Hostname: page-component-745bb68f8f-5r2nc Total loading time: 0 Render date: 2025-01-24T05:49:29.713Z Has data issue: false hasContentIssue false
  • English
  • Français

Depressive Syndromes in Dementia

Published online by Cambridge University Press:  02 December 2014

Lilian Thorpe  and
Bernard Groulx
Lilian Thorpe
Affiliation:
University of Saskatchewan, Saskatoon, SK, Canada
Bernard Groulx
Affiliation:
McGill University, Centre for Studies in Aging, Montreal QC, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Depressive syndromes in dementia are common, treatment is challenging and controlled intervention studies are small in number. The goal of this paper is to review known information about the etiology, epidemiology and treatment of these syndromes, as summarized at the recent Canadian Consensus Conference on Dementia.

Methods:

A number of Medline searches were performed (most recently updated in October 2000) using the subject categories dementia and depression, or apathy or emotional lability and other relevant articles were also reviewed. The background article was edited and amended at the Consensus Conference on Dementia. Final recommendations appearing in the summary article by Patterson et al were accepted by the group consensus process. Clinical discussion and informational updates were added for the current text by the authors.

Results:

Depressive syndromes, ranging in severity from isolated symptoms to full depressive disorders, increase in dementia. While clear-cut depressive disorder is increased in this population, sub-syndromal disorders are even more common and cause considerable distress. Antidepressant treatment may improve the quality of life in depressed, demented people, although it is less successful than in those without cognitive impairment and carries more risk of iatrogenic effects.

Conclusion:

Physicians should be alert to the presence of depressive syndromes in dementia. Depressive illness should be treated and, when necessary, referral should be made to an appropriate specialist. Treatment must minimize iatrogenic effects. Although there is some support for treatment of syndromes that do not meet criteria for depressive disorder or dysthymia, the first line of intervention in these situations should involve nonpharmacological approaches.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 28 , Supplement S1: Canadian Consensus Conference on Dementia , May 2001 , pp. S83 - S95
Copyright
Copyright © The Canadian Journal of Neurological 2001

References

REFERENCES

1. Canadian Medical Association. Guidelines for Canadian clinical practice guidelines. Ottawa: The Association; 1994.Google Scholar
2. Patterson, CJS, Gauthier, S, Bergman, H, et al. The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia. Can Med Assoc J 1999; 160 (12 Suppl):S1-S15.Google Scholar
3. Clarfield, AM. Canadian Consensus Conference on the Assessment of Dementia. Pub: Canadian Consensus Conference on the Assessment of Dementia; Division of Geriatrics, Sir Mortimer, B. Davis-Jewish General Hospital, Montreal, Canada.Google Scholar
4. Lyketsos, CG, Steele, C, Galik, E, et al. Physical aggression in dementia patients and its relationship to depression. Am J Psychiatry 1999;156(1):66–71.Google Scholar
5. Small, GW. Recognition and treatment of depression in the elderly. J Clin Psychiatry 1991; 52 Suppl: 11–22.Google Scholar
