A common challenge in older adults: Classification, overlap, and therapy of depression and dementia

Abstract

Late-life depression is frequently associated with cognitive impairment. Depressive symptoms are often associated with or even precede a dementia syndrome. Moreover, depressive disorders increase the risk of persistence for mild cognitive impairment and dementia. Here, we present both the current state of evidence and future perspectives regarding the integration and value of clinical assessments, neuropsychological, neurochemical, and neuroimaging biomarkers for the etiological classification of the dementia versus the depression syndrome and for the prognosis of depression relating to dementia risk. Finally, we summarize the existing evidence for both pharmacotherapy and psychotherapy of depression in demented patients. There is an urgent need for large-scale collaborative research to elucidate the role and interplay of clinical and biological features in elderly individuals with depressive disorders who are at elevated risk for developing dementia. To overcome barriers for successful drug development, we propose the introduction of the precision medicine paradigm to this research field.

The recency ratio is associated with reduced CSF glutamate in late-life depression

“…More importantly, our results may help elucidate the relationship between AD and MDD, and help the identification of elderly individuals with MDD who carry the highest risk of being at a prodromal stage of AD. Specifically, as noted recently by Leyhe et al (2016), individuals suffering from a pure depressive disorder, i.e., uncontaminated by dementia, do not present deficits of information storage. If Rr indeed signals an issue with consolidation of episodic information, then late-life MDD individuals with abnormally high Rr scores may be showing signs of a contaminated profile, and be in a prodromal stage of AD.…”

Neurogranin and BACE1 in CSF as Potential Biomarkers Differentiating Depression with Cognitive Deficits from Early Alzheimer’s Disease: A Pilot Study

“…Moreover, MDD has been discussed as a risk factor for the development of AD [1, 2]. Essentially, discriminating between AD and MDD is a prerequisite for an optimal clinical and pharmacological treatment [3]. …”

Neurocognitive and Affective Baseline Profile of the Elderly Individuals Living in Long-Term Care Nursing Home Facility: a New Brunswick Study

“…Evidence suggests that cognitive and emotional problems can overlap with the natural aging process, making them difficult to detect [7,8]. In fact, memory loss, grief and physical decline are among factors that can blur the line between normal aging and serious psychopathology.…”