|
 |
|
REVIEW |
|
|
|
| Year : 2010 | Volume
: 13
| Issue : 6 | Page : 69-73 |
| |
The complex relationship between depression and dementia
Krishna Prasad Muliyala, Mathew Varghese
Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences, Bangalore, India
| Date of Submission | 08-Sep-2010 |
| Date of Acceptance | 08-Sep-2010 |
| Date of Web Publication | 27-Dec-2010 |
Correspondence Address:
Mathew Varghese
National Institute of Mental Health and Neurosciences, Bangalore 560029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-2327.74248
 Abstract | | |
Dementia and depression are mental health problems that are commonly encountered in neuropsychiatric practice in the elderly. Approximately, half of the patients with late-onset depression have cognitive impairment. The prevalence of depression in dementias has been reported to be between 9 and 68%. Depression has been both proposed to be a risk factor for dementia as well as a prodrome of dementia. This article is a selective literature review of the complex relationship between the two conditions covering definitions, epidemiology, related concepts, treatment, and emerging biomarkers. The methodological issues and the mechanisms underlying the relationship are also highlighted. The relationship between the two disorders is far from conclusive.
Keywords: Alzheimer′s disease, dementia, depression, geriatric, vascular dementia
How to cite this article:
Muliyala KP, Varghese M. The complex relationship between depression and dementia. Ann Indian Acad Neurol 2010;13, Suppl S2:69-73 |
| Introduction | |  |
Depression, cognitive disturbances, and dementia are some of the commonest mental disorders in the elderly in India. While depression in old age is quite prevalent at about 10-20% of elders depending on the presence of other comorbid physical disorders, the prevalence of dementia is lower than in developed countries at about 3%. [1] The prevalence of milder cognitive disturbances is possibly higher at about 10-15% depending on the definitions of normal senescence to mild cognitive impairment (MCI). The presence of comorbid depression or other physical disorders may cause these prevalence rates to vary depending on whether the cognitive dysfunction is reversible or permanent. [2] In the next 5-10 years, India will have the largest population of elders in the world next only to China. This complex and rather fickle relationship among these three mental disorders would be very challenging for any physician dealing with elders. This paper is a selective literature review using search terms: "depression", "elderly", "late-onset depression (LOD)", and "dementia" in the Pubmed search engine. Important review articles were also used to obtain relevant cross references. The review though not a systematic one attempts to cover most of the issues relevant to these disorders.
Definitions
A depressive episode or disorder is diagnosed according to ICD-10 [3] as a syndrome in the presence of any two of the following: depressed mood, loss of interest and enjoyment, and reduced energy for at least a period of 2 weeks. The episodes are graded as mild, moderate or severe on the basis of number of ancillary and somatic symptoms, and disability. In the literature-related to the topic in discussion, however "depression" has been used in a broader sense. This includes clinically significant depressive symptoms that encompass syndromal depression as defined above in ICD-10 (or the DSM-IV [4] ) and also milder depressive symptoms as in subsyndromal depression, nondysphoric depression, and dysthymia. Late life/LOD has been variously defined as a depressive syndrome occurring for the first time after 45-65 years of age. [5]
MCI or minor neurocognitive disorder has been used for an intermediate state between normal cognitive aging and dementia. The precise definition of this potential pre-dementia syndrome continues to evolve. MCI has been further subdivided into amnestic and nonamnestic types: single domain and multidomain. [6] The amnestic type is purported to be a precursor of Alzheimer's disease (AD) with conversion rates of 10-15% every year. [6]
Dementia is a syndrome due to acquired disease of the brain in which there is a progressive deteriorating disturbance of multiple higher cortical functions such as memory, thinking, orientation, comprehension, calculation, language and judgment in the presence of clear consciousness, sufficient to impair personal activities of daily living [3] . The commonest type of dementia encountered in clinical practice is AD followed by vascular dementia as the next single most frequent cause. Provisional diagnostic criteria for depression in AD have also been proposed by the NIMH. [7]
Epidemiology
Approximately, half of the patients with LOD have generalized cognitive impairment [8],[9] Deficits in executive function and information processing have been described to be typical of LOD. Age, severity of depression, race, education, and vascular risk factors have been noted to make significant contributions to cognitive deficits in LOD. [10]
The cardiovascular health study (CHS) found a cumulative prevalence of 26% for depression among individuals with MCI. [11] In contrast, investigators of the Italian Longitudinal Study on Aging (ILSA) found depressive symptoms in 63% of the patients with MCI. [12] The wide range noted in the two studies might be explained by the use of different instruments to assess depression. The CHS used the Neuro Psychiatric Inventory, [13] whereas the ILSA used the Geriatric Depression Scale (GDS). [14] Both community- and hospital-based studies have shown this wide range of prevalence rates between 9 and 68%. Methodological issues such as use of different definitions of MCI other than sampling may also have contributed to the widely discrepant findings. Across the subtypes of MCI (amnestic vs. nonamnestic; vascular vs. nonvascular), the findings are inconclusive. [15],[16] The incidence of depression as observed in the longitudinal studies has been 12 and 30 per 100 person years in hospital and community studies, respectively. [12],[18]
