Treatments for Depression in Older Persons with Dementia
- Thu, 1/29/09 - 3:50pm
- 0 Comments
- 15992 reads
author affiliations:
Dr. Gellis is Associate Professor and Director, School of Social Policy & Practice, University of Pennsylvania, Center for Mental Health & Aging, Philadelphia; Dr. McClive-Reed is Research Assistant Professor, Institute of Gerontology, School of Social Welfare, State University of New York at Albany; and Dr. Brown is Associate Professor of Nursing, College of Nursing and Health Sciences, Florida International University, Miami.
_________________________________
CORRECTIONS:
In the section entitled “Pharmacologic Treatment of Depression in Dementia”, subsection “Antidepressants,” buspirone is referred to as an antidepressant. Specifically, buspirone is classed as an anxiolytic with serotonergic or antidepressant activity (see Buhr & White, 2006, referenced in original article). Although buspirone has demonstrated some efficacy in trials and clinical use for both primary and augmentative treatment of depression, it is currently FDA-approved only for the treatment of anxiety disorders.
In the same section, the paragraph titled “Anticholinergics” should be titled “Cholinergics.” The term “anticholinergics” is also substituted incorrectly for “cholinergics” in the final sentence of the final sentence in the section titled, “Antidepressants,” and in the first paragraph of the final “Summary” section. The authors apologize for these errors.
_________________________________
Worldwide, dementia is one of the most disabling health conditions, with estimates of 24.3 million people diagnosed with dementia in 2005 and 4.6 million new cases of dementia occurring annually. This evidence-based review of the literature on depression disorders among older adults with dementia focuses on prevalence, clinical recognition, assessment, and treatment. A search of the empirical literature was undertaken to determine the extent of the problem, and the effectiveness of various pharmacological and nonpharmacological treatments. (Annals of Long-Term Care: Clinical Care and Aging 2009;17[2]:29-36)
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.
1. Steinberg M, Corcoran C, Tschanz JT, et al. Risk factors for neuropsychiatric symptoms in dementia: The Cache County Study. Int J Geriatr Psychiatry 2006;21:824-830.
2. Amore M, Tagariello P, Laterza C, Savoia EM. Subtypes of depression in dementia. Arch Gerontol Geriatr 2007;44 Suppl 1:23-33.
3. Cankurtaran M, Yavuz BB, Cankurtaran ES, et al. Risk factors and type of dementia: Vascular or Alzheimer? Arch Gerontol Geriatr 2007;47(1):25-34. Published Online: August 10, 2007.
4. Starkstein SE, Jorge R, Mizrahi R, Robinson RG. The construct of minor and major depression in Alzheimer’s disease. Am J Psychiatry 2005;162: 2086-2093.
5. Tatsch MF, Bottino CM, Azevedo D, et al. Neuropsychiatric symptoms in Alzheimer disease and cognitively impaired, nondemented elderly from a community-based sample in Brazil: Prevalence and relationship with dementia severity. Am J Geriatr Psychiatry 2006;14:438-445.
6. Palmer K, Berger AK, Monastero R, et al. Predictors of progression from mild cognitive impairment to Alzheimer disease. Neurology 2007;68:1596-1602.
7. Solfrizzi V, D’Introno A, Colacicco AM, et al; Italian Longitudinal Study on Aging Working Group. Incident occurrence of depressive symptoms among patients with mild cognitive impairment - the Italian longitudinal study on aging. Dement Geriatr Cogn Disord 2007;24:55-64.
8. Hwang TJ, Masterman DL, Ortiz F, et al. Mild cognitive impairment is associated with characteristic neuropsychiatric symptoms. Alzheimer Dis Assoc Disord 2004;18:17-21.
9. Jorm AF. History of depression as a risk factor for dementia: An updated review. Aust N Z J Psychiatry 2001;35:776-781.
10. Ownby RL, Crocco E, Acevedo A, et al. Depression and risk for Alzheimer disease: Systematic review, meta-analysis, and metaregression analysis. Arch Gen Psychiatry 2006;63:530-538.
11. Devanand DP, Sano M, Tang MX, et al. Depressed mood and the incidence of Alzheimer’s disease in the elderly living in the community. Arch Gen Psychiatry 1996;53:175-182.
