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Depression in Cognitive Impairment

  • Geriatric Disorders (H Lavretsky, Section Editor)
  • Published:
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Abstract

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.

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Abbreviations

AD:

Alzheimer’s disease

APOE-ε4:

apolipoprotein epsilon 4 gene

BDNF:

brain derived neurotropic factor

CT:

computerized tomography

dAD:

depression in Alzheimer’s dementia

DIADS-2:

Depression in Alzheimer’s Dementia Study - 2

ECT:

electroconvulsive therapy

fMRI:

functional magnetic resonance imaging

HPA:

hypothalamic-pituitary-adrenal

HTA-SADD:

Health Technology Assessment Study of the use of Antidepressants for Depression in Dementia

LLD:

late-life depression

MCI:

mild cognitive impairment

NIMH:

National Institute of Mental Health

PET:

positron emission tomography

SPECT:

single photon emission computed tomography

TGF-β1:

tumor growth factor beta 1

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Acknowledgment

This paper is supported in part by National Institutes of Health: MH095971 (Christopher M. Marano).

Compliance with Ethics Guidelines

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Conflict of Interest

Laurel D. Pellegrino and Matthew E. Peters declare that they have no conflict of interest.

Constantine G. Lyketsos has received grant support (research or CME) from NIMH, National Institute on Aging, Associated Jewish Federation of Baltimore, Weinberg Foundation, Forest, GlaxoSmithKline, Eisai, Pfizer, AstraZeneca, Lilly, Ortho-McNeil, Bristol-Myers Squibb, Novartis, National Football League (NFL), Elan, Functional Neuromodulation, and Janssen; has received consultant/advisor fees from AstraZeneca, GlaxoSmithKline, Eisai, Novartis, Forest, Supernus, Adlyfe, Takeda, Wyeth, Lundbeck, Merz, Lilly, Pfizer, Genentech, Elan, NFL Players Association, NFL Benefits Office, Avanir, Zinfandel, and Bristol-Myers Squibb; and has received honorarium or travel support from Pfizer, Forest, GlaxoSmithKline, and Health Monitor.

Christopher M. Marano has received grant support from NIMH.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. 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. Pellegrino, Matthew E. Peters, Constantine G. Lyketsos & Christopher M. Marano

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  1. Laurel D. Pellegrino
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  2. Matthew E. Peters
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  3. Constantine G. Lyketsos
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Correspondence to Matthew E. Peters.

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Pellegrino, L.D., Peters, M.E., Lyketsos, C.G. et al. Depression in Cognitive Impairment. Curr Psychiatry Rep 15, 384 (2013). https://doi.org/10.1007/s11920-013-0384-1

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