Depression and cognitive impairment in the elderly: a multicentre study

Abstract

The present study, conducted in collaboration between the Departments of Psychiatry in Swiss Universities and the World Health Organization, had two main goals: to develop assessment methods which could subsequently be used in the Swiss centres in a standard manner; and to make arrangements for continuing collaboration between the centres in Switzerland and the acquisition of new knowledge about the distinctions between depression and cognitive impairment. For this aim, three different groups of elderly patients of either sex were selected during the period of November 1989 to July 1991 for inclusion in the study. The first two groups included the first ten patients of either sex over 60 years of age consecutively contacting the participating institutions and showing depression with or without clinically significant symptoms of cognitive impairment; the control group included patients showing no depression or clinically significant symptoms of cognitive impairment. A total of 125 patients were included in the initial evaluation, 69 of which were reassessed at a seven-month follow up (on average). Each patient was administered a number of clinician-rated or self-report instruments for the assessment of depression, cognitive impairment, disabilities, physical status and onset of disorders. The study has shown that a variety of instruments can be used for the reliable assessment of depression or cognitive impairment in the elderly; but the instruments for the assessment of depression differentiate only poorly between patients with or without cognitive impairment. Because of the importance of identifying both depressed and cognitively impaired patients among the elderly, different assessment instruments targeted at the different symptom clusters need to be administered simultaneously.

Dementia and depression: Co-distribution and risk factors in a geriatric in- and outpatient sample

“…Since also locus coeruleus and serotonergic cell groups are diminished, this may explain the higher incidence of depression in the elderly with brain atrophy. In Kielholz et al's (1995) multi-centre study of 68 patients followed over seven months, depression scores improved significantly with time, but not the cognitive measures. This is further evidence that depression and dementia follow their own time course.…”

“…This bias is, however, shared with most other clinically based studies of the subject (Ballard et al, 1993;Corey-Bloom et al, 1993;Kielholz et al, 1995). However, as 92% of the patients were sent for diagnostic purposes by neurologists, psychiatrists and general practitioners, the sample is certainly typical of those patients seeking medical advice from local health officials.…”