Depression in Older Adults (BMJ Clinical Review)

[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 2 Issue 4, November 2011].

Summary

This review article examines recent systematic reviews, meta-analyses, and randomised control trials (RCTs) to arrive at an overview of current approaches to the diagnosis and management of patients who develop late life depression. The review is structured under headings which answer the questions:

  1. What is late life depression and who gets it? The “risk factors” for depression in elderly people are summarised.
  2. How is depression diagnosed in older patients? This section covers DSM-IV criteria for a major depressive episode.
  3. Is depression more difficult to diagnose in older adults? Useful scales for depression are summarised, including the Cornell scale for depression in dementia.
  4. Does depression increase the risk of dementia? Depression is more prevalent in individuals with brain disorders including dementia, Parkinson’s disease, and stroke.
  5. How is late life depression managed?
  6. When should I refer and what are the risk factors for suicide in older people?
  7. Which medication should be prescribed?
  8. What if first line drug treatment doesn’t work?
  9. Can older adults benefit from psychological therapy? What is the outlook for older adults with depression?

The Dementia Connection?

Depression is associated with cognitive impairment and increased risk of dementia. The Cornell scale for depression in dementia (CSDD) is suitable for patients with cognitive deficit. While this test is not perfect for diagnosing depression, higher scores indicate the need for further evaluation. The article suggests further investigations to consider when depression is suspected.

One issue for future research involves how to better identify and manage depression in dementia.

Many studies have shown that depression in late life is accompanied by cognitive impairment, memory deficits, diminished executive function, and slower information processing abilities. The term “depressive pseudodementia” has been used previously to cover reversible dementia in depression, but the current authors say this over-simplifies the issue. Two systematic meta-analyses found that late onset depression (over the age of 65) is associated with a twofold risk of dementia, but causal relationships are not explained yet.

Various mechanisms have been suggested to explain the relationship between depression and dementia; including hypercortisolaemia, loss of hippocampal volume, neuro-inflammatory processes, Alzheimer-type pathology, reduced cognitive reserve, and vascular disease. Whatever the exact causal links, these are probably multi-factorial. Vascular changes in the brain have been given the highest attention in the literature so far. Disruption to prefrontal-striatal circuitry by cerebrovascular pathology may possibly result in mood disorders and executive dysfunction. This controversial concept does not appear to be confirmed by postmortem studies however.

There is no evidence yet to support the idea that treating depression in earlier or late life might reduce the incidence of dementia.

This article finishes with a summary of additional educational resources and a list of questions for future research.

Full Text Link (Athens password required).

Reference

Rodda, J. [and] Walker, Z. (2011). Depression in older adults. BMJ (Clinical research ed.), September 28th  2011, Vol.343(d5219).

About Dementia and Elderly Care News

Dementia and Elderly Care News. Wolverhampton Medical Institute: WMI. (jh)
This entry was posted in Depression, For Doctors (mostly), Systematic Reviews, Universal Interest and tagged , , , , . Bookmark the permalink.

2 Responses to Depression in Older Adults (BMJ Clinical Review)

  1. mathew harris says:

    ya righti suffer with PSEUDODEMENTIA and live in wolverhampton put on pills after 3 months discharged from the mentol heath to a doctor (gp) thats got no idea on whats what i ask for help and sent to health minds that turn round and say they cant help so tell me at 40 years old having memory problems going from a good speller to almost usless good with maths to finding in hard for every day maths to 10 minute shop trip and not a clue why im at the shop to finding it hard to hold a converstion with any one (on a bad day) why cause the word i want to say is on the tip of my tongue then when i work out the word i forget what im talking about as for support groups where are they as i cant find one as for help ya right my poor partner copes with 2 young kids and me where her help its a joke in the midlands i think

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.