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Clinical and neuropathological correlates of depression in Alzheimer's disease

Published online by Cambridge University Press:  09 July 2009

Hans Förstl ,
Alistair Burns ,
Philip Luthert ,
Nigel Cairns ,
Peter Lantos  and
Raymond Levy
Hans Förstl*
Affiliation:
Section of Old Age Psychiatry and the Department of Neuropathology, Institute of Psychiatry, London
Alistair Burns
Affiliation:
Section of Old Age Psychiatry and the Department of Neuropathology, Institute of Psychiatry, London
Philip Luthert
Affiliation:
Section of Old Age Psychiatry and the Department of Neuropathology, Institute of Psychiatry, London
Nigel Cairns
Affiliation:
Section of Old Age Psychiatry and the Department of Neuropathology, Institute of Psychiatry, London
Peter Lantos
Affiliation:
Section of Old Age Psychiatry and the Department of Neuropathology, Institute of Psychiatry, London
Raymond Levy
Affiliation:
Section of Old Age Psychiatry and the Department of Neuropathology, Institute of Psychiatry, London
*
1 Address for correspondence: Dr Hans Förstl, Central Institute of Mental Health, PO Box 122–120, I 5, W-6800 Mannheim 1, Germany.
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Synopsis

Depressive symptoms have been reported in patients with mild to moderate Alzheimer's disease (AD). Recent evidence suggests that a noradrenergic deficit originating from neuronal degeneration in brainstem nuclei may represent an organic correlate of these disturbances. We examined the neuropathological changes in the locus coeruleus (LC), substantia nigra (SN), basal nucleus of Meynert and cortex of 52 patients (12 male, 40 female, mean age 83·2 ± 6·4 years) with pathologically verified AD. Fourteen patients (1 male, 13 female) showed signs of depression. The majority of these patients suffered from severe physical disability or sensory impairment and developed persistent delusions, but had less cognitive impairment. Neuronal counts in the LC were significantly lower than in the 38 patients without depression (36·9 ± 14 ·0; 51·4 ± 28·0 neuromelaninpigmented cells per section per nucleus; F = 3·4, df = 1, 50, P = 0·04). Neuron counts were higher in the basal nucleus of Meynert in depressed AD patients and there were no differences of the neuron numbers in the SN. Depression (main effect; F = 4·5, P = 0·04) contributed significantly to the variance of neuronal counts in the LC, even when covarying for gender, age of onset, cognitive impairment and cortical Alzheimer pathology. The observed disproportionate loss of noradrenergic and cholinergic neurons in the LC and basal nucleus of Meynert may represent an important organic substrate of depression in AD.

Type
Original Articles
Information
Psychological Medicine , Volume 22 , Issue 4 , November 1992 , pp. 877 - 884
Copyright
Copyright © Cambridge University Press 1992

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