6. Verhey, FRJ, Jolles, J, Ponds, RW, et al. Diagnosing dementia: a comparison between a monodisciplinary and a multidisciplinary approach. J Neuropsychiatr Clin Neurosci 1993;5:78–85.Google Scholar
7. Katz, IR. Diagnosis and treatment of depression in patients with Alzheimer’s disease and other dementias. J Clin Psychiatry 1998;59(Suppl 9):38–44.Google Scholar
8. Emery, VO, Oxman, TE. Update on the dementia spectrum of depression. Am J Psychiatry 1992; 149(3): 305–317.Google Scholar
9. Kral, V. The relationship between senile dementia (Alzheimer type) and depression. Can J Psychiatry 1983;28:304–306.Google Scholar
10. Agbayewa, MO. Earlier psychiatric morbidity in patients with Alzheimer’s disease. J Am Geriatr Soc 1986;34:561–564.Google Scholar
11.Jorm, AF, Van Duyn, CM, Chandra, V, et al. Psychiatric history and related exposures as risk factors for Alzheimer’s disease: a collaborative re-analysis of case-control studies. Int J Epidemiol 1991;20:S43-S47.Google Scholar
12. Clayton, D. The Eurodem collaborative re-analysis of case-control studies of Alzheimer’s disease: some methodological considerations. Int J Epidemiol 1991;20:S62-S64.Google Scholar
13. Speck, CE, Kukull, WA, Brenner, DE, et al. History of depression as a risk factor for Alzheimer’s disease. Epidemiology 1995;6:366–369.Google Scholar
14. Steffens, DC, Plassman, BL, Helms, MJ, et al. A twin study of late-onset depression and apolipoprotein E epsilon 4 as risk factors for Alzheimer’s disease. Biol Psychiatry 1997;41:851–856.Google Scholar
15. Reifler, BV, Larson, E, Teri, L, Poulsen, M. Dementia of the Alzheimer’s type and depression. J Am Geriatr Soc 1986;34:855–859.CrossRefGoogle ScholarPubMed
16. Devanand, DP, Sano, M, Tang, MX, et al. Depressed mood and the incidence of Alzheimer’s disease in the elderly living in the community. Arch Gen Psychiatry 1996;53:175–182.Google Scholar
17. Jost, BC, Grossberg, GT. The evolution of psychiatric symptoms in Alzheimer’s disease: a natural history study. J Am Geriatr Soc 1996;44:1078–1081.Google Scholar
18. Dufouil, C, Fuhrer, R, Dartigues, JF, Alperovitch, A. Longitudinal analysis of the association between depressive symptomatology and cognitive deterioration. Am J Epidemiol 1996; 144(7): 634–641.Google Scholar
19. Zubenko, GS, Moosy, J. Major depression in primary dementia: clinical and neuropathologic correlates. Arch Neurol 1988; 45:1182–1186.Google Scholar
20. Zweig, RM, Ross, CA, Hedreen, JC. The neuropathology of aminergic nuclei in Alzheimer’s disease. Ann Neurol 1988;24: 233–242.Google Scholar
21. Förstl, H, Burns, A, Luthert, P, et al. Clinical and neuropathological correlates of depression in Alzheimer’s disease. Psychol Med 1992;22:877–884.Google Scholar
22. Sapolsky, RM. Glucocorticoids and hippocampal atrophy in neuropsychiatric disorders. Arch Gen Psychiatry 2000;57:925–935.Google Scholar
23. Burns, A, Jacoby, R, Levy, R. Psychiatric phenomena of Alzheimer’s disease. III: Disorders of mood. Br J Psychiatry 1990;157:81–86.Google Scholar
24. Migliorelli, R, Tesón, A, Sabe, L, et al. Prevalence and correlates of dysthymia and major depression among patients with Alzheimer’s disease. Am J Psychiatry 1995;152:37–44.Google ScholarPubMed
25. Fisher , P, Simanyi, M, Danielczyk, W. Depression in dementia of the Alzheimer type and in multi-infarct dementia. Am J Psychiatry 1990;147:1484–1487.Google Scholar
26. Gottlieb, GL, Gur, RE, Gur, RC. Reliability of psychiatric scales in patients with dementia of the Alzheimer type. Am J Psychiatry 1988;145:857–860.Google ScholarPubMed
