title: Depression in patients with moderate Alzheimer disease: a prospective observational cohort study.
abstract: Syndromes of depression are frequently concomitant with Alzheimer disease (AD), although often inaccurately diagnosed and/or treated. This prospective, multicenter, observational, cohort study assessed baseline data and 6-month disease changes in moderate AD patients (n=1249) from Spain. Baseline Cornell Scale for Depression in Dementia (CSDD) scores defined 2 cohorts (depressive ≥8 or nondepressive <8). Fewer patients had baseline Diagnostic and Statistical Manual for Mental disorders-IV depression diagnosis (38.9%) than CSDD ≥8 (55.6%). Analysis of diagnostic accuracy of the CSDD versus the Diagnostic and Statistical Manual for Mental disorders-IV criteria showed an optimal cutoff score of ≥12. However, the predefined CSDD cutoff score showed subsyndromal depressive symptomatology associated with lower functionality, worse neuropsychiatric symptomatology, increased caregiver distress, and greater 6-month functional and clinical impairments. Cognition (baseline and 6-month progression) was not significantly associated with depressive symptomatology. Depressive patients received more antidepressive and/or antipsychotic treatments, showing CSDD and Neuropsychiatric Inventory Questionnaire (severity and caregiver distress) 6-month improvements but maintaining doubled scores than nondepressive patients. In conclusion, CSDD ≥8 identified depressive symptomatology in moderate AD patients, significantly associated with excessive neuropsychiatric symptoms and functional, but not cognitive, 6-month deterioration. The health effects over patients and caregivers, alongside the finding that most patients remained depressive after 6 months, demand accurate diagnostic tools and effective treatments for depression in AD.
authors.affiliation: Hospital Universitario Clínico San Carlos, Madrid, Spain. jporta@yahoo.com
authors.forename: Jesús
authors.initials: J
authors.lastname: Porta-Etessam
authors.forename: José Luis
authors.initials: JL
authors.lastname: Tobaruela-González
authors.forename: Carlos
authors.initials: C
authors.lastname: Rabes-Berendes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies