Assessing Late Life Major Depression: Does Brain Disease Affect Measurement of Severity and Treatment Response?

Abstract

Sahar et al. 1 Saha S. Hatch D.J. Hayden K.M. et al. Appetite and weight loss symptoms in late life depression predict dementia outcomes. Am J Geriatr Psychiatry. 2016; https://doi.org/10.1016/j.jagp.2016.05.004 Abstract Full Text Full Text PDF Scopus (14) Google Scholar report that high scores on an appetite/weight loss factor in persons with late-life major depression without dementia are associated with an increased risk of both incident dementia and Alzheimer disease (AD) at follow-up. These provocative associations should be considered in the context of the extensive literature suggesting that both significant depressive symptoms 2 Ownby R.L. Crocco E. Acevedo A. et al. Depression and risk for Alzheimer disease: systematic review, meta-analysis, and meta-regression analysis. Arch Gen Psychiatry. 2006; 63: 530-538 Crossref PubMed Scopus (1056) Google Scholar , 3 Barnes D.E. Yaffe K. Byers A.L. et al. Midlife vs late-life depressive symptoms and risk of dementia: differential effects for Alzheimer disease and vascular dementia. Arch Gen Psychiatry. 2012; 69: 493-498 Crossref PubMed Scopus (297) Google Scholar , 4 Diniz B.S. Butters M.A. Albert S.M. et al. Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studies. Br J Psychiatry. 2013; 202: 329-335 Crossref PubMed Scopus (761) Google Scholar and MDD 5 Jorm A.F. History of depression as a risk factor for dementia: an updated review. Aust N Z J Psychiatry. 2001; 35: 776-781 Crossref PubMed Scopus (407) Google Scholar , 6 Steffens D.C. Plassman B.L. Helms M.J. et al. A twin study of late-onset depression and apolipoprotein E epsilon 4 as risk factors for Alzheimer's disease. Biol Psychiatry. 1997; 41: 851-856 Abstract Full Text PDF PubMed Scopus (174) Google Scholar are risk factors for dementia and AD. The longitudinal design of the Neurocognitive Outcomes of Depression in the Elderly study 7 Steffens D.C. Welsh-Bohmer K.A. Burke J.R. et al. Methodology and preliminary results from the Neurocognitive Outcomes of Depression in the Elderly study. J Geriatr Psychiatry Neurol. 2004; 17: 202-211 Crossref PubMed Scopus (79) Google Scholar enabled the authors to follow a systematically diagnosed and cognitively intact cohort of older persons with MDD. The methodology extends research beyond studies assessing incident dementia in population cohorts exceeding cutoffs for depressive symptoms or having chart diagnosis.