27. Moye, J, Robiner, WN, Mackenzie, TB. Depression in Alzheimer patients: discrepancies between patient and caregiver reports. Alzheimer Dis Assoc Disord 1993;7:187–201.Google Scholar
28. Cummings, JL, Ross, W, Absher, J, Gornbein, J, Hadjiaghai, L Depressive symptoms in Alzheimer’s disease: assessment and determinants. Alzheimer Dis Assoc Disord 1995;9:87–93.Google Scholar
29. Reisberg, B, Franssen, E, Sclan, SG, et al. Stage specific incidence of potentially remediable behavioural symptoms in aging and Alzheimer disease. Bull Clin Neurosci 1989;54:95–112.Google Scholar
30. Troisi, A, Pasini, A, Gori, G, Sorbi, T, et al. Assessment of depression in Alzheimer’s disease: symptoms, syndrome and computed tomography findings. Dementia 1993;4:87–93.Google Scholar
31. Sultzer, DL, Levin, HS, Mahler, ME, High, WM, Cummings , JL. Assessment of cognitive, psychiatric and behavioural disturbances in patients with dementia. The neurobehavioural rating scale. J Am Geriatr Soc 1992;40:549–555.Google Scholar
32. Usman, MA, Hahner, TP, Franzen, MD. Depression and insight correlate with age in Alzheimer’s disease. Poster presented at the American Association of Geriatric Psychiatry Eleventh Annual Meeting, Mar 8-11, 1998, San Diego.Google Scholar
33. Feher, EP, Mahurin, RK, Inbody, SB, Crook , TH, Pirozzollo FJ. Anosognosia in Alzheimer’s disease. Neuropsychiatry Neuropsychol Behav Neurol 1991;4:136–146.Google Scholar
34. Sevush, S, Leve, N. Denial of memory deficit in Alzheimer’s disease. Am J Psychiatry 1993;150:748–751.Google Scholar
35. Reed, BR, Jagust, WJ, Coulter, L. Anosognosia in Alzheimer’s disease: relationships to depression, cognitive function and cerebral perfusion. J Clin Exp Neuropsychol 1993;15:231–244.Google Scholar
36. Bungener, C, Jouvent, R, Derouesné, C. Affective disturbance in Alzheimer’s disease. J Am Geriatr Soc 1996;44:1066–1071.Google Scholar
37. Marin, RS, Fogel, BS, Hawkins, J, Duffy, J, Krupp, B. Apathy: a treatable syndrome. J Neuropsychiatry Clin Neurosci 1995; 7(1): 23–30.Google Scholar
38. Galynker, I, Ieronimo, C, Miner, C, et al. Methylphenidate treatment of negative symptoms in patients with dementia. J Neuropsychiatry Clin Neurosci 1997; 9(2): 231–239.Google ScholarPubMed
39. Seltzer, B, Sherwin, I. A comparison of clinical features in early and late-onset primary degenerative dementia: one entity or two? Arch Neurol 1983; 40:143–146.Google Scholar
40. Rabin, EH, Morris, JC, Berg, L. The progression of personality changes in senile dementia of the Alzheimer type. J Am Geriatr Soc 1987;35:721–725.Google Scholar
41. Petry, S, Cummings, J, Hill, MA, Shapira, J. Personality alterations in dementia of the Alzheimer type: a three-year follow-up study. Arch Neurol 1988;45:1187–1190.Google Scholar
42. Bozzola, FG, Gorelick, PB, Freels, S. Personality change in Alzheimer’s disease. Arch Neurol 1992;49:297–300.Google Scholar
43. Hoehn-Saric, R, Lipsey, JR, McLeod, DR. Apathy and indifference in patients on fluvoxamine and fluoxetine. J Clin Psychopharmacol 1990;32:672–674.Google Scholar
44. Duffy, JD, Marin, RS. Recent advances in the neuropsychiatry of disorders of motivation. J Neuropsychiatry Clin Neurosci 1995; 7:397(A).Google Scholar
45. Oliveira-Souza, RD, Figueiredo, WM. [Multimodal iatrogenic apathy]. Arq Neuropsiquiatr 1996 Jun; 54(2): 216–221.Google Scholar
