Depression in patient with dementia

IntroductionThis is a case of a patient with history of dementia who presented with agitation. Alzheimer disease drugs list This case demonstrates that depression in a patient with dementia may not present with typical symptoms of depression as seen in the general population. Definition of alzheimer’s disease Treatments may include behavioral and caregiver interventions in addition to medication.

The patient is a 77 year old man with past medical history significant for dementia, hyperlipidemia, coronary artery disease (CAD), s/p coronary artery bypass graft (CABG) and aortic valve replacement (AVR) who was referred to the Memory Clinic for agitation.

According to the patient’s family member, he started having memory problems in 2002, which worsened significantly after his CABG and AVR in 2004. Alzheimer’s disease prevalence At the time he presented to the clinic, he had functional deficits in the following instrumental activities of daily living (IADLs) – handling finances, driving, cooking and shopping.

The patient was noted to be easily agitated and irritable for sometime, and was referred to the Memory Clinic for exhibiting verbal and physical aggression towards his wife as well as others. How do you die from alzheimer’s disease The patient was recently seen by his primary care physician for this issue, and all of his laboratory exams were normal, and subsequent MRI of the brain was also unremarkable.

The patient noted good appetite and denied problems with sleeping or weight changes. Family alzheimer’s disease He also denied any suicidal ideations and visual/auditory hallucinations. How to treat alzheimer’s disease However, he stated that he was depressed because he was worried about his memory problems.

The patient’s Mini-Mental State Examination (MMSE) was 16/30, and Cornell Scale for Depression in Dementia was 8 for the patient and 14 for the wife.

The patient had few typical symptoms of depression, however had agitation and irritability noted by his wife in addition to depressed mood expressed by the patient. Symptoms of alzheimer’s disease In this case, the patient may be minimizing or is unaware of his symptoms due to his dementia. Etiology of alzheimer’s disease The patient was started on 25mg PO qD of a Selective Serotonin Reuptake Inhibitor (SSRI) which was increased to 50mg PO qD after one week. What are early signs of alzheimer’s disease The patient’s wife was also instructed on behavioral management of agitation and aggression, and was encouraged to contact the Alzheimer’s Association for caregiver support group.

The patient and his wife returned four weeks later. Mental effects of alzheimer disease The wife reported complete resolution of the symptoms, and the patient denied feelings of depression, stating “I am a happy man.” The patient’s wife also noted that she had contacted the Alzheimer’s Association, and joined a caregiver support group. Alzheimer’s disease research paper She learned about different strategies to care for her husband to minimize his symptoms.

Depression in older adults is estimated to range from 7-36 % in the outpatient setting (1), and in patients with dementia, the numbers range from 15-50 %. Prognosis of alzheimer disease today (2) Depression in patients with dementia may go undetected due to the fact that the symptomology of depression in these patients manifest differently from cognitively normal patients.

In a study comparing major depressive features between patients with Alzheimer’s disease (AD)* and cognitively normal older adults, several significant differences were noted in the study. Disease alzheimer’s Patients with AD had significantly diminished ability to concentrate or indecisiveness, less disturbances in sleep, and less reports of feelings of worthlessness or excessive guilt. Alzheimer’s disease stages However, patients with AD were noted to have higher rates of delusions and hallucinations. Alzheimer disease is caused by lack of which neurotransmitter There was also a trend towards higher rates of psychomotor agitation/retardation and fatigue/loss of energy in more advanced AD patients. Definition alzheimer’s disease (3)

While a screening tool such as the Geriatric Depression Scale (GDS) is commonly used to screen for depression, there may be an underreporting on the part of the patients with dementia as they are unable to recall or are not aware of the depressive symptoms reported by the caregivers. Diagnosis and treatment of alzheimer’s disease (3) The reliability of GDS diminishes with MMSE below 15. First sign of alzheimer’s disease (5) Input from caregivers become more important as the patient’s cognitive status declines. Alzheimer’s disease treatment Therefore, an assessment tool that incorporates caregiver input such as Cornell Scale for Depression in Dementia (CSDD) (6) may be more appropriate in patients with dementia. How to diagnose alzheimer’s disease CSDD scores above 12 requires treatment, and above 8 requires more close follow up and possibly treatment. Alzheimer disease international wikipedia (7)