12. Gabryelewicz T, Styczynska M, Luczywek E, et al. The rate of conversion of mild cognitive impairment to dementia: Predictive role of depression. Int J Geriatr Psychiatry 2007;22:563-567.
13. Li Y, Meyer JS, Thornby J. Depressive symptoms among cognitively normal versus cognitively impaired elderly subjects. Int J Geriatr Psychiatry 2001;16:455-461.
14. Simard M, van Reekum R, Cohen T. A review of the cognitive and behavioral symptoms in dementia with Lewy bodies. J Neuropsychiatry Clin Neurosci 2000;12:425-450.
15. Teng E, Lu PH, Cummings JL. Neuropsychiatric symptoms are associated with progression from mild cognitive impairment to Alzheimer’s disease. Dement Geriatr Cogn Disord 2007;24:253-259. Published Online: August 14, 2007.
16. Sutcliffe C, Burns A, Challis D, et al. Depressed mood, cognitive impairment, and survival in older people admitted to care homes in England. Am J Geriatr Psychiatry 2007;15:708-715. Published Online: May 15, 2007.
17. Appleby BS, Roy P, Valenti A, Lee HB. Diagnosis and treatment of depression in Alzheimer’s disease: Impact on mood and cognition. Panminerva Med 2007;49:139-149.
18. Hancock GA, Woods B, Challis D, Orrell M. The needs of older people with dementia in residential care. Int J Geriatr Psychiatry 2006;21:43-49.
19. Onega LL. Assessment of psychoemotional and behavioral status in patients with dementia. Nurs Clin North Am 2006;41:23-41, v.
20. Selwood A, Thorgrimsen L, Orrell M. Quality of life in dementia: A one-year follow-up study. Int J Geriatr Psychiatry 2005;20:232-237.
21. Conn D, Thorpe L. Assessment of behavioural and psychological symptoms associated with dementia. Can J Neurol Sci 2007;34 Suppl 1:S67-S71.
22. Twelftree H, Qazi A. Relationship between anxiety and agitation in dementia. Aging Ment Health 2006;10:362-367.
23. Black W, Almeida OP. A systematic review of the association between the behavioral and psychological symptoms of dementia and burden of care. Int Psychogeriatr 2004;16:295-315.
24. Kales HC, Chen P, Blow FC, et al. Rates of clinical depression diagnosis, functional impairment, and nursing home placement in coexisting dementia and depression. Am J Geriatr Psychiatry 2005;13:441-449.
25. Potter GG, Steffens DC. Contribution of depression to cognitive impairment and dementia in older adults. Neurologist 2007;13:105-117.
26. Daiello LA. Current issues in dementia pharmacotherapy. Am J Manag Care 2007;13 Suppl 8:S198-S202.
27. Thompson S, Herrmann N, Rapoport MJ, Lanctôt KL. Efficacy and safety of antidepressants for treatment of depression in Alzheimer’s disease: A metaanalysis. Can J Psychiatry 2007;52:248-255.
28. Buhr GT, White HK. Difficult behaviors in long-term care patients with dementia. J Am Med Dir Assoc 2006;7:180-192.
29. Herrmann N, Lanctôt KL. Pharmacologic management of neuropsychiatric symptoms of Alzheimer disease. Can J Psychiatry 2007;52:630-646.
30. Sink KM, Holden KF, Yaffe K. Pharmacological treatment of neuropsychiatric symptoms of dementia: A review of the evidence. JAMA 2005;293:596-608.
31. Caballero J, Hitchcock M, Beversdorf D, et al. Long-term effects of antidepressants on cognition in patients with Alzheimer’s disease. J Clin Pharm Ther 2006;31:593-598.
32. Lyketsos CG, DelCampo L, Steinberg M, et al. Treating depression in Alzheimer disease: Efficacy and safety of sertraline therapy, and the benefits of depression reduction: The DIADS. Arch Gen Psychiatry 2003;60:737-746.
33. Starkstein SE, Mizrahi R. Depression in Alzheimer’s disease. Expert Rev Neurother 2006;6:887-895.
34. Cooper JP. Buspirone for anxiety and agitation in dementia. J Psychiatry Neurosci 2003;28:469.
35. APA Work Group on Alzheimer’s Disease and Other Dementias, Rabins PV, Blacker D, Rovner BW, et al. American Psychiatric Association practice guideline for the treatment of patients with Alzheimer’s Disease and other dementias. Second edition. Am J Psychiatry 2007;164(12 suppl):5-56.