46. McAllister, TW. Apathy. Sem Clin Neuropsychiatr 2000;5(4):275–282.Google Scholar
47. Kaplitz, S. Withdrawn, apathetic geriatric patients responsive to methylphenidate. J Am Geriatr Soc 1996; 123:271–276.Google Scholar
48. Kaufer, DI, Cummings, JL, Christine, D. Effect of tacrine on behavioural symptoms in Alzheimer’s disease: an open label study. J Geriatr Psychiatry Neurol 1996;9:1–6.Google Scholar
49. Kaufer, D. Metrifonate in Alzheimer’s disease: effect on neuropsychiatric symptoms. Presentation at the Fifth International Geneva/Springfield Symposium on Advances on Alzheimer’s Therapy. April 18, 1998, Geneva, Switzerland.Google Scholar
50. Van-Reekum, R, Bayley, M, Garner, S, et al. N of 1 study: amantadine for the amotivational syndrome in a patient with traumatic brain injury. Brain Inj 1995; 9(1): 49–53.Google Scholar
51. Muller, U, Von Cramon, DY. The therapeutic potential of bromocriptine in neuropsychological rehabilitation of patients with acquired brain damage. Prog Neuropsychopharmacol Biol Psychiatry 1994; 18(7): 1103–1120.Google Scholar
52. Raheja , RK, Bharwani, I, Penetrante AE. Efficacy of risperidone for behavioural disorders in the elderly: a clinical observation. J Geriatr Psychiatry Neurol 1995; 8(3): 159–161.Google Scholar
53. Tariot, PN, Cohen, RM, Sunderland, T, et al. L-deprenyl in Alzheimer’s disease. Preliminary evidence for behavioural change with monoamine oxidase B inhibition. Arch Gen Psychiatry 1987;44:427–433.CrossRefGoogle ScholarPubMed
54. Freedman, M, Rewilak, D, Xerri, T, et al. L-deprenyl in Alzheimer’s disease. Neurology 1998;50:660–668.Google Scholar
55. Arciniegas, DB, Topkoff, J. The neuropsychiatry of pathologic affect: an approach to evaluation and treatment. Sem Clin Neuropsychiatry 2000;5(4):290–306.Google Scholar
56. Starkstein, SE, Sabe, L, Vazquez, S, et al. Neuropsychological, psychiatric and cerebral blood flow findings in vascular dementia and Alzheimer’s disease. Stroke 1996; 27(3): 408–414.CrossRefGoogle ScholarPubMed
57. Haupt, M. Emotional lability, intrusiveness and catastrophic reactions. Int Psychogeriatr 1996; 8 Suppl 3: 409–414.Google Scholar
58. Ott, BR, Tate, CA, Gordon, NM, Heindel, WC. Gender differences in the behavioural manifestations of Alzheimer’s disease. J Am Geriatr Soc 1996; 44(5): 583–587.Google Scholar
59. Robinson, RG, Travella, JL. Neuropsychiatry of mood disorders. In: Fogel, Schiffer and Rao, eds. Neuropsychiatry. Baltimore, Maryland: Williams and Wilkins, 1996;287–305.Google Scholar
60. Morris, PL, Robinson, RG, Raphael, B. Emotional lability after stroke. Aust N Z J Psychiatry 1993; 27(4): 601–605.Google Scholar
61. Starkstein, SE, Robinson, RG, Price, TR. Comparison of patients with and without post-stroke major depression matched for size and location of lesion. Arch Gen Psychiatry 1988;45:247–252.Google Scholar
62. Adler, L, Wedekind, D, Pilz, J, Weniger, G, Huether, G. Endocrine correlates of personality traits: a comparison between emotionally stable and emotionally labile healthy young men. Neuropsychobiology 1997; 35(4): 205–210.Google Scholar
63. Fritze , J, Lanczik, M, Sofic, E, Struck, M, Riederer, P. Cholinergic neurotransmission seems not to be involved in depression but possibly in personality. J Psychiatry Neurosci 1995; 20(1): 39–48.Google Scholar
64. Feinstein, A, Feinstein, K, Gray, T, O’Connor, P. Prevalence and neurobehavioural correlates of pathological laughing and crying in multiple sclerosis. Arch Neurol 1997; 54(9): 1116–1121.Google Scholar
