Abstract
Background: Alzheimer's disease (AD) and other forms of dementia are among the most common causes of disability in the elderly. Dementia is often accompanied by depression, but specific diagnostic criteria and treatment approaches are still lacking. This study aimed to gather expert opinions on dementia and depressed patient management to reduce heterogeneity in everyday practice.Methods: Prospective, multicenter, 2-round Modified Delphi survey with 53 questions regarding risk factors (11), signs and symptoms (7), diagnosis (8), and treatment (27) of depression in dementia, with a particular focus on AD. The questionnaire was completed by a panel of 37 expert physicians in neurodegenerative diseases (19 neurologists, 17 psychiatrists, and 1 geriatrician).Results: Consensus was achieved in 40 (75.5%) of the items: agreement in 33 (62.3%) and disagreement in 7 (13.2%) of them. Among the most relevant findings, depression in the elderly was considered an early sign (prodromal) and/or a dementia risk factor, so routine cognitive check-ups in depressed patients should be adopted, aided by clinical scales and information from relatives. Careful interpretation of neuropsychological assessment must be carried out in patients with depression as it can undermine cognitive outcomes. As agreed, depression in early AD is characterized by somatic symptoms and can be differentiated from apathy by the presence of sadness, depressive thoughts and early-morning awakening. In later-phases, symptoms of depression would include sleep-wake cycle reversal, aggressive behavior, and agitation. Regardless of the stage of dementia, depression would accelerate its course, whereas antidepressants would have the opposite effect. Those that improve cognitive function and/or have a dual or multimodal mode of action were preferred: Duloxetine, venlafaxine/desvenlafaxine, vortioxetine, tianeptine, and mirtazapine. Although antidepressants may be less effective than in cognitively healthy patients, neither dosage nor treatment duration should differ. Anti-dementia cholinesterase inhibitors may have a synergistic effect with antidepressants. Exercise and psychological interventions should not be applied alone before any pharmacological treatment, yet they do play a part in improving depressive symptoms in demented patients.Conclusions: This study sheds light on several unresolved clinical challenges regarding depression in dementia patients. Further studies and specific recommendations for this comorbid patient population are still needed.
Highlights
IntroductionWith the aging of the world’s population, the number of people living with dementia worldwide is expected to rise to 82 million in 2030 and almost double in 2050
Aging is the strongest risk factor associated with dementia
A total number of 53 items were grouped into 4 sections regarding risk factors [11], signs and symptoms [7], diagnosis [8], and treatment [12] of depression in Alzheimer’s disease (AD) and other dementias
Summary
With the aging of the world’s population, the number of people living with dementia worldwide is expected to rise to 82 million in 2030 and almost double in 2050. Considering that dementia is one of the most common causes of disability among the elderly, such estimates will have a physical, emotional and financial impact on dementia sufferers as well as their caregivers and relatives. Chronic and progressive cognitive impairment is the clinical hallmark of dementias, namely Alzheimer’s disease (AD) or other less common types such as vascular, Lewy body, and frontotemporal dementia (FTD) [1]. Around one third of the adult population with depression is diagnosed with concomitant mild cognitive impairment (MCI) [4]. Alzheimer’s disease (AD) and other forms of dementia are among the most common causes of disability in the elderly. This study aimed to gather expert opinions on dementia and depressed patient management to reduce heterogeneity in everyday practice
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