Depressive Symptoms in the Elderly-An Early Symptom of Dementia? A Systematic Review.

Published on Feb 7, 2020in Frontiers in Pharmacology3.845
· DOI :10.3389/FPHAR.2020.00034
Wietse Wiels1
Estimated H-index: 1
Chris Baecken30
Estimated H-index: 30
+ 0 AuthorsSebastiaan Engelborghs
Background: Depression and dementia are common incapacitating diseases in old age. The exact nature of the relationship between these conditions remains unclear, and multiple explanations have been suggested: depressive symptoms may be a risk factor for, a prodromal symptom of, or a coincidental finding in dementia. They may even be unrelated or only connected through common risk factors. Multiple studies so far have provided conflicting results. Objectives: To determine whether a systematic literature review can clarify the nature of the relation between depressive symptoms and dementia. Methods: Using the Patient/Problem/Population, Intervention, Comparator, Outcome or PICO paradigm, a known framework for framing healthcare and evidence questions, we formulated the question "whether depressive symptoms in cognitively intact older adults are associated with a diagnosis of dementia later in life." We performed a systematic literature review of MEDLINE and PsycINFO in November 2018, looking for prospective cohort studies examining the aforementioned question. Results: We critically analyzed and listed 31 relevant papers out of 1,656 and grouped them according to the main hypothesis they support: depressive symptoms as a risk factor, not a risk factor, a prodromal symptom, both, or some specific other hypothesis. All but three studies used clinical diagnostic criteria for dementia alone (i.e., no biomarkers or autopsy confirmation). Several studies contain solid arguments for the hypotheses they support, yet they do not formally contradict other findings or suggested explanations and are heterogeneous. Conclusions: The exact nature of the relationship between depressive symptoms and dementia in the elderly remains inconclusive, with multiple studies supporting both the risk factor and prodromal hypotheses. Some provide arguments for common risk factors. It seems unlikely that there is no connection at all. We conclude that at least in a significant part of the patients, depressive symptoms and dementia are related. This may be due to common risk factors and/or depressive symptoms being a prodromal symptom of dementia and/or depression being a risk factor for dementia. These causal associations possibly overlap in some patients. Further research is warranted to develop predictive biomarkers and to develop interventions that may attenuate the risk of "conversion" from depressive symptoms to dementia in the elderly.
  • References (78)
  • Citations (1)
📖 Papers frequently viewed together
3 Citations
6 Authors (Mehmet Alpay Ates, ..., Mesut Cetin)
1 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
#1Ingrid van Maurik (VU: VU University Amsterdam)H-Index: 1
#2Rosalinde E.R. Slot (VU: VU University Amsterdam)H-Index: 7
Last. Wiesje M. van der Flier (VU: VU University Amsterdam)H-Index: 77
view all 17 authors...
Background Biomarkers such as cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) have predictive value for progression to dementia in patients with mild cognitive impairment (MCI). The pre-dementia stage takes far longer, and the interpretation of biomarker findings is particular relevant for individuals who present at a memory clinic, but are deemed cognitively normal. The objective of the current study is to construct biomarker-based prognostic models for personalized risk of clini...
2 CitationsSource
#1Ruth Brauer (UCL: University College London)H-Index: 1
#2Wallis C. Y. Lau (UCL: University College London)H-Index: 12
Last. Ian C. K. Wong (UCL: University College London)H-Index: 48
view all 8 authors...
Background In vitro and animal studies have suggested that trazodone, a licensed antidepressant, may protect against dementia. However, no studies have been conducted to assess the effect of trazodone on dementia in humans. This electronic health records study assessed the association between trazodone use and the risk of developing dementia in clinical practice. Methods and findings The Health Improvement Network (THIN), an archive of anonymised medical and prescribing records from primary care...
#1Ali Ezzati (Albert Einstein College of Medicine)H-Index: 11
#2Mindy Joy Katz (Albert Einstein College of Medicine)H-Index: 40
Last. Richard B. Lipton (Albert Einstein College of Medicine)H-Index: 94
view all 5 authors...
BACKGROUND:: There is increasing evidence that depressive symptoms are associated with increased risk of cognitive impairment and dementia in older adults. In current study, we aimed to investigate the effect of depressive symptoms on incident Alzheimer disease and all-cause dementia in a community sample of older adults. METHODS:: Participants were 1219 older adults from the Einstein Aging Study, a longitudinal cohort study of community-dwelling older adults in Bronx County, New York. The Geria...