65. Robinson, RG, Parikh, RM, Lipsey, JR, Starkstein, SE, Price, TR. Pathological laughing and crying following stroke: validation of a measurement scale and a double-blind treatment study [see comments]. Am J Psychiatry 1993; 150(2): 286–293.Google Scholar
66. Schiffer, RB, Herndon, RM, Rudick, RA. Treatment of pathologic laughing and weeping with amitriptyline. N Engl J Med 1985; 312(23): 1480–1482.Google Scholar
67. Lawson, I, MacLeod, R. The use of imipramine and other psychiatric drugs in organic emotionalism. Br J Psychiatry 1969;115:281–285.Google Scholar
68. Anderson, G, Vestergaard, K, Riis, JO. Citalopram for post-stroke pathological crying. Lancet 1993;342:837–839.Google Scholar
69. Kocsis, JH. Geriatric dysthymia. J Clin Psychiatry 1998;59(Suppl 10):13–15.Google Scholar
70. Devanand, DP, Nobler, MS, Singer, T, et al. Is dysthymia a different disorder in the elderly? Am J Psychiatry 1994;151:1592–1599.Google Scholar
71. Lima, MS, Moncrief, J. A comparison of drugs versus placebo for the treatment of dysthymia. Cochrane Database Syst Rev 2000;(2):CD001130.Google Scholar
72. Bellino, S, Bogetto, F, Vaschetto, P, Ziero, S, Ravizza, . Recognition and treatment of dysthymia in elderly patients. Drugs Aging 2000;16(2):107–121.Google Scholar
73. Williams, JW Jr, Barrett, J, Oxman, T, et al. Treatment of dysthymia and minor depression in primary care: a randomized controlled trial in older adults [see comments]. JAMA 2000;284(12):1519–1526.Google Scholar
74. Bella, R, Biondi, R, Raffaele, R, Pennisi, G. Effect of acetyl-L-carnitine on geriatric patients suffering from dysthymic disorders. Int J Clin Pharmacol Res 1990;10(6):355–360.Google Scholar
75. Reifler, BV, Larson, E, Hanley, R. Coexistence of cognitive impairment and depression in geriatric outpatients. Am J Psychiatry 1982;139:623–626.Google Scholar
76. Rovner, BW, Broadhead, J, Spencer, M, Carson, K, Folstein, MF. Depression in Alzheimer’s disease. Am J Psychiatry 1989;146:350–353.Google Scholar
77. Wragg, RE, Jeste, DV. Overview of depression and psychosis in Alzheimer’s disease. Am J Psychiatry 1989;145:577–587.Google Scholar
78. Klatka, LA, Louis, ED, Schiffer, RB. Psychiatric features in diffuse Lewy body disease: a clinicopathologic study using Alzheimer’s disease and Parkinson’s disease comparison groups. Neurology 1996;47:1148–1152.Google Scholar
79. Weiner, MF, Edland, SD, Luszczynska, H. Prevalence and incidence of major depression in Alzheimer’s disease. Am J Psychiatry 1994;151:1006–1009.Google Scholar
80. Brodaty, H, Luscombe, G. Depression in persons with dementia. Int Psychogeriatr 1996;8(4):609–622.Google Scholar
81. Pearlson, GD, Ross, CA, Lohr, WD, et al. Association between family history of affective disorder and the depressive syndrome of Alzheimer’s disease. Am J Psychiatry 1990;147:452–456.Google Scholar
82. Strauss, ME, Ogrocki, PK. Confirmation of an association between family history of affective disorder and the depressive syndrome of Alzheimer’s disease. Am J Psychiatry 1996;153:1340–1342.Google Scholar
83. Lazarus, LW, Newton, N, Cohler, B, et al. Frequency and presentation of depressive symptoms in patients with primary degenerative dementia. Am J Psychiatry 1987;144:41–45.Google Scholar
84. Newman, SC. The prevalence of depression in Alzheimer’s disease and vascular dementia in a population sample. J Affect Disord 1999;52:169–176.Google Scholar
