A common challenge in older adults: Classification, overlap, and therapy of depression and dementia.
Late-life depression is frequently associated with cognitive impairment. Depressive symptoms are often associated with or even precede a dementia syndrome. Moreover, depressive disorders increase the risk of persistence for mild cognitive impairment and dementia. Here, we present both the current state of evidence and future perspectives regarding the integration and value of clinical assessments, neuropsychological, neurochemical, and neuroimaging biomarkers for the etiological classification of the dementia versus the depression syndrome and for the prognosis of depression relating to dementia risk. Finally, we summarize the existing evidence for both pharmacotherapy and psychotherapy of depression in demented patients. There is an urgent need for large-scale collaborative research to elucidate the role and interplay of clinical and biological features in elderly individuals with depressive disorders who are at elevated risk for developing dementia. To overcome barriers for successful drug development, we propose the introduction of the precision medicine paradigm to this research field.
Center of Old Age Psychiatry, Psychiatric University Hospital, Basel, Switzerland. Electronic address: thomas.leyhe@upkbs.ch.
Thomas
T
Leyhe
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Charles F
CF
Reynolds
Center of Old Age Psychiatry, Psychiatric University Hospital, Basel, Switzerland.
Tobias
T
Melcher
Center of Old Age Psychiatry, Psychiatric University Hospital, Basel, Switzerland.
Christoph
C
Linnemann
Department of Psychiatry and Psychotherapy, Center for Geriatric Medicine and Gerontology, Department of Neurology, University Medical Center Freiburg, Freiburg, Germany.
Stefan
S
Klöppel
Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.
Kaj
K
Blennow
Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; University College London Institute of Neurology, London, UK.
Henrik
H
Zetterberg
Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) & Institut du Cerveau et de la Moelle épinière (ICM), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, Paris, France.
Bruno
B
Dubois
IHU-A-ICM-Paris Institute of Translational Neurosciences, Pitié-Salpêtrière University Hospital, Paris, France; AXA Research Fund & UPMC Chair, Paris, France.
Simone
S
Lista
Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) & Institut du Cerveau et de la Moelle épinière (ICM), Département de Neurologie, Hôpital de la Pitié-Salpêtrière, Paris, France; AXA Research Fund & UPMC Chair, Paris, France.
Harald
H
Hampel
D000375:Aging; D003704:Dementia / Q000145:classification / Q000175:diagnosis / Q000628:therapy; D003863:Depression / Q000145:classification / Q000175:diagnosis / Q000628:therapy; D003937:Diagnosis, Differential; D006801:Humans; D059906:Neuroimaging; D009483:Neuropsychological Tests
Biomarkers; Classification; Dementia; Depression; Differential diagnosis; Neuroimaging; Pharmacotherapy; Precision medicine; Prognosis; Psychological intervention