Treatment Of Depression In Dementia Research Articles

Fall-Risk-Increasing Drugs in People With Dementia Who Live in a Residential Aged Care Facility: A Pilot Study.

Background Psychotropic medications feature in prescribing guidelines for the treatment of depression in dementia as well as the management of behavioural and psychological symptoms of dementia (BPSD). They include antidepressants, antipsychotics, and benzodiazepines, and are among an established collective of pharmacotherapies known as fall-risk-increasing drugs (FRIDs). These psychoactive medications are known to increase fall risk in elderly adults, including those with a dementia diagnosis. Medication reviews are an integral part of falls prevention programs in residential aged care and provide an opportunity to modify medications to reduce fall risk related to pharmacotherapy.Objectives This pilot study explores the characteristics of a group of elderly people with dementia living in residential care with a focus on patterns of falls and usage of psychotropic medications.Methods This is a retrospective study conducted using data collected from health records. The Neuroscience-based Nomenclature (NbN) classification of psychotropic medicines is employed to highlight relevant pharmacological domains targeted by the medications rather than traditional drug classes.Results Four pharmacological neurotransmitter domains emerged as key players in the pharmacotherapy of study participants. These were serotonin, dopamine, noradrenaline, and gamma-aminobutyric acid A (GABA-A). Serotonin was the most frequently implicated domain as related to observed usage of psychotropic treatments for depression and BPSD. Over the retrospective study period, 75% of participants were taking prescribed psychotropics known to target these four domains, and most (69.4%) were elderly women over the age of 80. Many participants experienced multiple falls, mostly among women, and most falls were rated as harmful to some degree.Conclusion This study observes recurrent falls and frequent usage of psychoactive drugs in elderly people with dementia. We conclude that further investigations are both warranted to support prescribing guidelines for dementia and feasible according to the methodology of this pilot study.

Management of Depression in Patients with Dementia: Is Pharmacological Treatment Justified?

Depression in the context of dementia is common and contributes to poorer outcomes in individuals and those who care for them. Non-pharmacological treatments are the preferred initial approach to managing these symptoms but data in support of these are scarce. There are a number of pharmacological treatment options available to clinicians but efficacy is uncertain and concern about potential side effects in an aging and vulnerable population needs to be taken into consideration. This review aims to provide a concise overview of pharmacological treatments for depression in dementia. Antidepressants are the mainstay of pharmacological treatment for clinically significant depression in the general population but evidence to support their use in dementia is mixed. Trials of antidepressants should generally be reserved for individuals with depression where the symptoms are distressing and surpass the threshold for major depression. Acetylcholinesterase inhibitors and memantine are effective in the symptomatic treatment of Alzheimer's disease but current evidence does not support their use to treat depressive symptoms in dementia. Similarly, antipsychotics and mood stabilizers have no proven efficacy for depression and the risk of adverse effects seems to outweigh any potential benefit. Pain can be a frequent problem in dementia and may have significant effects on behavior and mood. Preliminary evidence supports a role of adequate analgesia in improving mood in people with dementia.

Antidepressant treatment of depression in dementia

Antidepressant treatment of depression in dementia

Is Electroconvulsive Therapy (ECT) Effective and Safe for Treatment of Depression in Dementia?

Depression is one of the most frequently diagnosed psychiatric disorders in patients with dementia with a prevalence of up to 50%. The detrimental effects of depression in dementia include disability in daily living, worse quality of life, and faster cognitive decline. Although electroconvulsive therapy (ECT) is a well-established and effective treatment for depression in the elderly, it is currently an overlooked treatment option in the elderly with dementia and depression. The aim of this review was to provide a critical analysis of the efficacy and safety of ECT in depression superimposed on dementia by reviewing the current literature on this topic. Current evidence suggests that ECT is an effective treatment for depression in dementia, although the relatively small number of controlled studies hampers the comparison of effectiveness between healthy nongeriatric patients and those with dementia. Moreover, the systematic reports on cognitive side effects are very limited in number and currently only apply to moderately mild or mild dementia of nonvascular origin. Some studies do suggest that cognitive side effects are likely in later stages of dementia and in patients with vascular dementia. It is therefore of crucial relevance to prospectively study effects of ECT in different types and phases of dementia in controlled trials. From a clinical perspective, it is essential to inform and educate patients and family about the possible risks and benefits of ECT treatment for depression in dementia.

HTA-SADD a definative multicentre placebo controlled RCT of the clinical effectiveness of sertraline and mirtazapine for the treatment of depression in dementia

HTA-SADD a definative multicentre placebo controlled RCT of the clinical effectiveness of sertraline and mirtazapine for the treatment of depression in dementia

Cortical Serotonin 1A Receptor Levels Are Associated with Depression in Patients with Dementia with Lewy Bodies and Parkinson’s Disease Dementia

Background: Serotonin 1A receptors (5-HT_1A) have not been studied in dementia with Lewy bodies (DLB) or Parkinson’s disease dementia (PDD) patients with depression. Aim: To examine 5-HT_1A in DLB and PDD postmortem in relation to depression. Methods: [³H]8-hydroxy-2-dipropylaminotetralin binding to 5-HT_1A was determined in temporal cortex (Brodmann areas, BA20 and BA36) from 10 DLB patients, 17 PDD patients and 9 controls. Results: 5-HT_1A density was significantly higher in BA36 in combined DLB/PDD patients with depression, but was unaltered in BA20. Conclusion: Higher BA36 5-HT_1A density in PDD and DLB patients than in control is dependent on whether the patient had experienced depression during life, not DLB/PDD diagnosis. A 5-HT_1A antagonist adjuvant may improve treatment of depression in dementia.