The prevalence of depression in dementia has been reported to be 20-60%. [19],[20] The prevalence of major depression decreases as severity of dementia increases. [21],[22] Vascular and mixed subtypes of dementia have a higher prevalence of depression as compared to AD. [23],[24],[25]
Concepts of pseudo dementia, vascular depression, and apathy
From the clinical standpoint it is necessary to identify the cognitive impairment in depressed patients so also to evaluate for depression in patients with cognitive impairment. In the clinical setting, certain features were believed to be characteristic of depressive pseudo dementia. [26],[27] Some of these features described are:
- higher subjective cognitive complaint scores
- complaints of difficulties with concentration and recent memory
- poor effort on examination
- provision of "I don't know" answers
- inconsistency in sequential performances
This cognitive impairment was considered reversible on treatment with antidepressants or electroconvulsive therapy. These distinctions were, however, not borne out on objective research - patients with dementia being equally likely to give "I don't know" answers [28] and subjective memory complaints in persons with early stage dementia. In a recent study of 23 centers from low and middle income group countries, subjective memory deficits (SMD) frequency was the lowest in normal elderly subjects (26.2%) and higher in those with depression (50.0%) and dementia (66.7%). Depression and dementia were consistently associated with SMD. In those with dementia, SMD was associated with better cognitive function, whereas the reverse was the case in normal controls [29]
In addition, the persistence of cognitive impairment in a subset of patients after depression was treated prompted commentaries such as these being cases of mistaken identity [30] or "pseudo-pseudo dementia". It has become increasingly evident that cognitive impairment seen during or after the depressive episode is not "pseudo", but perhaps a part of depression (state or trait) or a predementia harbinger. [2]
Another concept that is relevant in the context of this complex relationship is that of vascular depression. It was hypothesized that cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes. [31],[32] The interaction and co-morbidity of depression and cerebrovascular disease have been difficult to disentangle. This subset of LOD has greater overall cognitive impairment, apathy, psychomotor retardation, less guilt, greater lack of insight, and greater disability. [33]
Apathy as a neuropsychiatric symptom may be noted in both dementia and depression. Hence, distinguishing isolated apathy from its presentation as a symptom of depression in the context of dementia becomes clinically important. Moreover, nondysphoric depression is commonly observed in patients with dementia. [5] As the severity of dementia increases, the prevalence of apathy increases while that of depression decreases. Apathy may also have a differential impact in the conversion of MCI to dementia with greater conversion in patients having apathy as a symptom. [34] This distinction is difficult to make clinically though it is of therapeutic relevance.
Rating scales for assessing depression in MCI/dementia and vice-versa
The assessment of depression using structured interviews such as structured clinical interview for DSM-IV (SCID) is comprehensive but deemed impractical as it is too lengthy and needs training. They may also not capture features unique to LOD such as apathy and motor impairment. The Geriatric Depression Rating Scale [14] uses a yes or no format and is brief; however, it is only a patient self-report measure of depression and has limitations when used in patients with MCI or dementia. The scale also requires adaptation and modification when used in languages other than English and in rural illiterate population. [35] The Cornell Scale for depression in dementia [36] utilizes clinician's judgment, patient reports, and informant reports; however, it is insensitive to change. The Neuropsychiatric Inventory [13] assesses 12 behavioral and psychological symptoms on the basis of informant reports and is the most extensively used in the literature though not specific for depression. It can be used by non-psychiatrists and has excellent psychometric properties. Other rating scales used are Hamilton Depression Rating Scale, [37] Beck Depression Inventory, [38] Dementia Mood Assessment Scale, [39] and Centre for Epidemiological Studies for Depression Scale. [40] All the rating scales and structured interview schedules currently available are not without limitations while evaluating for depression in cognitively impaired subjects.
The Mini Mental State Examination (MMSE) [41] is frequently used as a bedside screening tool for cognitive disorders (including dementia), but it suffers from ceiling effects in individuals with MCI. Education and Culturally fair modifications such as the Hindi Mental State Examination (HMSE) [42] also have similar limitations. The Clinical Dementia Rating (CDR) Scale, [43] Mattis Dementia Rating Scale, [44] and the Blessed Orientation-Memory concentration test [45] may be more appropriate in the context of evaluating for cognitive impairment in LOD. In the past years, many instruments which are education and culturally fair like the Cognitive Screening Battery, [46] the 10/66 Dementia Research Group Cognitive test, [47] and the Addenbrooke's Cognitive Evaluation [48] have been developed in the Indian context for detection of dementia and differentiate from depression. Detailed neuropsychological batteries may be time consuming and are not feasible in routine clinical settings, but may be used for research.