2 CitationsSource
#1Ching-Wen Chu (TSGH: Tri-Service General Hospital)H-Index: 1
#2Wu-Chien Chien (NDMC: National Defense Medical Center)H-Index: 8
Last. Nian-Sheng Tzeng (NDMC: National Defense Medical Center)H-Index: 16
view all 8 authors...
Background: Electroconvulsive therapy (ECT) is an effective treatment for schizophrenia, bipolar disorder, and major depressive disorder. Temporary memory loss may occur after ECT. However, the association between ECT in patients with schizophrenia, bipolar disorder, and major depressive disorder, and the risk of dementia has yet to be examined. This study aimed to clarify whether ECT is associated with the risk of dementia after ECT in patients with schizophrenia, bipolar disorder, and major de...
4 CitationsSource
A seismic shift in our understanding of the ability to diagnose Alzheimer disease (AD) is occurring. For the last several decades, AD has been a clinical–pathologic diagnosis, and this conceptualization of the disease has served the field well. Typically, the clinician would identify a syndrome such as mild cognitive impairment or dementia, and label the condition as “probable AD” since the diagnosis of definite AD could not be made until an autopsy revealed the presence of amyloid plaques and t...
7 CitationsSource
Objective:To understand the role of depressive symptoms in preclinical Alzheimer’s disease, it is essential to define their temporal relationship to Alzheimer’s proteinopathies in cognitively normal older adults. The study objective was to examine associations of brain amyloid beta and longitudinal measures of depression and depressive symptom clusters in a cognitively normal sample of older adults.Method:A total of 270 community-dwelling, cognitively normal elderly individuals underwent baselin...
42 CitationsSource
#1Gill Livingston (UCL: University College London)H-Index: 62
#2Andrew Sommerlad (UCL: University College London)H-Index: 8
Last. Naaheed Mukadam (UCL: University College London)H-Index: 12
view all 24 authors...
Acting now on dementia prevention, intervention, and care will vastly improve living and dying for individuals with dementia and their families, and in doing so, will transform the future for society. Dementia is the greatest global challenge for health and social care in the 21st century. It occurs mainly in people older than 65 years, so increases in numbers and costs are driven, worldwide, by increased longevity resulting from the welcome reduction in people dying prematurely. The Lancet Comm...
779 CitationsSource
The process of phenotyping and classification of dementia has improved over decades of careful clinicopathological correlation, and through the discovery of in vivo biomarkers of disease. Elahi and Miller review the salient features of the most common dementia subtypes, emphasizing neuropathology, epidemiology, risk factors, and signature signs and symptoms.
35 CitationsSource
#1Osvaldo P. Almeida (UWA: University of Western Australia)H-Index: 67
#2Graeme J. Hankey (UWA: University of Western Australia)H-Index: 110
Last. Leon Flicker (UWA: University of Western Australia)H-Index: 54
view all 5 authors...
Depression is an accepted risk factor for dementia, but it is unclear if this relationship is causal. This study investigated whether dementia associated with depression decreases with antidepressant use and is independent of the time between exposure to depression and the onset of dementia. We completed a 14-year longitudinal study of 4922 cognitively healthy men aged 71–89 years, and collected information about history of past depression, current depression and severity of depressive symptoms....
18 CitationsSource
#1L Jacob (University of Paris)H-Index: 11
#2Jens Bohlken (Praxis)H-Index: 7
Last. Karel Kostev (IMS Health)H-Index: 19
view all 3 authors...
AIMS: To study the impact of the use of antidepressants on dementia in German patients with depression treated in general (GPs) or psychiatric practices (PPs). METHODS: Patients with a first-time documentation of depression with known severity level between 2010 and 2013 (index date) were identified by 1,126 general practitioners and 176 psychiatrists in the IMS Disease Analyzer database. We included patients between the ages of 60 and 80 years who had not previously received prescriptions for a...
4 CitationsSource
Cited By1
#1Fu-Hsuan Kuo (CSMU: Chung Shan Medical University)H-Index: 1
Last. Shun-Fa Yang (CSMU: Chung Shan Medical University)H-Index: 40
view all 7 authors...
The aim of the present study was to survey the relationship between the severity of glaucoma and subsequent dementia using the National Health Insurance Research Database (NHIRD) in Taiwan. Subjects with glaucoma were selected into the study group after an exclusion process, and each subject in the study group was propensity score-matched to another non-glaucoma patient that constituted the control group. The Cox proportional hazard regression that considered multiple potential risk factors of d...