Detection of Depression in Older Adults with Dementia

Abstract

<h4>EXCERPT</h4> <p>Depression and dementia are the two most frequent psychiatric syndromes in the older adult population, yet depression in older adults with and without dementia often goes unrecognized and untreated (Charney et al., 2003; Kales, Chen, Blow, Welsh, & Mellow, 2005). Estimates of the prevalence of depression in older adults with dementia vary widely (Alexopoulos & Abrams, 1991; Wragg & Jeste, 1989), which is attributed to differences in sampling, diagnostic criteria used to identify depression, and the way it is assessed (Alexopoulos & Abrams, 1991; McCabe et al., 2006). In a recent study conducted in a nursing home, 25% of residents screened positive for major depression (Gruber-Baldini et al., 2005). This is close to the prevalence rate of major depression reported for individuals with Alzheimer’s disease (15% to 20%, Alexopoulos & Abrams, 1991; 22%, Lyketsos et al., 1997; 10% to 20%, Wragg & Jeste, 1989).</p>

Apolipoprotein E4 Genotype and Depressive Symptoms as Risk Factors for Dementia in an Older Korean Population

“…Prospective studies have reported that depression is associated with subsequent dementia, including AD,2-4 although some exceptions have been reported 5. A review article stated that depression might be a prodromal phenomenon in the course of dementia 6. Furthermore, only the most severe syndromes and cases of depression were risk factors for dementia in cohort studies in China and the United Kingdom (UK) 7.…”

Depression Case Finding in Individuals with Dementia: A Systematic Review and Meta‐Analysis

“…Part of the diagnostic challenge for depression in dementia is related to overlapping symptomatology, such as apathy, poor memory or concentration, which precludes accurate or timely diagnosis . This is compounded by the potentially decreased ability to convey symptoms or a lack of insight, which can be common in dementia …”

“…D epression is underdiagnosed and undertreated in elderly adults, especially those with dementia. [1][2][3][4] The reported prevalence of depression in individuals with dementia has a wide range among studies because of differences in populations, dementia severity, and measurement of depression. 5 One study found that even when diagnosed with depression, only 18% of individuals with dementia received treatment.…”

“…7 Depression in dementia is associated with poorer cognition, greater caregiver burden, poorer physical function, greater mortality, admission to LTC, and poorer quality of life. 1,4,[6][7][8][9] This is especially relevant because there are available nonpharmacological (e.g., interpersonal therapy; see 10 ) and pharmacological therapies for depression. 2,8,11 Depression occurs in all stages of dementia, and some research indicates it may be an early symptom or contribute to the development of dementia.…”

Measuring Symptoms of Depression: Comparing the Cornell Scale for Depression in Dementia and the Patient Health Questionnaire-9-Observation Version

“…On the other hand, as a scale with more items and different weightings, the CSDD and its higher cut-off point for depression appear to accommodate low levels of multiple symptoms that do not reach the threshold for depression in individuals with dementia. Although a PHQ-9-OV cut-off point of ≥5 may err on the side of higher sensitivity and lower specificity for detecting any depressive symptoms, this is desirable in LTC settings where the goal of screening is to identify residents who may need further diagnostic evaluation by a skilled health care provider (Brown, Raue, Halpert, Adams, & Titler, 2009). The effciency of the PHQ-9-OV is particularly suited to LTC staff with current familiarity of residents’ symptoms and behaviors.…”