholar
  47. 47.
    Petersen RC, Roberts RO, Knopman DS, Boeve BF, Geda YE, Ivnik RJ, et al. Mild Cognitive Impairment. Arch Neurol. 2009;66(12):1447–55.  https://doi.org/10.1001/archneurol.2009.266.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Apostolova LG, Cummings JL. Neuropsychiatric manifestations in mild cognitive impairment: a systematic review of the literature. Dement Geriatr Cogn Disord. 2007;25(2):115–26.  https://doi.org/10.1159/000112509.CrossRefPubMedGoogle Scholar
  49. 49.
    Brodaty H, Heffernan M, Kochan NA, Draper B, Trollor JN, Reppermund S, et al. Mild cognitive impairment in a community sample: The Sydney Memory and Ageing Study. Alzheimers Dement. 2013;9(3):310–317.e1.  https://doi.org/10.1016/j.jalz.2011.11.010.CrossRefPubMedGoogle Scholar
  50. 50.
    Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256(3):183–94.  https://doi.org/10.1111/j.1365-2796.2004.01388.x.CrossRefGoogle Scholar
  51. 51.
    Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund L-O, et al. Mild cognitive impairment–beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004;256(3):240–6.  https://doi.org/10.1111/j.1365-2796.2004.01380.x.CrossRefPubMedGoogle Scholar
  52. 52.
    Petersen RC, Aisen PS, Beckett LA, Donohue MC, Gamst AC, Harvey DJ, et al. Alzheimer’s Disease Neuroimaging Initiative (ADNI): clinical characterization. Neurology. 2010;74(3):201–9.  https://doi.org/10.1212/WNL.0b013e3181cb3e25.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Xu W, Tan L, Wang H-F, Jiang T, Tan M-S, Tan L, et al. Meta-analysis of modifiable risk factors for Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2015;86(12):1299–306.  https://doi.org/10.1136/jnnp-2015-310548.CrossRefPubMedGoogle Scholar
  54. 54.
    Byers AL, Yaffe K. Depression and risk of developing dementia. Nat Rev Neurol. 2011;7(6):323–31.  https://doi.org/10.1038/nrneurol.2011.60.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Kaszniak AW, Fox J, Gandell DL, Garron DC, Huckman MS, Ramsey RG. Predictors of mortality in presenile and senile dementia. Ann Neurol. 1978;3(3):246–52.CrossRefGoogle Scholar
  56. 56.
    Richard E, Reitz C, Honig LH, Schupf N, Tang MX, Manly JJ, et al. Late-Life Depression, Mild Cognitive Impairment, and Dementia. JAMA Neurol. 2013;70(3):383.  https://doi.org/10.1001/jamaneurol.2013.603.CrossRefGoogle Scholar
  57. 57.
    Kessing LV, Søndergård L, Forman JL, Andersen PK. Antidepressants and dementia. J Affect Disord. 2009;117(1–2):24–9.  https://doi.org/10.1016/j.jad.2008.11.020.CrossRefPubMedGoogle Scholar
  58. 58.
    Steiner JP, Bachani M, Wolfson-Stofko B, Lee M-H, Wang T, Wang T, et al. Interaction of paroxetine with mitochondrial proteins mediates neuroprotection. Neurotherapeutics. 2015;12(1):200–16.  https://doi.org/10.1007/s13311-014-0315-9.CrossRefPubMedGoogle Scholar
  59. 59.
    Chang K-A, Kim JA, Kim S, Joo Y, Shin KY, Kim S, et al. Therapeutic potentials of neural stem cells treated with fluoxetine in Alzheimer’s disease. Neurochem Int. 2012;61(6):885–91.  https://doi.org/10.1016/j.neuint.2012.03.017.CrossRefPubMedGoogle Scholar
  60. 60.
    Tifratene K, Robert P, Metelkina A, Pradier C, Dartigues JF. Progression of mild cognitive impairment to dementia due to AD in clinical settings. Neurology. 2015;85(4):331–8.  https://doi.org/10.1212/WNL.0000000000001788.CrossRefPubMedGoogle Scholar
  61. 61.
    Halahakoon DC, Roiser JP. Cognitive impairment in depression and its (non-)response to antidepressant treatment. Evid Based Ment Health. 2016;19(4):e23–e23.  https://doi.org/10.1136/eb-2016-102438.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Sara Pozzoli
    • 1
  • Vera De Carlo
    • 1
  • Domenico Madonna
    • 1
  1. 1.Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoUniversity of MilanMilanItaly

Personalised recommendations