Case for and against specificity of depression in Alzheimer's disease

Authors: Even, Christian¹; Weintraub, Daniel²

Source: Psychiatry and Clinical Neurosciences, Volume 64, Number 4, 1 August 2010 , pp. 358-366(9)

Publisher: Wiley-Blackwell

Abstract:

Aims:  The aims of this study were to assess the epidemiological, phenomenological, and pathophysiological evidence that suggests the specificity of depression associated with Alzheimer's disease (AD).

Methods:  We reviewed the English-language literature.

Results:  Depression occurs significantly more often in patients with AD than in the general elderly population. While development of depression in response to the disability and emotional stress of AD may be a contributory factor in some patients, several studies showed that depression was not, or was only seldom, related to self-awareness of AD and these studies could not explain the high prevalence figures. To overcome the overlapping phenomenology of the two diseases, specific diagnostic criteria have been developed for depression in this context. Mixed findings have come from neuropathological and neuroimaging studies, with some evidence linking the underlying neural substrate of AD and depression, suggesting an overlapping cause of primary depression and depression comorbid with AD. Few randomized controlled trials for depression associated with AD have been conducted, with rather poor results for the use of antidepressants.

Conclusions:  Currently, depression associated with AD is not considered a separate disorder by regulatory authorities and is unlikely to be considered as such in the near future. Several obstacles remain to support such a specific position, including the heterogenous nature of depression in general and within AD itself, the lack of a distinct set of symptoms, and limited treatment.

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1440-1819.2010.02108.x

Affiliations: 1: Clinique des Maladies Mentales et de l'Encéphale, Centre Hospitalier Sainte-Anne - Université Paris-V René Descartes, INSERM U675, Centre de Psychiatrie et Neurosciences, Paris, France and 2: University of Pennsylvania - Parkinson's Disease and Mental Illness Research, Education and Clinical Centers (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Center, Pennsylvania, USA

Publication date: 2010-08-01

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