85. NIH Consensus Development Panel. Diagnosis and treatment of depression in late life. JAMA 1992;268:1018–1024.Google Scholar
86. Nebes, RD, Pollock, BG, Mulsant, BH, et al. Low-level serum anticholinergicity as a source of baseline cognitive heterogeneity in geriatric depressed patients. Psychopharmacol Bull 1997;33(4):715–720.Google Scholar
87. Nussbaum, PD. Late-life depression: a neuropsychological perspective. In: Nussbaum, PD, ed. Handbook of Neuropsychology and Aging. New York and London: Plenum Press, 1997.Google Scholar
88. Porsteinsson, AP, Tariot, PN, Schneider, LS. Mood disturbances in Alzheimer’s disease. Sem Clin Neuropsychiatry 1997;2(4):265–275.Google Scholar
89. Morley , JE, Kraneske, D. Causes of weight loss in a community nursing home. J Am Geriatr Soc 1994;42:583–585.Google Scholar
90. Barrett-Connor, E, Edelstein, SL, Corey-Bloom, J, Wiederholt, WC. Weight loss precedes dementia in community-dwelling older adults. J Am Geriatr Soc 1996;44:1147–1152.Google Scholar
91. Reynolds, CF, Kupfer, DJ, Houck, PR, et al. Reliable discrimination of elderly depressed and demented patients by electroencephalo-graphic sleep data. Arch Gen Psychiatry 1988;45:258–264.Google Scholar
92. Alexopoulos, GS, Abrams, RC, Young, RC, et al. Cornell scale for depression in dementia. Biol Psychiatry 1988;23:271–284.Google Scholar
93. Sunderland, T, Alterman, IS, Yount, D, et al. A new scale for the assessment of depressed mood in demented patients. Am J Psychiatry 1988;145:955–959.Google ScholarPubMed
94. Katona, CLE, Aldridge, CR. The dexamethasone suppression test and depressive signs in dementia. J Affect Disord 1985;8:83–89.Google Scholar
95. Greenwald, BS, Kramer, E. Major depression in severe dementia, in New Research Program and Abstracts: American Psychiatric Association 144th Annual Meeting. New Orleans, LA, May 11–16, 1991, p 70.Google Scholar
96. Jacobs, MR, Strauss, ME, Patterson, MB, Mack, JL. Characterization of depression in Alzheimer’s disease by the CERAD Behaviour Rating Scale for dementia (BRSD). Am J Geriatr Psychiatry 1998;6(1):53–58.Google Scholar
97. Tariot, PN, Mack, JL, Patterson, MB, et al. The behaviour rating scale for dementia of the Consortium to establish a registry for Alzheimer’s Disease. Am J Psychiatry 1995;152:1349–1357.Google Scholar
98. Mack, JL, Patterson, MB. Manual: CERAD Behaviour Rating Scale for Dementia, 2nd Edition. Durham, NC, Consortium to Establish a Registry for Alzheimer’s Disease, 1996.Google Scholar
99. Patterson, MB, Mack, JL, Mackell, JA, et al. A longitudinal study of behavioural pathology across five levels of dementia severity in Alzheimer’s Disease: the CERAD Behaviour Rating Scale for Dementia. Alzheimer Dis Assoc Disord 1997;11(supp 2):7540–544.Google Scholar
100. Morault, P, Palem, E, Paty, J, Bourgeois, M. Pseudodemence depressive. Interet diagnostique de l’EEG quantifie. [Depressive pseudodementia. Diagnostic importance of quantified EEG] Neurophysiol Clin 1994; 24(5): 343–356.Google Scholar
101. Curran, SM, Murray, CM, VanBeck, M, et al. A single photon emission computerised tomography study of regional brain function in elderly patients with major depression and with Alzheimer-type dementia. Br J Psychiatry 1993; 163: 155–165.Google Scholar
102. Starkstein, S, Vazquez, S, Migliorelli, R. ASPECT study of depression in Alzheimer’s disease. Neuropsychiatr Neuropsychol Behav Neurol 1995;8:38–43.Google Scholar
