ADDRESSING DEPRESSION WITH AND WITHOUT COEXISTING ANXIETY IN COMMUNITY-DWELLING PERSONS WITH DEMENTIA

Abstract

Introduction Depression and anxiety are common in persons with dementia (PWD) and are associated with a myriad of poor outcomes, which include poorer quality of life, greater impairment in activities of daily living, worsened cognitive impairment, and higher rates of institutionalization. Guidelines for treating depression in PWD are heterogeneous. Multiple international guidelines suggest repeated screening and evaluation over time for depression and other neuropsychiatric symptoms with appropriate treatment if symptoms are present. While mild to moderate depression should primarily be managed with psychosocial or environmental interventions when available, severe, persistent depression often requires pharmacological management. In contrast to depression, formal guidelines for treating depression with coexisting anxiety in PWD are lacking. Few studies have investigated the impact of coexisting depression and anxiety in this population. This study's goals were to increase knowledge about depression with and without coexisting anxiety in PWD living in the community. It explores prevalence, pharmacologic management, and mental health service use in PWD with depression with and without coexisting anxiety. Methods The sample for this cross-sectional study comprised 160 community-dwelling PWD enrolled in a randomized, controlled trial of a behavioral intervention aimed to prevent the development of aggression in PWD by addressing the management of pain, depression and communication with their caregivers. Baseline data on depression, anxiety, psychotropic medications and mental health service use were examined. Outcome variables included proportions of participants receiving antidepressant, anxiolytic, antipsychotic and sleep medications; total number of psychotropic medications per participant; and frequency of mental health services visits. The first analysis used one-way ANOVA and chi-square tests to compare participants with dementia alone to participants with dementia and depression and participants with dementia and depression with co-existing anxiety. The second analysis used chi-square and Fisher exact tests to compare participants with mild to moderate depression to participants with severe depression based on total score on the Geriatric Depression Scale (GDS). Presence of clinically significant depression and anxiety symptoms were defined by previously validated score cut-points of the GDS and the Geriatric Anxiety Inventory (GAI), respectively. Results The sample's mean GDS score was 11.22 (SD = 6.16) and median GAI score was 1 (IQR = 0-3). Forty-one percent of participants had dementia alone, 28% had dementia with depression, 27% had dementia and depression with coexisting anxiety, and 4% had dementia with anxiety. Fifty-five percent of participants reported clinically significant depression. Clinically significant anxiety was present in 49% of participants with depression and in 27% of the total sample. The proportion of participants with severe depression symptoms was significantly larger in participants with depression and anxiety compared to those participants with depression alone (Fisher exact p Conclusions This study adds to the literature on the prevalence, pharmacologic management and mental health service use in PWD with depression with and without coexisting anxiety living in the community. Additional studies need to explore the relationship between dementia with depression with coexisting anxiety and short- and long-term patient outcomes, as the literature is lacking in this area. Depression with and without anxiety is very common in PWD, but there is variable adherence to treatment guidelines. Absence of pharmacological and nonpharmacological treatment in a significant minority of participants with severe depression in this study may reflect a lack of detection or lack of treatment. The considerable number of patients with dementia alone prescribed antidepressants may be explained by several factors. These include the fact that antidepressants are used in the treatment of multiple neuropsychiatric symptoms in PWD, participants in this group may have had partial or full response to an antidepressant trial and were being continued on maintenance treatment to prevent relapse, or the possibility that antidepressant medications are being used improperly and without indication in this sample. Mental health service use is low and there is a need for patient, provider, and system-level interventions to facilitate access to mental health providers This research was funded by: National Institute of Nursing Research