Major depression as a risk factor for early institutionalization of dementia patients living in the community.
OBJECTIVE
Although depression is known to be frequently associated with dementia, it is nonetheless under-diagnosed and under-treated among this patient population. Its effect on outcome for dementia patients is thought to be substantial, because depression appears to induce higher than normal rates of disability as well as supplementary cognitive decline. The aim of this study was to measure the impact of major depression on the institutionalization rate of community-dwelling dementia patients.


METHODS
Prospective cohort study.


METHODS
Paris, France.


METHODS
Three-hundred forty-eight consecutive dementia outpatients of a geriatric clinic (mean age: 81 years, 69.8% women, 65.5% dementia of Alzheimer's type, mean baseline MMSE score: 20.5), followed between 1997 and 2002 (mean follow-up: 20.5 months).


RESULTS
Twenty-five percent of the patients met the criteria of major depression at baseline, and only 30.3% of these received antidepressant medication. Major depression at baseline was independently associated with nursing home admission within one year of the baseline assessment. Antidepressant medication tended to protect against this outcome, but not to a statistically significant extent.


CONCLUSIONS
Major depression at baseline is an independent risk factor for early institutionalization of dementia sufferers. Early institutionalization is defined in this study as nursing home placement within a year of diagnosis with dementia at our specialized outpatient center. The study highlights the need for better management of depression among dementia outpatients. Further investigation is needed to evaluate the protective effect of antidepressant medication (and/or non-pharmacological therapies) on the institutionalization rate.
Dorenlot
Pascale
P
INSERM u 687-IFR 69, St-Maurice, France. psdorenlot@aol.com
Harboun
Marc
M
Bige
Vincent
V
Henrard
Jean-Claude
JC
Ankri
Joël
J
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D003704:Dementia / Q000523:psychology*; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D005602:France; D006801:Humans; D007326:Institutionalization; D008297:Male; D009735:Nursing Homes; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors
D000928:Antidepressive Agents