A common challenge in older adults: Classification, overlap, and therapy of depression and dementia

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Abstract

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.

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Most cited references 119

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Kaj Blennow, Mony J. de Leon, Henrik Zetterberg (2006)

Alzheimer's disease is the most common cause of dementia. Research advances have enabled detailed understanding of the molecular pathogenesis of the hallmarks of the disease--ie, plaques, composed of amyloid beta (Abeta), and tangles, composed of hyperphosphorylated tau. However, as our knowledge increases so does our appreciation for the pathogenic complexity of the disorder. Familial Alzheimer's disease is a very rare autosomal dominant disease with early onset, caused by mutations in the amyloid precursor protein and presenilin genes, both linked to Abeta metabolism. By contrast with familial disease, sporadic Alzheimer's disease is very common with more than 15 million people affected worldwide. The cause of the sporadic form of the disease is unknown, probably because the disease is heterogeneous, caused by ageing in concert with a complex interaction of both genetic and environmental risk factors. This seminar reviews the key aspects of the disease, including epidemiology, genetics, pathogenesis, diagnosis, and treatment, as well as recent developments and controversies.

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Nonpharmacological Therapies in Alzheimer’s Disease: A Systematic Review of Efficacy

J. Olazarán, Javier Olazarán, Barry Reisberg … (2010)

Introduction: Nonpharmacological therapies (NPTs) can improve the quality of life (QoL) of people with Alzheimer’s disease (AD) and their carers. The objective of this study was to evaluate the best evidence on the effects of NPTs in AD and related disorders (ADRD) by performing a systematic review and meta-analysis of the entire field. Methods: Existing reviews and major electronic databases were searched for randomized controlled trials (RCTs). The deadline for study inclusion was September 15, 2008. Intervention categories and outcome domains were predefined by consensus. Two researchers working together detected 1,313 candidate studies of which 179 RCTs belonging to 26 intervention categories were selected. Cognitive deterioration had to be documented in all participants, and degenerative etiology (indicating dementia) had to be present or presumed in at least 80% of the subjects. Evidence tables, meta-analysis and summaries of results were elaborated by the first author and reviewed by author subgroups. Methods for rating level of evidence and grading practice recommendations were adapted from the Oxford Center for Evidence-Based Medicine. Results: Grade A treatment recommendation was achieved for institutionalization delay (multicomponent interventions for the caregiver, CG). Grade B recommendation was reached for the person with dementia (PWD) for: improvement in cognition (cognitive training, cognitive stimulation, multicomponent interventions for the PWD); activities of daily living (ADL) (ADL training, multicomponent interventions for the PWD); behavior (cognitive stimulation, multicomponent interventions for the PWD, behavioral interventions, professional CG training); mood (multicomponent interventions for the PWD); QoL (multicomponent interventions for PWD and CG) and restraint prevention (professional CG training); for the CG, grade B was also reached for: CG mood (CG education, CG support, multicomponent interventions for the CG); CG psychological well-being (cognitive stimulation, multicomponent interventions for the CG); CG QoL (multicomponent interventions for PWD and CG). Conclusion: NPTs emerge as a useful, versatile and potentially cost-effective approach to improve outcomes and QoL in ADRD for both the PWD and CG.

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Author and article information

Journal

Journal ID (publisher-id): ALZ

Title: Alzheimer's & Dementia

Abbreviated Title: Alzheimer's & Dementia

Publisher: Elsevier BV

ISSN: 15525260

Publication date Created: January 2017

Publication date (Print): January 2017

Publication date (Electronic): September 28 2016

Volume: 13

Issue: 1

Pages: 59-71

Affiliations

[1 ]Center of Old Age Psychiatry; Psychiatric University Hospital; Basel Switzerland

[2 ]Western Psychiatric Institute and Clinic, Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh PA USA

[3 ]Department of Psychiatry and Psychotherapy, Center for Geriatric Medicine and Gerontology, Department of Neurology; University Medical Center Freiburg; Freiburg Germany

[4 ]Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology; The Sahlgrenska Academy at the University of Gothenburg; Mölndal Sweden

[5 ]University College London Institute of Neurology; London UK

[6 ]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

[7 ]IHU-A-ICM-Paris Institute of Translational Neurosciences; Pitié-Salpêtrière University Hospital; Paris France

[8 ]AXA Research Fund & UPMC Chair; Paris France