Thursday, 21 August 2003
This presentation is part of : What Works in a Clinical Approach to Dementia: Stages and Cultures

S090-003 Initial Stage: Depression and Cognitive Impairment

Luis Fernando Agüera Ortiz, Psychiatry, Psychiatry, Hospital Universitario 12 de Octubre, Madrid, Spain

Objective:To review the relationships between depression and dementia, the assessment of risk factors, to discuss the efficacy of drugs in the treatment of depression and in the prevention of dementia preceded by depression and to develop criteria for using the MMS as a screening tool for depression, taking also into account cultural diversity in the interpretation of the findings.

Design: Review of relevant papers. Analysis of certain parts of the MMS to find correlations with Yessavage’s GDS and the diagnosis of dementia and depression.

Materials and Methods: Analysis of current and relevant literature for the review part. For the new research part, MMS, Yesavage’s GDS and other diagnostic tools for dementia and depression were administered to 200 patients 65 years or older

Results: Dementia and depression are frequent disorders in the elderly. Both may appear independently but can be more closely related than it was previously thought. Between 20 and 50% of patients with a primary diagnosis of dementia will suffer from depressive symptoms of different severity. The aetiology is related to changes in the CNS and difficulties in the adaptation to cognitive changes. Those symptoms usually increase the global burden of dementia and may accelerate the progression of cognitive decline. Detection and appropriate treatment of depression in the context of dementia is crucial. We will discuss available data on the efficacy of different means of diagnosis, both clinical and instrumental, of depressive symptoms. Data on the comparative efficacy of different antidepressants and other drugs used for dementia-related depression will also be presented. Depression may precede the onset of dementia. It can be considered either a risk factor or a very early symptom, appearing months or years before the onset of cognitive decline. Data supporting both possibilities exist, are controversial, and will be critically discussed. The biological mechanisms that relate depression and the development of dementia could be based on the deleterious effect that hypercotisolism has on certain hypocampal structures, possibly mediated by the NMDA receptor. Those findings will be discussed, together with the role that the NMDA antagonist memantine might have in the prevention of delay of dementia preceded by depressive symptoms. Preliminary results of an ongoing trial will be presented. Analysis of the content of the sentence written by the patient in the MMS shows a correlation (p<0,05) between a sad or pessimistic content, GDS results and the clinical diagnosis of depression

Conclusion: Dementia and depression are two frequent clinical entities that may coexist or be related, being one of them a risk factor for the development of the other. Detection of depression in the elderly population is a priority. Early diagnosis and treatment can prevent the enormous burden of depression and might even decrease the incidence of dementia. Some treatments like antidepressants and memantine show promise in this indication. Certain parts of the Mini Mental Examination can be used as a screening tool for depression.

Back to S090 What Works in a Clinical Approach to Dementia: Stages and Cultures
Back to The Eleventh International Congress