Biomarkers
Biomarkers in late life mental disorders have involved structural and functional neuroimaging, genomics, CSF studies, neurophysiologic studies, and plasma analysis. We will briefly review select recent literature related to Apo lipoprotein E (ApoE) gene and neuroimaging. APOE-4 is a major risk factor for dementia; however, its association with depression has been inconsistent in studies. The Honolulu-Asia Aging Study, a population-based prospective cohort study of Japanese American men examined the independent and combined effects of depression and APOE-4 allele on the risk of dementia and its subtypes. The presence of both depressive symptoms and APOE-4 allele increased several fold the risk for dementia across subtypes. [49] The association of the APOE-4 allele with specific genetic variants of other genes (e.g., CYP2D6, ACE) negatively modulates the therapeutic response to multifactorial treatments affecting cognition, mood, and behavior. [50] Frontal and right parietal white matter hyperintensities were reported as the strongest brain structural correlates of apathy and depression in AD. [51] In patients from a memory clinic, cerebrovascular pathology had no impact on the NPI items in AD. [52] The risk for dementia in patients with depression was observed to be not mediated by smaller hippocampal or amygdalar volumes in the Rotterdam Scan Study. [53] Approximately, one-half of nine remitted patients with LOD demonstrated PiB retention indicative of brain β-amyloid accumulation in cortical areas in a pattern characteristic of early AD in a PET scan study.[54] The gray matter changes in LOD involve smaller volumes of several frontal, temporal areas, cingulum, parahippocampal, inferior parietal area, and putamen. There was correlation of volume loss in these areas with short duration of illness and later age at onset supporting the dementia prodrome model over the toxic stress model. [55]
Treatment
The treatment of depression occurring in patients with dementia has involved the use of tricyclic agents, SSRIs and MAOIs. The evidence to support the contention that these agents are effective is weak. Randomized controlled trials have evaluated the use of Imipramine, Citalopram, Fluoxetine, Sertraline, and Moclobemide with beneficial results. [56],[57],[58],[59],[60] However, a recent multicenter, randomized placebo-controlled trial did not demonstrate efficacy for the treatment of depression with Sertraline in patients with AD. There are on the other hand observations to suggest that antidepressant treatment may reduce cognitive decline in depressed older AD patients. [61] Augmentation of cholinsterase inhibitors with SSRI may improve ADL and global functioning in patients with dementia. [62] There are no RCTs that have evaluated the use of ECT in the treatment of depression in dementia. Nonpharmacological management of depression in the cognitively impaired group involves both patient focused interventions as well as family or caregiver support. A controlled clinical investigation involving the use of two behavioral treatments showed that these methods are effective. [63] Cholinesterase inhibitors ameliorate some types of behavioral symptoms in patients with Alzheimer's disease. Treatment with donepezil delayed progression to AD among depressed subjects with aMCI. [64]
| Limitations/Caveats While Reviewing Literature | | |
There are certain limitations that one has to bear in mind while reviewing the literature on the complex relationship between depression and dementia. [20] The studies vary in terms of settings-epidemiological/hospital and specialty clinic/general hospital/primary care settings, use of rating scales differs across studies, diagnostic criteria for cognitive impairment are being refined constantly, and the exclusion of subjects with medical comorbidity. [20] There is also a need to operationalize and validate criteria for a depressive syndrome in dementia. In the background of these limitations, inferences drawn from the review of literature may only be inaccurate or erroneous.
| Mechanisms Underlying the Relationship | | |
There is a growing body of evidence to suggest that depression may be a risk factor for the development of dementia. [53],[65],[66] Past/lifetime history of depression is also known to increase the risk of developing both AD and vascular dementia. This is true even when depression occurred more than 10 years before the onset of dementia. [65] A history of depression nearly doubles the risk of developing dementia-findings of a meta analysis that reviewed both case-control and prospective studies. [67] Interval between diagnoses of depression and AD was positively related to increased risk of developing AD, suggesting that rather than a prodrome, depression may be a risk factor for AD. [68] This is further confirmed by a neuropathological study that demonstrated increased hippocampal plaque and tangle formation in AD patients with lifetime history of depression. [69] Prolonged damage to the hippocampus due to hypercortisolemia linked to depression has been proposed to underlie this finding. [2]
The other way this relationship has been construed is that depression may represent a predementia syndrome or that it serves as a prodrome of cognitive decline. [70] Recent history of depression has been associated with the increased incidence of dementia. Patients with LOD and cognitive impairment go on to develop dementia within a few years after the onset of depression. Depressive syndrome may just be the early manifestation of an underlying neurodegenerative disease. This coexistence can also be because of risk factors that are shared between both disorders such as genetic, vascular, or other environmental determinants. [2],[5]
Depression could also be a reaction or a psychological response to the diagnosis of cognitive impairment. [2] Depression can also unmask clinical cognitive impairment. Depression serves to compromise cognitive reserve and allow symptoms of dementia to be manifested earlier than they would have been otherwise. [2] Cognitive impairment in depressed elderly can also be contributed by the use of several tricyclic antidepressants that have anticholinergic effects, though with the use of SSRI's this should become less likely. All of the above hypotheses are not mutually exclusive and multiple types of interaction may be involved.
