Annals of Long Term Care

Treatments for Depression in Older Persons with Dementia

Author:Zvi D. Gellis, PhD, Kimberly P. McClive-Reed, PhD, and Ellen L. Brown, EdD, MS, ARNP

Depression in Dementia

Dementia itself is not a disease, but a constellation of symptoms caused by diseases and disorders that affect the brain, including Alzheimer’s disease (AD), Parkinson’s disease (PD), diffuse Lewy body disease, strokes, and others. Dementia involves progressive loss of memory and other cognitive functions, such as problem-solving and emotional control. The earliest diagnosable stage of dementia, mild cognitive impairment (MCI), does not always lead to dementia; for those who do develop dementia, abilities to independently perform basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are generally impaired as the condition progresses.

Behavioral and psychological symptoms of dementia (BPSD), also frequently referred to as neuropsychiatric symptoms of dementia, affect up to 95% of those with dementia during the course of the illness.1 Symptoms of depression are especially common in MCI and throughout the course of dementia. Reported prevalence of depression or depressive symptoms in persons with dementia ranges from 0% to 96%,2-5 while moderate to high rates of depression or its symptoms are consistently reported for persons with MCI (ie, 36% by Palmer and colleagues6; 63.3% by Solfrizzi and colleagues7; 39% by Hwang and colleagues8). The wide range of prevalence for depression in dementia is due to several factors, including differences in researchers’ focus on symptoms versus specifically defined depressive disorders, diverse study samples varying in causes of dementia, stage of illness, country of residence, and placement of patient, as well as variation in the instruments used to assess depressive symptoms and disorders. A recently published evidence-based practice guideline provides a feasible approach to depression assessment in persons with dementia; an overview of the guideline algorithm is provided in the Table. The guideline can be accessed at the National Guideline Clearinghouse, a public resource for evidence-based clinical practice guidelines.

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