Depression and Dementia - Depression and Dementia - Open Access Pub

Relationship between dementia is very complex and individual. There are some pathogenetic processes that may be common to both conditions: neurotransmitter deficits, vascular changes and beta amyloid deposits. Presence of depression in persons with dementia have serious consequences on progression of dementia, quality of life and behavioral symptoms of dementia. Therefore, it is important to treat effectively even minor depressive symptoms. DOI10.14302/issn.2476-1710.jdt-16-1260 Depression is the most common psychiatric condition in people with dementia. It occurs already in 16.9% of people with “cognitive impairment no dementia” (CIND, a clinical syndrome consisting of measurable decline in memory / cognition with little effect on day-to-day functioning that does not meet criteria for dementia listed by DSM-IVTR) 1. In people with mild cognitive impairment (MCI), prevalence of depression is 44% in hospital-based studies and 16% in population-based studies 2. Prevalence of depression increases with severity of depression, reaching 42.5% in institutionalized people with severe dementia 3. Depression is often underdiagnosed in people with cognitive impairment. Using Geriatric Depression Scale in people with MCI or moderate dementia to compare different sources of depression diagnosis, it was found that only 11% of people had clinical diagnosis, while information from collateral sources indicated that 49% of them were depressed 4. Similarities of Pathogeneses in Depression and Dementia. The high prevalence of depression in people with cognitive impairment could be due to some similarities of pathological processes between depression and dementia. These similarities include changes in neurotransmitters, especially serotonin, brain vascular changes and beta amyloid deposits as will be explained in the following paragraphs. Neurotransmitters. Alzheimer’s disease causes serotoninergic and noradrenergic denervation 5, 6 and loss of serotonin receptors 7. Serotonin is involved in sexual behavior, appetite and aggression and together with norepinephrine in mood state, irritability and thought processes. High prevalence of depression in individuals with Alzheimer’s disease can be expected because of these monoaminergic deficits. The importance of serotonin for depression is supported by the most effective medications which are selective serotonin reuptake inhibitors (SSRIs). Treatment with antidepressants that potentiate the effect of serotonin may be similar to treatment with cholinesterase inhibitors that potentiate the effect of acetylcholine. Vascular Changes