| Conclusions | | |
The relationship between depression and dementia is far from clear with the existing body of evidence pointing to a complex interaction. There is a need to sort out several methodological limitations that hinder us from elucidating the relationship. Some of these may include use of uniformed criteria for cognitive impairment, operationalizing, and validating criteria for depression in dementia, using better instruments to measure depression and cognitive impairment when they coexist. This area has enormous public health implications considering our growing elder population, and there is a need to understand the mechanisms involved in the association of these two disorders.
| References | | |
| 1. | Varghese M, Patel V. The graying of India: mental health perspectives. In: Agarwal SP, editor. Mental Health: An Indian Perspective, 1946-2003. DGHS, Ministry of Health and Family Welfare. New Delhi: Elsevier; 2004. 
|
| 2. | Ganguli M. Depression, cognitive impairment and dementia: Why should clinicians care about the web of causation? Indian J Psychiatry 2009;51:29-34.
 |
| 3. | World Health Organization. The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.
|
| 4. | American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Text Revision (DSM-IV-TR). Washington DC: American Psychiatric Association; 2000.
|
| 5. | Panza F, Frisardi V, Capurso C, D'Introno A, Colacicco AM, Imbimbo BP, et al. Late-life depression, mild cognitive impairment, and dementia: possible continuum? Am J Geriatr Psychiatry 2010;18:98-116.
|
| 6. | Gauthier S, Reisberg B, Zaudig M, Petersen RC, Ritchie K, Broich K, et al. Mild cognitive impairment. Lancet 2006;367:1262-70.
|
| 7. | Olin JT, Schneider LS, Katz IR, Meyers BS, Alexopoulos GS, Breitner JC, et al. Provisional diagnostic criteria for depression of Alzheimer disease. Am J Geriatr Psychiatry 200210:125-8.
|
| 8. | Butters MA, Whyte EM, Nebes RD, Begley AE, Dew MA, Mulsant BH, et al. The nature and determinants of neuropsychological functioning in late-life depression. Arch Gen Psychiatry 2004;61:587-95.
|
| 9. | Köhler S, Thomas AJ, Barnett NA, O'Brien JT. The pattern and course of cognitive impairment in late-life depression. Psychol Med 2010;40:591-602.
|
| 10. | Sheline YI, Barch DM, Garcia K, Gersing K, Pieper C, Welsh-Bohmer K, et al. Cognitive function in late life depression: Relationships to depression severity, cerebrovascular risk factors and processing speed. Biol Psychiatry 2006;60:58-65.
|
| 11. | Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: Results from the cardiovascular health study. JAMA 2002;288:1475-83.
|
| 12. | Solfrizzi V, D'Introno A, Colacicco AM, Capurso C, Del Parigi A, Caselli RJ, et al. 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.
|
| 13. | Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-14.
|
| 14. | Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression screening scale: A preliminary report. J Psychiatr Res 1982-1983;17:37-49.
|
| 15. | Rozzini L, Vicini Chilovi B, Conti M, Delrio I, Borroni B, Trabucchi M, et al. Neuropsychiatric symptoms in amnestic and nonamnestic mild cognitive impairment. Dement Geriatr Cogn Disord 2008;25:32-6.
|
| 16. | Ellison JM, Harper DG, Berlow Y, Zeranski L. Beyond the "C" in MCI: Noncognitive symptoms in amnestic and non-amnestic mild cognitive impairment. CNS Spectr 2008;13:66-72.
|
| 17. | Lee KS, Cho HS, Hong CH, Kim DG, Oh BH. Differences in neuropsychiatric symptoms according to mild cognitive impairment subtypes in the community. Dement Geriatr Cogn Disord 2008;26:212-7.
|
| 18. | Li YS, Meyer JS, Thornby J. Longitudinal follow-up of depressive symptoms among normal versus cognitively impaired elderly. Int J Geriatr Psychiatry 2001;16:718-7.
|
| 19. | Tsuno N, Homma A. What is the association between depression and Alzheimer's disease? Expert Rev Neurother 2009;9:1667-76.
|
| 20. | Steffens DC, Otey E, Alexopoulos GS, Butters MA, Cuthbert B, Ganguli M, et al. Perspectives on depression, mild cognitive impairment, and cognitive decline. Arch Gen Psychiatry 2006;63:130-8.
|
| 21. | Forsell Y, Winblad B. Major depression in a population of demented and nondemented older people: Prevalence and correlates. J Am Geriatr Soc 1998;46:27-30.
|
| 22. | Rubin EH, Veiel LL, Kinscherf DA, Morris JC, Storandt M. Clinically significant depressive symptoms and very mild to mild dementia of the Alzheimer type. Int J Geriatr Psychiatry 2001;16:694-701.
|
| 23. | Sultzer DL, Levin HS, Mahler ME, High WM, Cummings JL. A comparison of psychiatric symptoms in vascular dementia and Alzheimer's disease. Am J Psychiatry 1993;150:1806-12.
|
| 24. | Naarding P, de Koning I, dan Kooten F, Dippel DW, Janzing JG, van der Mast RC, et al. Depression in vascular dementia. Int J Geriatr Psychiatry 2003;18:325-30.
|
| 25. | Castilla-Puentes RC, Habeych ME. Subtypes of depression among patients with Alzheimer's disease and other dementias. Alzheimer's Dement 2010;6:63-9.