103. Pozzi , D, Golimstock, A, Petracchi, M, Garcia, H, Starkstein, S. Quantified electroencephalographic changes in depressed patients with and without dementia. Biol Psychiatry 1995; 38(10): 677–683.Google Scholar
104. Pozzi, D, Golimstock, A, Migliorelli, R, et al. Quantified electro-encephalographic correlates of depression in Alzheimer’s disease. Biol Psychiatry 1993;34:386–391.Google Scholar
105. Azorin, JM, Donnet, A, Habib, M, Regis, H. Diagnostic criteria of depressive pseudodementia. Encephale 1990;16(1):31–34.Google Scholar
106. Teri, L. Behavioural treatment of depression in patients with dementia. Alzheimer Dis Assoc Disord 1994; 8(supp 3):66–74.Google Scholar
107. Teri, L, Logsdon, RG, Uomoto, J, McCurry, SM. Behavioural treatment of depression in dementia patients: a controlled clinical trial. J Gerontol B Psychol Sci Soc Sci 1997; 52(4): P159-166.Google Scholar
108. Haley, WE, Levine, EG, Brown, SL, Berry, JW, Hughes, GH. Psycho-logical, social and health consequences of caring for a relative with senile dementia. J Am Geriatr Soc 1987; 35(5): 405–411.Google Scholar
109. Clipp, EC, George, LK. Psychotropic drug use among caregivers of patients with dementia. J Am Geriatr Soc 1990;38(3):227–235.Google Scholar
110. Lawton, MP, Brody, EM, Saperstein, AR. A controlled study of respite service for caregivers of Alzheimer’s patients. Gerontologist 1989; 29(1): 8–16.Google Scholar
111. Mohide, EA, Pringle, DM, Streiner, DL, et al. A randomized trial of family caregiver support in the home management of dementia. J Am Geriatr Soc 1990; 38(4): 446–454.Google Scholar
112. Mittelman, MS, Ferris, SH, Shulman, E, Steinberg, G, Levin, B. A family intervention to delay nursing home placement of patients with Alzheimer’s disease. JAMA 1996;276:1625–1631.Google Scholar
113. Weinberger, M, Gold, DT, Divine, GW, et al. Social service, interventions for caregivers of patients with dementia: impact on health care utilization and expenditures. J Am Geriatr Soc 1993; 41(2):153–156.Google Scholar
114. Wallis, GG, Baldwin, M, Higginbotham, P. Reality orientation therapy – a controlled trial. Br J Med Psychol 1983; 56 (Pt 3): 271–277.Google Scholar
115. Teri, L, Gallagher-Thompson, D. Cognitive-behavioural inter-ventions for treatment of depression in Alzheimer’s patients. Gerontologist 1991;31:413–416.Google Scholar
116. Nahas, Z, Kunik, ME, Orengo, CA, Molinari, V, Workman, R. Depression in male geropsychiatric inpatients with and without dementia: a naturalistic study. J Affect Disord 1997; 46(3): 243–246.Google Scholar
117. Reynolds, CF, Perel, JM, Kupfer, DJ, et al. Open-trial response to antidepressant treatment in elderly patients with mixed depression and cognitive impairment: Psychiatry Res 1987 Jun; 21(2): 111–122.Google Scholar
118. Trappler, B, Cohen, CI. Use of the SSRIs in “very old” depressed nursing home residents. Am J Geriatr Psychiatry 1998;6:83–89.Google Scholar
119. Alexopoulos, GS. The treatment of depressed demented patients. J Clin Psychiatry 1996;57(suppl 14):14–20.Google Scholar
120. Reynolds, CF, Kupfer, DJ, Hoch, , et al. Two year follow-up of elderly patients with mixed depression and dementia: clinical and electroencephalographic sleep findings. J Am Geriatr Soc 1986;34:793–799.Google Scholar
121. Reifler, BV, Teri, L, Raskind, M, et al. Double-blind trial of imipramine in Alzheimer’s disease patients with and without depression [see comments]. Am J Psychiatry 1989;146:809–810.Google Scholar
