1. Exploring the Relationship Between Depression and Dementia
Review of article for CMDA
Nov 6, 2018
Sing Palat MD CMD

2. Article under Medical News and Perspectives,
Overview
Article under Medical News and Perspectives,
JAMA. 2018;320(10): doi: /jama
Highlights recent studies on relationship between depression and dementia
Examines how Depression with Dementia is different than Depression, and effects of interventions

3. Does depression cause dementia?
Depression and dementia both associated with neurodegeneration and inflammation
Mixed data
2014 review: Yes
2017 longitudinal study:
Midlife depression: No
Later life depression: Yes
2017 Australian study: Yes, especially in men

4. Does dementia cause depression?
At least 20% of patients with dementia develop depression.
Dementia is linked to social isolation and severity of depression symptoms.

5. Difficult Diagnosis
Many symptoms are common to both depression and dementia
Loss of interest
Social withdrawal
Impaired thinking
Complications
Reluctance to discuss (stigma)
Under-reporting and under-recognition
Increase in somatic symptoms

6. Difficult Diagnosis Late life depression is concerning for dementia.
A first episode of depression in older adult should be considered a sentinel event.
Dementia diagnosis requires ruling out depression.

7. Benefits of concurrent treatment
Treating depression may delay dementia
From Mild Cognitive Impairment: Citalopram delayed the progression of MCI to Dementia by 3 years.
Treating dementia may improve depression
However, only 18% of dementia treatment trials study neuropsychiatric symptoms as primary target.

8. Do we really want to prescribe more?
Increase in antidepressants prescribed for depression with dementia between 2005 to 2015 (UK study 2017)

9. Antidepressants not effective
Antidepressants are not helpful for depression in people with dementia.
Cognitive control dysfunction may be resistant to SSRI.
Antidepressants did not improve severity of depressive symptoms in community dwelling older adults.
Antidepressants did not improve depression symptoms in dementia per Cochrane review.

10. New nonpharmacotherapy ideas
Behavioral and psychotherapy difficult as dementia progresses.
Windows with natural light decreased depression scores in dementia community.
Social isolation was associated with severity of depression; antidepressants use was not.
Break stigma, build cultures of support

11. 2018 CMDA Annual Conference
Lifelong
Late onset
Dementia
Vulnerable brain
MMI
Which is predominant?
Lea Watson MD,
Geriatric Psychiatry

12. 2018 CMDA Annual Conference -Watson
Most studies of antidepressants done in young, healthy people in an acute episode.
Antidepressants do not work well at all in people with dementia, history of treatment resistance, or multiple chronic illnesses.
Banerjee, Lancet 2011: 208 people with AD and depression: no difference on sertraline, mirtazapine, placebo – all improved.

13. Pearls Depression/ Dementia: assess for both
Recognize that Depression in Dementia is a different illness
Early or Midlife depression: SIG E CAPS, DSM-V
Late life depression: PHQ9, GDS, Cornell Scale
Treat symptoms with as little medication as needed.