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Depression associated with dementia

Depression bei Demenz

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Abstract

Depression and cognitive disorders, including dementia and mild cognitive impairment, are common disorders in old age. Depression is frequent in dementia, causing distress, reducing the quality of life, exacerbating cognitive and functional impairment and increasing caregiver stress. Even mild levels of depression can significantly add to the functional impairment of dementia patients and the severity of psychopathological and neurological impairments increases with increasing severity of depression. Depressive symptoms may be both a risk factor for, as well as a prodrome of dementia. Major depressive syndrome of Alzheimer’s disease may be among the most common mood disorders of older adults. Treating depression is therefore a key clinical priority to improve the quality of life both of people with dementia as well as their carergivers. Nonpharmacological approaches and watchful waiting should be attempted first in patients who present with mild to moderate depression and dementia. In cases of severe depression or depression not able to be managed through nonpharmacological means, antidepressant therapy should be considered.

Zusammenfassung

Depressive und kognitive Störungen, insbesondere Demenz und leichte kognitive Beeinträchtigungen, sind verbreitete Krankheitsbilder bei Menschen im höheren Lebensalter. Depressive Syndrome sind häufig bei an Demenz Erkrankten nachweisbar und verursachen Leidensdruck, schränken die Lebensqualität ein, verstärken kognitive wie funktionelle Einbußen und erhöhen die Belastung der Pflegenden. Bereits leichtere depressive Zustandsbilder können das Funktionsniveau Demenzkranker signifikant vermindern, und die Ausprägung psychopathologischer und neuropsychiatrischer Symptome nimmt mit steigendem Schweregrad der Depression zu. Depressive Zustandsbilder können einer Demenz vorausgehen, und zwar sowohl im Sinne eines Risikofaktors als auch einer Prodromalsymptomatik. Eine majore Depression im Rahmen einer Alzheimer Erkrankung ist eine der häufigsten affektiven Störungen im höheren Lebensalter. Der Behandlung depressiver Syndrome kommt somit eine hohe klinische Priorität zu im Hinblick auf eine Verbesserung der Lebensqualität sowohl der an Demenz Erkrankten als auch der sie betreuenden und pflegenden Personen. Nichtmedikamentöse Therapien und aufmerksame Verlaufsbeobachtung („watchful waiting“) sind bei Demenzkranken mit komorbider leichter bis mittelschwerer Depression zunächst in Betracht zu ziehen. Bei einer schweren depressiven Symptomatik oder fehlendem Ansprechen auf nichtmedikamentöse Therapien sollte eine antidepressive Pharmakotherapie erwogen bzw. eingeleitet werden.

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  1. Retzdorffpromenade 3, 12161, Berlin, Germany

    H. Gutzmann

  2. University College London, London, UK

    A. Qazi

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Gutzmann, H., Qazi, A. Depression associated with dementia. Z Gerontol Geriat 48, 305–311 (2015). https://doi.org/10.1007/s00391-015-0898-8

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