36. Garcia-Alloza M, Gil-Bea FJ, Diez-Ariza M, et al. Cholinergic-serotonergic imbalance contributes to cognitive and behavioral symptoms in Alzheimer’s disease. Neuropsychologia 2005;43:442-449.
37. Birks J. Cholinesterase inhibitors for Alzheimer’s disease. Cochrane Database Syst Rev 2006;(1):CD005593.
38. Mowla A, Mosavinasab M, Haghshenas H, Haghighi AB. Does serotonin augmentation have any effect on cognition and activities of daily living in Alzheimer’s dementia? A double-blind, placebo-controlled clinical trial. J Clin Psychopharmacol 2007;27:484-487.
39. Franco KN, Messinger-Rapport B. Pharmacological treatment of neuropsychiatric symptoms of dementia: A review of the evidence. J Am Med Dir Assoc 2006;7:201-202. Published Online: February 7, 2006.
40. Sival RC, Haffmans PM, Jansen PA, et al. Sodium valproate in the treatment of aggressive behavior in patients with dementia--a randomized placebo controlled clinical trial. Int J Geriatr Psychiatry 2002;17:579-585.
41. Sajatovic M, Ramsay E, Nanry K, Thompson T. Lamotrigine therapy in elderly patients with epilepsy, bipolar disorder or dementia. Int J Geriatr Psychiatry 2007;22:945-950.
42. Maidment ID, Fox CG, Boustani M, et al. Efficacy of memantine on behavioral and psychological symptoms related to dementia: A systematic meta-analysis. Ann Pharmacother 2008;42:32-38. Published Online: December 4, 2007.
43. Alexopoulos GS, Jeste DV, Chung H, et al. The expert consensus guideline series. Treatment of dementia and its behavioral disturbances. Introduction: methods, commentary, and summary. Postgrad Med 2005;Spec No:6-22.
44. Woods B. Invited commentary on: Non-pharmacological interventions in dementia. Adv Psychiatr Treat 2004;10:178-179.
45. Finnema E, Dröes RM, Ribbe M, Van Tilburg W. The effects of emotion-oriented approaches in the care for persons suffering from dementia: A review of the literature. Int J Geriatr Psychiatry 2000;15:141-161.
46. Moos I, Bjorn A. Use of the life story in the institutional care of people with dementia: A review of intervention studies. Ageing and Society 2006;26:431-454.
47. Neal M, Briggs M. Validation therapy for dementia. Cochrane Database Syst Rev 2003;(3):CD001394.
48. Peak JS, Cheston RI. Using simulated presence therapy with people with dementia. Aging Ment Health 2002;6:77-81.
49. Baldelli MV, Pirani A, Motta M, et al. Effects of reality orientation therapy on elderly patients in the community. Arch Gerontol Geriatr 1993;17:211-218.
50. Browne CJ, Shlosberg E. Attachment theory, ageing and dementia: A review of the literature. Aging Ment Health 2006;10:134-142.
51. Chin AMH. Clinical effects of reminiscence therapy in older adults: A meta-analysis of controlled trials. Hong Kong Journal of Occupational Therapy 2007;17:10-22.
52. Douglas S, James I, Ballard C. Non-pharmacological interventions in dementia. Adv Psychiatr Treat 2004;10:171-177.
53. Kasl-Godley J, Gatz M. Psychosocial interventions for individuals with dementia: An integration of theory, therapy, and a clinical understanding of dementia. Clin Psychol Rev 2000;20:755-782.
54. Livingston G, Johnston K, Katona C, et al; Old Age Task Force of the World Federation of Biological Psychiatry. Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. Am J Psychiatry 2005;162:1996-2021.
55. Schrijnemaekers V, van Rossum E, Candel M, et al. Effects of emotion-oriented care on elderly people with cognitive impairment and behavioral problems. Int J Geriatr Psychiatry 2002;17:926-937.
56. Zeiss AM, Lewinsohn PM. Adapting behavioral treatment for depression to meet the needs of the elderly. Clinical Psychologist 1986;39:98-100.
57. Logsdon RG, Teri L. The Pleasant Events Schedule-AD: Psychometric properties and relationship to depression and cognition in Alzheimer’s disease patients. Gerontologist 1997;37:40-45.