|
| 26. | Haggerty JJ Jr, Golden RN, Evans DL, Janowsky DS. Differential diagnosis of pseudodementia in the elderly. Geriatrics 1988;43:61-9,72,74.
|
| 27. | Lishman WA. Organic psychiatry: The psychological consequences of cerebral disorder. 3rd ed. Hoboken, NJ: Wiley Blackwell; 1998.
|
| 28. | Young RC, Manley MW, Alexopoulos GS. "I don't know" responses in elderly depressives and in dementia. J Am Geriatr Soc 1985;33:253-7.
|
| 29. | 10/66 Dementia Research Group. Subjective memory deficits in people with and without dementia: findings from the 10/66 dementia research group pilot studies in low- and middle-income countries. J Am Geriatr Soc 2009;57:2118-24.
|
| 30. | Reifler B. A case of mistaken identity: Pseudodementia is really predementia. J Am Geriatr Soc 2000;48:593-4.
|
| 31. | Krishnan KR, Hays JC, Blazer DG. MRI-defined vascular depression. Am J Psychiatry 1997;154:497-501.
|
| 32. | Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. Vascular depression hypothesis. Arch Gen Psychiatry 1997;54:915-22.
|
| 33. | Alexopoulos GS, Meyers BS, Young RC, Kakuma T, Silbersweig D, Charlson M. Clinically defined vascular depression. Am J Psychiatry 1997;154:562-5.
|
| 34. | Vicini Chilovi B, Conti M, Zanetti M, Mazzω I, Rozzini L, Padovani A. Differential impact of apathy and depression in the development of dementia in mild cognitive impairment patients. Dement Geriatr Cogn Disord 2009;27:390-8.
|
| 35. | Ganguli M, Dube S, Johnston JM, Pandav R, Chandra V, Dodge HH. Depressive symptoms, cognitive impairment and functional impairment in a rural elderly population in India: A Hindi version of the geriatric depression scale (GDS-H). Int J Geriatr Psychiatry 1999;14:807-20.
|
| 36. | Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell scale for depression in dementia. Biol Psychiatry 1988;23:271-84.
|
| 37. | Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62.
|
| 38. | Beck AT, Steer RA, Brown GK. Beck depression inventory-II manual. San Antonio, TX: Psychological Corporation; 1996.
|
| 39. | Sunderland T, Alterman IS, Yount D, Hill JL, Tariot PN, Newhouse PA, et al. A new scale for the assessment of depressed mood in demented patients. Am J Psychiatry 1988; 145:955-9.
|
| 40. | Radloff LS. The CES-D scale: A self report depression scale for research in the general population. Appl Psychol Meas 1977:1;385-401.
|
| 41. | Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.
|
| 42. | Ganguli M, Ratcliff G, Chandra V, Sharma S, Gilby J, Pandav R, et al. A Hindi version of the MMSE: The development of a cognitive screening instrument for a largely illiterate rural elderly population in India. Int J Geriatr Psychiatry 1996;10:367-77.
|
| 43. | Morris JC. The Clinical Dementia Rating (CDR): Current version and scoring rules. Neurology 1993;43:2412-4.
|
| 44. | Monsch AU, Bondi MW, Salmon DP, Butters N, Thal LJ, Hansen LA, et al. Clinical validity of the mattis dementia rating scale in detecting dementia of the alzheimer type: A double cross-validation and application to a community-dwelling sample. Arch Neurol 1995;52:899-904.
|
| 45. | Fillenbaum GG, Heyman A, Wilkinson WE, Haynes CS. Comparison of two screening tests in Alzheimer's disease: The correlation and reliability of the Mini-Mental State Examination and the modified Blessed test. Arch Neurol 1987;44:924-7.
|
| 46. | Ganguli M, Chandra V, Gilby JE, Ratcliff G, Sharma SD, Pandav R, et al. Cognitive test performance in a community-based nondemented elderly sample in rural India: The Indo-U.S. Cross-National Dementia Epidemiology Study. Int Psychogeriatr 1996;8:507-24.
|
| 47. | Prince M, Acosta D, Chiu H, Scazufca M, Varghese M; 10/66 Dementia Research Group. Dementia diagnosis in developing countries: A cross-cultural validation study. Lancet 2003;361:909-17.
|
| 48. | Mathuranath PS, Hodges JR, Mathew R, Cherian PJ, George A, Bak TH. Adaptation of the ACE for a Malayalam speaking population in southern India. Int J Geriatr Psychiatry 2004;19:1188-94.
|
| 49. | Irie F, Masaki KH, Petrovitch H, Abbott RD, Ross GW, Taaffe DR, et al. Apolipoprotein E epsilon4 allele genotype and the effect of depressive symptoms on the risk of dementia in men: The Honolulu-Asia Aging Study. Arch Gen Psychiatry 2008;65:906-12.
|
| 50. | Cacabelos R. Pharmacogenetic basis for therapeutic optimization in Alzheimer's disease. Mol Diagn Ther 2007;11:385-405.