A Placebo-Controlled Double-Blind Randomized Study of Venlafaxine in the Treatment of Depression in Dementia

Background/Aims: To evaluate the efficacy and safety of venlafaxine in the treatment of major depression in dementia. Methods: Thirty-one outpatients who had dementia and major depression participated in this randomized, double-blind, placebo-controlled, 6-week, flexible dose clinical trial. The screening measures were Cornell Scale for depression in dementia, DSM-IV for depression and dementia and Mini-Mental State Examination. The outcome measures were response rate, Montgomery-Åsberg Depression Rating scale and Clinical Global Impressions. Results: The percentage of patients defined as Montgomery-Åsberg Depression Rating scale responders was approximately the same in the placebo and in the venlafaxine groups. Clinical Global Impressions showed no significant difference between the groups. The reasons for dropouts show borderline significance between the two groups. There was no statistically significant difference in the incidence of adverse events between the venlafaxine and placebo-treated groups. Conclusions: Our data do not support the hypothesis that venlafaxine improves mood in elderly demented patients.

Recognition and treatment of depression in dementia

AbstractOur series Prescribing in older people gives practical advice for successful management of the special problems experienced by this patient group. Here, the authors describe the assessment and treatment of depression in patients with dementia. Copyright © 2007 Wiley Interface Ltd

A series of brief cognitive therapy interventions with people experiencing both dementia and depression: a description of techniques and common themes

AbstractDepression in the context of dementia is common, but treatment approaches are under‐developed. This paper presents one of the first case series of cognitive therapy interventions with individuals with concurrent dementia and depression. Seven patients diagnosed as having mild/moderate dementia (MMSE range 20–30) each received eight individual cognitive therapy sessions. On average, there was a statistically significant 3.7 point improvement on the Geriatric Depression Scale (30 items). Two of the patients showed a significant Reliable Change Index. It is argued that with some modification a cognitive therapy approach can facilitate a reduction in the level of depression experienced by this particular group. In this sample, impaired cognitive abilities did not prove to be an insurmountable obstacle to the application of cognitive therapy. A number of common themes arose, including attributions about the cause of the cognitive impairment, catastrophic thinking regarding the implications of the diagnosis and the emergence of previous trauma. Whilst a full understanding of the interrelationship between dementia and depression has yet to be developed, a body of literature is developing that describes some of the skills necessary for this type of work. Controlled studies of psychological treatments for depression in dementia are now required. Copyright © 2003 John Wiley & Sons, Ltd.

The diagnosis and treatment of depression in dementia.

For many years, the problem of accurate diagnosis of depression among elderly patients with cognitive impairment has focused on patients with major depression who are misdiagnosed as having dementia—cases of so-called depressive pseudodementia. Yet the more common, and possibly more difficult, predicament for the clinician is making the diagnosis of depression for the patient with established dementia. This difficulty is often exacerbated when a diagnosis is needed for an institutionalized patient with severe dementia, yet reliable information about subjective affective symptoms is lacking due to the patient’s cognitive status. This paper discusses ways to improve diagnostic accuracy in treating patients with depression and dementia and reviews treatment options for these patients. Diagnostic issues

Physical aggression in dementia patients and its relationship to depression.

The goal of this study was to determine the frequency of physically aggressive behavior in community-residing patients with dementia and its relationship to depression. A consecutive series of 541 patients with DSM-IV-defined dementia underwent comprehensive neuropsychiatric evaluation and were rated on the Cornell Scale for Depression in Dementia, the Mini-Mental State, the Psychogeriatric Dependency Rating Scale, and the General Medical Health Rating. Physically aggressive behavior was exhibited by 79 patients in the 2 weeks before evaluation. Aggressive behavior was closely associated with moderate to severe depression, male gender, and greater impairment in activities of daily living, even after adjustment for delusions, hallucinations, sleep disturbance, and severity of cognitive impairment. After adjustment for depression, gender, and impairment in activities of daily living, there was no association between physically aggressive behavior and the presence of either delusions or hallucinations. A substantial minority of patients with dementia exhibit physically aggressive behavior, and this aggression is strongly linked with the presence of depressive symptoms. It is possible that the identification and treatment of depression in dementia may be a means of preventing and managing physically aggressive behavior.

Depression and Alzheimer's disease

Depressive symptoms, due either major depression or clinically significant, subsyndromal depression, occur commonly in the course of Alzheimer's disease. For a variety of clinical and methodological reasons, this remains an area that begs for new investigation. At the very least, these depressive symptoms should be viewed as a cause of significant and treatable "excess disability" (Kramer and Reifler, 1992). Demented patients with clinically significant depression (e.g., depressed mood, significant loss of appetite, insomnia, fatigue, irritability, and agitation) should be considered for a trial of antidepressant therapy, even when they fail to meet full diagnostic criteria for major depression. These symptoms will, in most instances, respond to antidepressant therapy. The "rules" for treatment of depression in dementia are slightly different than for cognitively intact patients: (a) start low, go slower, (b) pay attention to cognitive toxicity of all medication combinations, and (c) depressive symptoms do not persist as long as in cognitively intact patients. Current treatments, especially those SSRI's like fluoxetine and sertraline that have cognitive enhancing effects, should be considered the "first line" antidepressants. We need to emphasize early detection and treatment of depressive symptoms in dementia in all arenas.