Depression in cognitive impairment.
Depression and cognitive disorders, including dementia and mild cognitive impairment, are common in the elderly. Depression is also a common feature of cognitive impairment although the symptoms of depression in cognitive impairment differ from depression without cognitive impairment. Pre-morbid depression approximately doubles the risk of subsequent dementia. There are two predominant, though not mutually exclusive, constructs linking pre-morbid depression to subsequent cognitive impairment: Alzheimer's pathology and the vascular depression hypothesis. When evaluating a patient with depression and cognitive impairment, it is important to obtain caregiver input and to evaluate for alternative etiologies for depressive symptoms such as delirium. We recommend a sequential approach to the treatment of depression in dementia patients: (1) a period of watchful waiting for milder symptoms, (2) psychosocial treatment program, (3) a medication trial for more severe symptoms or failure of psychosocial interventions, and (4) possible ECT for refractory symptoms.
Department of Psychiatry and Behavioral Sciences, Division of Geriatric Psychiatry and Neuropsychiatry, The Johns Hopkins University, 5300 Alpha Commons Drive, Baltimore, MD 21224, USA.
Laurel D
LD
Pellegrino
Matthew E
ME
Peters
Constantine G
CG
Lyketsos
Christopher M
CM
Marano
D000928:Antidepressive Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000473:pathology / Q000523:psychology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000379:methods; D006801:Humans; D012307:Risk Factors
D000928:Antidepressive Agents