|
| 51. | Starkstein SE, Mizrahi R, Capizzano AA, Acion L, Brockman S, Power BD. Neuroimaging correlates of apathy and depression in Alzheimer's disease. J Neuropsychiatry Clin Neurosci 2009;21:259-65.
|
| 52. | Klugman A, Marshall J, Tabet N. Impact of cerebrovascular pathology on behavioural and neuropsychiatric symptoms in patients with Alzheimer's dementia: Findings from a retrospective, naturalistic study. Int J Clin Pract 2009;63:1024-30.
|
| 53. | Geerlings MI, den Heijer T, Koudstaal PJ, Hofman A, Breteler MM. History of depression, depressive symptoms, and medial temporal lobe atrophy and the risk of Alzheimer disease. Neurology 2008;70:1258-64.
|
| 54. | Butters MA, Klunk WE, Mathis CA, Price JC, Ziolko SK, Hoge JA, et al. Imaging Alzheimer pathology in late-life depression with PET and Pittsburgh Compound-B. Alzheimer Dis Assoc Disord 2008;22:261-8.
|
| 55. | Andreescu C, Butters MA, Begley A, Rajji T, Wu M, Meltzer CC, et al. Gray matter changes in late life depression--a structural MRI analysis. Neuropsychopharmacology 2008;33:2566-72.
|
| 56. | Reifler BV, Teri L, Raskind M, Veith R, Barnes R, White E, et al. Double-blind trial of imipramine in Alzheimer's disease patients with and without depression. Am J Psychiatry 1989;146:45-9.
|
| 57. | Karlsson I, Godderis J, Augusto De Mendonça Lima C, Nygaard H, Simányi M, Taal M, et al. A randomised, double-blind comparison of the efficacy and safety of citalopram compared to mianserin in elderly, depressed patients with or without mild to moderate dementia. Int J Geriatr Psychiatry 2000;15:295-305.
|
| 58. | Petracca GM, Chemerinski E, Starkstein SE. A double-blind, placebo-controlled study of fluoxetine in depressed patients with Alzheimer's disease. Int Psychogeriatr 2001;13:233-40.
|
| 59. | Roth M, Mountjoy CQ, Amrein R. Moclobemide in elderly patients with cognitive decline and depression: An international double-blind, placebo-controlled trial. Br J Psychiatry 1996;168:149-57.
|
| 60. | Rosenberg PB, Drye LT, Martin BK, Frangakis C, Mintzer JE, Weintraub D, et al. Sertraline for the treatment of depression in Alzheimer disease. Am J Geriatr Psychiatry 2010;18:136-45.
|
| 61. | Mossello E, Boncinelli M, Caleri V, Cavallini MC, Palermo E, Di Bari M, et al. Is antidepressant treatment associated with reduced cognitive decline in Alzheimer's disease? Dement Geriatr Cogn Disord 2008;25:372-9.
|
| 62. | 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;27:484-7.
|
| 63. | 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:P159-66.
|
| 64. | Lu PH, Edland SD, Teng E, Tingus K, Petersen RC, Cummings JL, Alzheimer's Disease Cooperative Study Group. Donepezil delays progression to AD in MCI subjects with depressive symptoms. Neurology 2009;72:2115-21.
|
| 65. | Speck CE, Kukull WA, Brenner DE, Bowen JD, McCormick WC, Teri L, et al. History of depression as a risk factor for Alzheimer's disease. Epidemiology 1995;6:366-9.
|
| 66. | Green RC, Cupples LA, Kurz A, Auerbach S, Go R, Sadovnick D, et al. Depression as a risk factor for Alzheimer disease: The MIRAGE study. Arch Neurol 2003;6:753-9.
|
| 67. | Jorm AF. History of depression as a risk factor for dementia: An updated review. Aust N Z J Psychiatry 2001;35:776-81.
|
| 68. | Ownby RL, Crocco E, Acevedo A, John V, Loewenstein D. Depression and risk for Alzheimer disease: systematic review, meta-analysis, and metaregression analysis. Arch Gen Psychiatry 2006;63:530-8.
|
| 69. | Rapp MA, Schnaider-Beeri M, Grossman HT, Sano M, Perl DP, Purohit DP, et al. Increased hippocampal plaques and tangles in patients with Alzheimer disease with a lifetime history of major depression. Arch Gen Psychiatry 2006;63:161-7.
|
| 70. | Brommelhoff JA, Gatz M, Johansson B, McArdle JJ, Fratiglioni L, Pedersen NL. Depression as a risk factor or prodromal feature for dementia? Findings in a population-based sample of Swedish twins. Psychol Aging 2009;24:373-84.
