[My patient has dementia, but so far, it is not that bad...].
Depression can be the first sign of dementia or can occur in the follow-up of a clearly demented patient. One must be able to distinguish symptoms of depression and dementia, and recognize depression superimposed on dementia in order to provide optimal treatment. Suicidal risk must be assessed, and major depressive episodes must be appropriately treated. Useful drugs to treat depression in demented patients are reviewed. At this stage of the dementing illness, the patient still needs medical attention for other medical problems, periodic health exams, other chronic conditions, etc. It is also important to address the issues of CPR and level of care, if it has not been done previously. Legal aspects must also be clarified at this stage. The patient's ability to consent or to make financial decisions must be assessed. Some objective criteria are suggested. At this stage of the disease, the family physician can really make the difference between a premature nursing home placement and a patient staying at home with his family.
Frenette
Guy
G
Service de gériatrie ambulatoire du CHUQ-CHUL, Québec.
Béland
Guy
G
D001007:Anxiety / Q000209:etiology; D003704:Dementia / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D003863:Depression / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D016743:Mental Competency / Q000331:legislation & jurisprudence; D019964:Mood Disorders / Q000209:etiology; D013557:Switzerland