Depression in Cognitive Impairment

• Published in: Current psychiatry reports 2013-09, Vol.15 (9), p.384-384, Article 384
• Main Authors: Pellegrino, Laurel D., Peters, Matthew E., Lyketsos, Constantine G., Marano, Christopher M.
• Format: Article
• Language: English
• Subjects: Antidepressive Agents - therapeutic use; Cognition Disorders - pathology; Cognition Disorders - psychology; Cognitive ability; Dementia; Depressive Disorder - diagnosis; Depressive Disorder - etiology; Depressive Disorder - therapy; Electroconvulsive Therapy - methods; Geriatric Disorders (H Lavretsky; Humans; Medicine; Medicine & Public Health; Mental depression; Psychiatry; Risk Factors; Section Editor; Topical Collection on Geriatric Disorders
• ISSN: 1523-3812; 1535-1645
• DOI: 10.1007/s11920-013-0384-1

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.