Depression in Dementia Effects on Cognition

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Our understanding of whether the presence of depression in persons with dementia, particularly in those with AD, is associated with excess cognitive disabilities is limited. Ross, Arnsberger, and Fox (1998) reported that although a group of depressive and nondepressive patients with AD had similar MMSE scores, cognition was significantly related to depression diagnosis beyond psychosocial and demographic predictors. Their study, from the California Alzheimer's Disease Cooperative, consisted of 183 patients with depression and 1,300 nondepressed patients. The authors concluded that depression contributes to cognitive excess disabilities. These findings have been reported by others as well (see Lichtenberg, Ross, Mills, & Manning, 1995, for a review). Of greater interest more recently has been whether there is a specific pattern of cognitive excess disability in depressed persons with dementia.

Wefel, Hoyt, and Massman (2000) compared 37 depressed Alzheimer's patients with 98 nondepressed Alzheimer's patients on 13 neuropsycho-logical measures. The groups were matched on MMSE scores; and tests of general intellectual functioning, attention and concentration, memory functioning, language functioning, and psychomotor functioning were administered to both groups. A modified Bon Ferroni procedure was used for the multiple comparisons. The depressed group demonstrated significantly worse cognitive functioning than the nondepressed group only on tasks of complex attention and speeded motor programming. The authors concluded that these findings were consistent with cerebral dysfunction in the frontal-subcortical areas. This pattern of results has been found in a group of younger unipolar depressed individuals as well (Massman, Delis, Butters, Dupont, & Gillin, 1992).

Clinical Implications

• Depression is linked to cognitive and noncognitive excess disabilities.

• Interventions that focus on keeping persons with dementia functionally and physically active may prevent or postpone depressive reactions.

• There is a need for studies that investigate whether functionally based interventions reduce depression in persons with dementia.

• Aggressive and agitated long-term care residents are likely to have co-morbid depression.

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