122. Petracca, G, Tesón, A, Chemerinski, E, Leiguarda, R, Starkstein, S. A double-blind placebo-controlled study of clomipramine in depressed patients with Alzheimer’s disease. J Neuropsychiatry Clin Neurosciences 1996;8(3):270–275.Google Scholar
123. Roth, M, Mountjoy, CQ, Amrein, R. Moclobemide in elderly patients with cognitive decline and depression: an international double-blind, placebo-controlled trial. Br J Psychiatry 1996;168(2): 149–157.Google Scholar
124. Gottfries, CG, Karlsson, I, Nyth, AL. Treatment of depression in elderly patients with and without dementia disorders. Int Clin Psychopharmacol 1992; 6 Suppl 5: 55–64.Google Scholar
125. Lyketsos, CG, Sheppard, JM, Steele, CD, et al. Randomized, placebocontrolled, double-blind clinical trial of sertraline in the treatment of depression complicating Alzheimer’s disease: initial results from the depression in Alzheimer’s disease study. Am J Psychiatry 2000;157(10):1686–1689.Google Scholar
126. Magai, C, Kennedy, G, Cohen, CI, Gomberg, D. A controlled clinical trial of sertraline in the treatment of depression in nursing home patients with late-stage Alzheimer’s disease. Am J Geriatr Psychiatry 2000;8(1):66–74.Google Scholar
127. Fuchs, A, Hehnke, U, Erhart, C, Schell, C, Pramshohler, B, Danninger, B, Schautzer, F. Video rating analysis of effect of maprotiline in patients with dementia and depression. Pharmacopsychiatry 1993; 26(2): 37–41.Google Scholar
128. Menting, JE, Honig, A, Verhey, FR, et al. Selective serotonin reuptake inhibitors (SSRIs) in the treatment of elderly depressed patients: a qualitative analysis of the literature on their efficacy and side-effects. Int Clin Psychopharmacol 1996; 11(3): 165–75.Google Scholar
129. Flint, AJ. Pharmacologic treatment of depression in late life. Can Med Assoc J 1997;157(8):1061–1067.Google Scholar
130. Sunderland, T, Tariot, PN, Cohen, RM, et al. Anticholinergic sensitivity in patients with dementia of the Alzheimer’s type: a dose response study. Arch Gen Psychiatry 1987;44:418–426.Google Scholar
131. Teri, L, Reifler, BV, Veith, RC, et al. Imipramine in the treatment of depressed Alzheimer’s patients: impact on cognition. J Gerontol 1991; 46(6): 372–377.Google Scholar
132. Richardson, JS, Keegan, DL, Bowen, RC, et al. Verbal learning by major depressive disorder patients during treatment with fluoxetine or amitriptyline. Int Clin Psychopharmacol 1994;9:35–40.Google Scholar
133. Cole, JO, Branconnier, R, Salomon, M, Dessain, E. Tricyclic use in the cognitively impaired elderly. J Clin Psychiatry 1983; 44(9 Pt 2): 14–19.Google Scholar
134. Fitz, AG, Teri, L. Depression, cognition and functional ability in patients with Alzheimer’s disease. J Am Geriatr Soc 1994;42(2):186–191.Google Scholar
135. Rao, V, Lyketsos, CG. The benefits and risks of ECT for patients with primary dementia who also suffer from depression. Int J Geriatr Psychiatry 2000;15:729–735.Google Scholar
136. Rabins, P, Blacker, D, Bland, W, et al. Practice Guidelines for the treatment of patients with Alzheimer’s disease and other dementias of late life. Am J Psychiatry 1997;154(5:supp):1–39.Google Scholar
137. Small, GW, Rabins, PV, Barry, PP, et al. Diagnosis and treatment of Alzheimer’s disease and related disorders. Consensus statement of the American Association of Geriatric Psychiatry, the Alzheimer’s Association and the American Geriatrics Society. JAMA 1997;278:1363–1371.CrossRefGoogle Scholar