|
| This article has been cited by | | 1 |
Participatory design and evaluation of virtual reality physical rehabilitation for people living with dementia |
|
| Maria Matsangidou, Fotos Frangoudes, Eirini Schiza, Kleanthis C. Neokleous, Ersi Papayianni, Katerian Xenari, Marios Avraamides, Constantinos S. Pattichis | | Virtual Reality. 2022; | | [Pubmed] | [DOI] | | | 2 |
“Bring me sunshine, bring me (physical) strength”: the case of dementia. Designing and implementing a virtual reality system for physical training during the COVID-19 Pandemic |
|
| Maria Matsangidou, Fotos Frangoudes, Marios Hadjiaros, Eirini Schiza, Kleanthis C. Neokleous, Ersi Papayianni, Marios Avraamides, Constantinos S. Pattichis | | International Journal of Human-Computer Studies. 2022; : 102840 | | [Pubmed] | [DOI] | | | 3 |
Inclusion of gerodontology in dental curriculum: an urgent case for India |
|
| Kamal Shigli, Sushma S. Nayak, Vasanti Lagali-Jirge, Rashmi A. Kusurkar, Jayashri Tamanna Nerali, Fadekemi Olufunmilayo Oginni | | Gerontology & Geriatrics Education. 2022; : 1 | | [Pubmed] | [DOI] | | | 4 |
Counterfactual analysis of differential comorbidity risk factors in Alzheimer’s disease and related dementias |
|
| Yejin Kim, Kai Zhang, Sean I. Savitz, Luyao Chen, Paul E. Schulz, Xiaoqian Jiang, Dukyong Yoon | | PLOS Digital Health. 2022; 1(3): e0000018 | | [Pubmed] | [DOI] | | | 5 |
Depression and Dementia in Elderly People |
|
| Gjon Preci, Iliriana Zekja, Jera Kruja, Erjona Abazaj | | Open Access Macedonian Journal of Medical Sciences. 2022; 10(B): 216 | | [Pubmed] | [DOI] | | | 6 |
Faces of pseudodementia |
|
| Jana Zmeková, Ján Praško, Marie Ocisková, Michaela Holubová, František Hodný, Jakub Vanek | | Psychiatrie pro praxi. 2021; 22(3): 158 | | [Pubmed] | [DOI] | | | 7 |
Predicting Dementia With Prefrontal Electroencephalography and Event-Related Potential |
|
| Dieu Ni Thi Doan, Boncho Ku, Jungmi Choi, Miae Oh, Kahye Kim, Wonseok Cha, Jaeuk U. Kim | | Frontiers in Aging Neuroscience. 2021; 13 | | [Pubmed] | [DOI] | | | 8 |
Usefulness of Orientation to the Year as an Aid to Case Finding of Mild Cognitive Impairment or Depression in Community-Dwelling Older Adults |
|
| Hanhee Bae, Sunyoung Kim, Byungsung Kim, Miji Kim, Jisoo Yang, Eunjin Jeong, Yoonki Kim, Changwon Won | | International Journal of Environmental Research and Public Health. 2021; 18(15): 8096 | | [Pubmed] | [DOI] | | | 9 |
Association of late-life depression with cognitive impairment: evidence from a cross-sectional study among older adults in India |
|
| T. Muhammad, Trupti Meher | | BMC Geriatrics. 2021; 21(1) | | [Pubmed] | [DOI] | | | 10 |
Depressive symptoms and cognitive impairment: A 10-year follow-up study from the Survey of Health, Ageing and Retirement in Europe |
|
| Fei-Fei Han, Hui-Xin Wang, Jia-Jia Wu, Wu Yao, Chang-Fu Hao, Jin-Jing Pei | | European Psychiatry. 2021; 64(1) | | [Pubmed] | [DOI] | | | 11 |
Grapes and their derivatives in modulation of cognitive decline: a critical review of epidemiological and randomized-controlled trials in humans |
|
| Patrizia Restani, Ursula Fradera, Jean-Claude Ruf, Creina Stockley, Pierre-Louis Teissedre, Simone Biella, Francesca Colombo, Chiara Di Lorenzo | | Critical Reviews in Food Science and Nutrition. 2021; 61(4): 566 | | [Pubmed] | [DOI] | | | 12 |
Low-Frequency Transcranial Magnetic Stimulation (LF-TMS) in Treating Depression in Patients With Impaired Cognitive Functioning |
|
| Daniel R Schaffer, Hamid R Okhravi, Serina A Neumann | | Archives of Clinical Neuropsychology. 2021; 36(5): 801 | | [Pubmed] | [DOI] | | | 13 |
Lipocalin 2 as a link between ageing, risk factor conditions and age-related brain diseases |
|
| Doortje W. Dekens, Ulrich L.M. Eisel, Leonie Gouweleeuw, Regien G. Schoemaker, Peter P. De Deyn, Petrus J.W. Naudé | | Ageing Research Reviews. 2021; 70: 101414 | | [Pubmed] | [DOI] | | | 14 |
Association of life-course depression with the risk of dementia in late life: A nationwide twin study |
|