58. Teri L, Gibbons LE, McCurry SM, et al. Exercise plus behavioral management in patients with Alzheimer disease: A randomized controlled trial. JAMA 2003;290:2015-2022.
59. Lichtenberg PA, Kemp-Havican J, MacNeill SE, Schafer Johnson A. Pilot study of behavioral treatment in dementia dare units. Gerontologist 2005;45:406-410.
60. Teri L, Gallagher-Thompson D. Cognitive-behavioral interventions for treatment of depression in Alzheimer’s patients. Gerontologist 1991;31:413-416.
61. Teri L, Logsdon RG, Uomoto J, McCurry SM. Behavioral treatment of depression in dementia patients: A controlled clinical trial. J Gerontol B Psychol Sci Soc Sci 1997;52(4):P159-P166.
62. Koder DA. Treatment of anxiety in the cognitively impaired elderly: Can cognitive-behavior therapy help? Int Psychogeriatr 1998;10:173-182.
63. D’Zurilla TJ, Nezu AM. Problem-Solving Therapy: A Social Competence Approach to Clinical Intervention. 2nd ed. New York: Springer;1999.
64. Alexopoulos GS, Raue P, Areán P. Problem-solving therapy versus supportive therapy in geriatric major depression with executive dysfunction. Am J Geriatr Psychiatry 2003;11:46-52.
65. Mackin RS, Areán P, Elite-Marcandonatou A. Problem solving therapy for the treatment of depression for a patient with Parkinson’s disease and mild cognitive impairment: A case study. Neuropsychiatric Disease and Treatment 2006;2:375-379.
66. Snow AL, Powers D, Liles D. Cognitive-behavioral therapy for long-term care patients with dementia. In: Hyer L, Intrieri RC, eds. Geropsychological Interventions in Long-Term Care. New York: Springer, 2006:265-294.
67. Stanley M, McNeese T. Cognitive behavior therapy for treating anxiety in people with dementia. Michael Debakey Veterans Affairs Medical Center: National Institutes of Mental Health. U.S. National Institutes of Health Website. http://clinicaltrials.gov/show/NCT00596284. Accessed December 2, 2008.
68. D’Ath P, Katona P, Mullan E, et al. Screening, detection and management of depression in ederly primary care attenders. I: The acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions. Fam Pract 1994;11:260-266.
69. Kiosses DN, Dimitris N. Effectiveness of problem solving therapy in treating depressed, cognitively impaired older adults. Weill Medical College of Cornell University. U.S. National Institutes of Health Website. http://clinicaltrials.gov/show/NCT00368940. Accessed December 2, 2008.
70. Rusted J, Sheppard L, Waller D. A multi-centre randomized control group trial on the use of art therapy for older people with dementia. Group Analysis 2006;39:517-536.
71. Gräsel E, Wiltfang J, Kornhuber J. Non-drug therapies for dementia: An overview of the current situation with regard to proof of effectiveness. Dement Geriatr Cogn Disord 2003;15:115-125.
72. Killick J, Allan K. The arts in dementia care: Tapping a rich resource. Journal of Dementia Care 1999;7:35-38.
73. Lord TR, Garner JE. Effects of music on Alzheimer patients. Percept Mot Skills 1993;76:451-455.
74. Holmes C, Knights A, Dean C, et al. Keep music live: Music and the alleviation of apathy in dementia subjects. Int Psychogeriatr 2006;18:623-630.
75. Sherratt K, Thornton A, Hatton C. Music interventions for people with dementia: A review of the literature. Aging Ment Health 2004;8:3-12.
76. Gerdner LA. Music, art, and recreational therapies in the treatment of behavioral and psychological symptoms of dementia. International Psychogeriatrics 2000;12:359-366. doi:10.1017/S1041610200007286.
77. Sung HC, Chang AM. Use of preferred music to decrease agitated behaviours in older people with dementia: A review of the literature. J Clin Nurs 2005;14:1133-1140.
78. Irish M, Cunningham CJ, Walsh JB, et al. Investigating the enhancing effect of music on autobiographical memory in mild Alzheimer’s disease. Dement Geriatr Cogn Disord 2006;22:108-120. Published Online: May 23, 2006.
Post new comment