CS06.01 - How to rate depression and apathy in dementia and in non demented elderly: The VA experience

Abstract

The evaluation of mental health patients of all age groups in Department of Veterans Affaires (VA) is complicated by the problem of separating symptoms of depression from those of apathy in young and old patients alike. In older patients, dementia of the Alzheimer's type often coexists with depression and at the same time with frontal-lobe signs of loss of executive skills and apathy. Furthermore dementias predominantly involving the frontal lobes have been proving more common than previously thought and these patients often present with psychiatric symptoms including apathy.

In younger patients returning from service in Iraq and Afghanistan symptoms of depression again may overlap with cognitive symptoms in this case due to occult mild traumatic brain injury (TBI) due to exposure of improvised explosive devices (IEDs) on the battlefield. Post-traumatic Stress Disorder (PTSD), which is also common in these groups, further complicates the diagnostic picture, and may exist in any age-group of veterans.

Currently the VA is exploring the most efficient means to effectively screen populations of veterans of all age groups for overlapping symptoms of depression, apathy and cognitive impairment. Data will be presented on the most effective screening paradigms for bringing these veterans to treatment efficiently.