| Wenzhe Yang, Xuerui Li, Kuan-Yu Pan, Rongrong Yang, Ruixue Song, Xiuying Qi, Nancy L. Pedersen, Weili Xu | | Alzheimer's & Dementia. 2021; 17(8): 1383 | | [Pubmed] | [DOI] | | | 15 |
Multi-time-point data preparation robustly reveals MCI and dementia risk factors |
|
| Daman Kaur, Magda Bucholc, David P. Finn, Stephen Todd, KongFatt Wong-Lin, Paula L. McClean | | Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring. 2020; 12(1) | | [Pubmed] | [DOI] | | | 16 |
Long-term dietary flavonoid intake and risk of Alzheimer disease and related dementias in the Framingham Offspring Cohort |
|
| Esra Shishtar, Gail T Rogers, Jeffrey B Blumberg, Rhoda Au, Paul F Jacques | | The American Journal of Clinical Nutrition. 2020; 112(2): 343 | | [Pubmed] | [DOI] | | | 17 |
Aspirin and Risk of Dementia in Patients with Late-Onset Depression: A Population-Based Cohort Study |
|
| Ya-Hsu Yang, Chih-Chiang Chiu, Hao-Wei Teng, Chun-Teng Huang, Chun-Yu Liu, Ling-Ju Huang | | BioMed Research International. 2020; 2020: 1 | | [Pubmed] | [DOI] | | | 18 |
The Association between Delivery during the COVID-19 Pandemic and Immediate Postpartum Maternal Cognitive Function |
|
| Hagai Hamami, Eyal Sheiner, Tamar Wainstock, Elad Mazor, Talya Lanxner Battat, Asnat Walfisch, Tamar Kosef, Gali Pariente | | Journal of Clinical Medicine. 2020; 9(11): 3727 | | [Pubmed] | [DOI] | | | 19 |
Depression in Dementia or Dementia in Depression? Systematic Review of Studies and Hypotheses |
|
| Agnieszka Brzezinska, Julius Bourke, Rayito Rivera-Hernández, Magda Tsolaki, Joanna Wozniak, Jakub Kazmierski | | Current Alzheimer Research. 2020; 17(1): 16 | | [Pubmed] | [DOI] | | | 20 |
Quantitative comorbidity risk assessment of dementia in Taiwan |
|
| Chun-Hung Richard Lin, Jui-Hsiu Tsai, Shihn-Sheng Wu, Yang-Pei Chang, Yen-Hsia Wen, Jain-Shing Liu, For-Wey Lung | | Medicine. 2018; 97(15): e0298 | | [Pubmed] | [DOI] | | | 21 |
Does gender influence cognitive function in non-psychotic depression? |
|
| Daniela Caldirola, Erika Sangiorgio, Alice Riva, Massimiliano Grassi, Alessandra Alciati, Chiara Scialň, Giampaolo Perna | | Personalized Medicine in Psychiatry. 2017; 4-6: 25 | | [Pubmed] | [DOI] | | | 22 |
Prolong Exposure of NSAID in Patients With RA Will Decrease the Risk of Dementia |
|
| Kuang-Hsi Chang, Yi-Chao Hsu, Chih-Chao Hsu, Cheng-Li Lin, Chung Y. Hsu, Chang-Yin Lee, Lee-Won Chong, Hui-Chuan Liu, Ming-Chia Lin, Chia-Hung Kao | | Medicine. 2016; 95(10): e3056 | | [Pubmed] | [DOI] | | | 23 |
Depressive symptoms predict incident dementia during short- but not long-term follow-up period |
|
| Saira Saeed Mirza, Renée F.A.G. Bruijn, Nese Direk, Albert Hofman, Peter J. Koudstaal, M. Arfan Ikram, Henning Tiemeier | | Alzheimer's & Dementia. 2014; 10(5S) | | [Pubmed] | [DOI] | | | 24 |
Medial temporal lobe atrophy in Alzheimerćs disease/mild cognitive impairment with depression |
|
| V Dhikav,M Sethi,K S Anand | | The British Journal of Radiology. 2014; 87(1042): 20140150 | | [Pubmed] | [DOI] | | | 25 |
rTMS as a Treatment of Alzheimer’s Disease with and without Comorbidity of Depression: A Review |
|
| Grant Rutherford,Rebecca Gole,Zahra Moussavi | | Neuroscience Journal. 2013; 2013: 1 | | [Pubmed] | [DOI] | | | 26 |
Oral health in nursing home residents with different cognitive statuses |
|
| Authors of Document Chen, X., Clark, J.J.J., Naorungroj, S. | | Gerodontology. 2013; | | [Pubmed] | | | 27 |
result 3 Document The older patient with heart failure: High risk for frailty and cognitive impairment |
|
| Harkness, K., Heckman, G.A., McKelvie, R.S. | | Source of the Document Expert Review of Cardiovascular Therapy. 2012; | | [Pubmed] | | | 28 |
result 2 Document Benzodiazepine use and risk of Dementia: Prospective population based study |
|
| Billioti, S., Bégaud, B., Bazin, F., (...), Kurth, T., Pariente, A. | | BMJ (Online). 2012; | | [Pubmed] | | | 29 |
Cognitive impairment in patients with advanced heart failure and its implications on decision-making capacity |
|
| Gaviria, M., Pliskin, N., Kney, A. | | Congestive Heart Failure. 2011; 17(4): 175-179 | | [Pubmed] | |
|
|
|
|
|
|
|
|