Depression can be a contributing factor in functional decline in dementia, and treatment of depression may improve functional levels in these patients. Define alzheimer’s disease (8,7)

Non-pharmacological methods should be the first-line intervention in treatment of depression in patients with dementia. Alzheimer’s disease international Interventions targeting the patient as well as the caregiver are important. Symptoms alzheimer’s disease These may range from arranging a day care for the patient to participate in activities to educating the caregivers on different care giving skills. Treatment of alzheimer’s disease (7)

Once the non-pharmacological intervention has been instituted, and or if a patient suffers from severe depressive symptoms, pharmacological intervention is warranted. Meaning alzheimer disease A SSRI is generally recommended due to the relatively benign side effect profile. Information about alzheimer’s disease (7) Recommended antidepressants and their doses are shown in the table below.

Antidepressants should be titrated to improvement in the target symptoms. Symptoms of early onset alzheimer’s disease In addition to the classical symptoms of depression such as sadness, anhedonia, insomnia and anorexia, other symptoms such as irritability, anxiety, and agitation are also valid target symptoms for treatment. 10 early signs and symptoms of alzheimer disease Medications should be started at a low dose, and titrated slowly, and 8-12 weeks may be needed for a full treatment response. Effects of alzheimer disease on the family (9,8)

SSRIs in general: widely used due to favorable safety profile and effect on anxiety. Alzheimer disease and dementia journal impact factor Side effects include GI distress, anxiety, insomnia, medication interactions. Alzheimer’s disease cure FDA warning concerning emerging suicidality suggests careful monitoring in initial 10 days of treatment.

Side effect of hypertension less common than venlafaxine, sexual side effects less common than SSRIs. Medical definition alzheimer disease May be helpful for pain and somatizing syndromes.

I would like to thank Dr. Alzheimer’s disease define Paul Rosenberg of the Division of Geriatric Psychiatry and Neuropsychiatry at the Johns Hopkins School of Medicine for his review of this educational module.

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• Zubenko GS, Zubenko WN, McPherson S, et al. Alzheimer’s disease is characterized by A collaborative study of the emergence and clinical features of the major depressive syndrome of Alzheimer’s disease. Pathophysiology of alzheimer’s disease Am J Psychiatry. Alzheimer’s disease genetic 2003;160:857-866.

• Evans DA, Funkenstein HH, Albert MS, et al. Dementia and alzheimer’s disease Prevalence of Alzheimer’s disease in a community population of older persons. How long can you live with alzheimer’s disease higher than previously reported. What causes alzheimer disease 2013 JAMA. Alzheimer’s disease medications 1989;262:2551-2556.

• Lyketsos CG, Lee HB. Treatment for alzheimer’s disease Diagnosis and treatment of depression in Alzheimer’s disease. Early signs of alzheimer disease may include A practical update for the clinician. The first stage of alzheimer disease is characterized by Dement Geriatr Cogn Disord. 10 signs of alzheimer disease 2004;17:55-64.

• Lyketsos CG, DelCampo L, Steinberg M, et al. Physiological effects of alzheimer disease Treating depression in alzheimer disease: Efficacy and safety of sertraline therapy, and the benefits of depression reduction: The DIADS. Alzheimer’s disease dementia Arch Gen Psychiatry. First stage of alzheimer disease is characterized by 2003;60:737-746.

• Rosenberg PB, Lyketsos CB. Alzheimer disease smell test Depression in alzheimer disease. Stages of alzheimer’s disease In: Charney, D.S and Evans D., ed. Alzheimer’s disease research center The Physician’s Guide to Depression and Bipolar Disorder. Alzheimer’s disease prevention McGraw-Hill; 2006.