Presence of Depression in Patients Diagnosed with Alzheimer’s disease

Presence of Depression in perseverings Diagnosed with Alzheimers sickness Alzheimers complaint (AD) is a imperfect tense and fatal neurodegenerative disorder which is associated with cognitive and stock board declivity, liberalist impairment of activities of daily supporting, a variety of neuropsychiatric symptoms and behavioral disturbances (Robinson). This indisposition is seen in active 2-4 million Ameri asss and is usually occurs after the age of 65 years (Robinson).According to Teri and Wagner (1992) there is growing agreement among physicians that Alzheimers affection is stalkly accompanied by mood and behavior disturbances, especially slump. Depression and Alzheimers aberration argon two separate disorders, one is disorder of require opposite disorder of cognition (Terri, & Wagner 1992). Despite this, economic crisis and madness trade a number of characteristics and frequently coexist. Impact of Associated Depression with Alzheimers unsoundness on Patient s and Cargongivers According to Terry & Wagner (1992) feeling is one of the around frequent comorbidpsychiatric disorders in Alzheimers illness and another(prenominal) dementias, and is associated with poor character of life, great floor of disability in activities of daily living, a faster cognitive decline, a high rate of nursing home keisterment and high deathrate rate. AD patient roles with coexistent falloff exhibit significantly more operational disability due to front line of depressive symptoms equivalent dysphoric mood, vegetative signs, affectionate withdrawal, spillage of interest, intuitive feelings of guilt and worthlessness, and suicidal ideation etcetera(Terry, & Wagner 1992).According to Newcomer, Yordi, DuNah, Fox, & Wilkinson (1999) slack in the patient is practically a major inauguration of stress, burden, and depression for c ar providers Caregivers of people with dementia and depression live been describen to experience depression, anger, anx iety, guilt, and to report negative attitudes toward the patient and other family members All these conundrums in patients with AD and depression can lead to massively increased health care costs (Terry and Wagner, 1992). sagacity of the Problem pull together data on depression in order to straightly pass judgment the prevalence of depressionamongst the patients agony from AD is a very operose problem due to more reasons as mentioned below Lack of established procedures to command depressive symptoms in AD Absence of a standardized procedure for estimate of depression in patients with AD was probably the main factor which has contri neverthelessed to the shifting rates of depression (15%-86%) in different studies (Terri, & Wagner 1992). Different versions of the DSM III 1980 and DSM-III-R 1987 criteria were employ in various studies which gave rise to different rates of prevalence of depression in patients with Alzheimers disease.AD and depression are now lots clear de fined by using well-accepted diagnostic criteria, such as the symptomatic and Statistical Manual of Mental Disorders, 3rd ed. , rev. (DSM-III-R) and the National Institute of neurological and Communicative Diseases and Stroke/Alzheimers Disease and Related Disorders Association (NINCDS-ADRDA), and well-established measures spanning the range of self-report and interviewer perspicacity (Terri, & Wagner, 1992).Other more established measures are also been intentiond now, including the Hamilton Depression military rank Scale (HDRS) and the Geriatric Depression Scale. Using DSM-III-R criteria, Teri, and Wagner (1991) reported prevalence of depression among AD patients in their contract as 29%.. Overlap of symptoms amidst depression and AD Since there can be overlap of symptoms amongst the two, it is difficult to attribute the symptom to a segmenticular disorder. This overlap can often con open up the diagnosis of depression (Terri, & Wagner 1992).Existent measures can identify t he presence of specific symptomatology, but they can non clarify its cause. For e. g. a person might be experiencing loss of interest, Now this loss could be due to the cognitive deterioration of dementia or due to anhedonia (loss of pleasure) related to depression.. Thus it becomes very difficult to differentiate dementia from depression in some cases. The primary source from which the history of depressive symptoms is obtainedAccording to number of studies (Gilley, et al. 1996 Teri, & Wegner1991) the traditional methods of obtaining history about depressive symptoms like patient interview and self reporting questionnaires might not put forward accurate to assess the patients symptoms as the patient with Alzheimers disease might be suffering from significant cognitive impairment. As a result of this cognitive impairment AD patients are ineffective to provide accurate information about their symptoms of depression .As an alternative to patient-report methods, the use of collatera l informants (patients care provider) to ascertain depressive symptomatology in cognitively impair patients has been employed nowadays. In 1991 Teri and Wegner conducted a study in AD patients to show that the reports condition by the patients themselves indicated less depression than reports from either their caregivers or reports given by clinicians after clinical observation of the patient. .The results of their study indicated that most of the patients suffering from AD and dementia seemed to be unaware of their depression.Although the use of collateral informants seems to be an attractive alternative approach for the assessment of depression in AD patients, it is not without important potential limitations. Caregivers whitethorn be unavailable for many patients or the care provider whitethorn not be living with the patient (Terry &Wegner 1992). If the care provider does not stay with the patient he might not get an opportunity to routinely observe the patient and will not be a ble to provide accurate information. The kind amidst the care-provider and the patient also take to be considered.According to many studies (Terri, & Wegner 1992 Gilley, et al. 1995) nipper or spouse of the patient has been identified as the most accurate informant. Inaccurate data may be obtained if other sources of collateral informants are used. Caregivers may also provide inaccurate history as they may deposit more on observable behaviors than on other sources of information because they are unable to evaluate the patients emotional state, or conversely, caregivers may rely more on inference, using their subjective beliefs to evaluate how the patient is feeling (Teri& Wegner 1991).In cases where the care provider is not available, it typically becomes the responsibility of the clinician to make a diagnosis of depression. However clinicians diagnosis is based on abbreviated periods of patients observation and thus might not reelect accurate results (Terri & Wegner 1992). E ffect of Depression on Cognitive Deficits Associated with AD. Pronounced divided memory impairment is one of the cardinal manifestations of AD. Depression on its let is also related with some amount of memory loss.Since both depression and AD have been found to result in memory deficits, it may be hypothesized that the simultaneous occurrence of both these diseases would add to the memory problems resulting from AD alone (Terry & Wagner 1992). numerous neuropathological and clinical studies have attempted to determine whether the human beings of one disorder predisposes an individual to the development of the other and whether the cognitive deficits seen in AD become more pronounced if the person also suffers from depression.The results of the study performed by Fahlander, Berger & Wahlin (1999) indicated that depression does not boost impair episodic memory action in patients with AD. This result was in agreement with a prior query done by Backman, Hassing, Forsell, and Vii tanen (1996) who determined the co morbidity effectuate of AD and depression on episodic memory performance in very old persons (90-100 years of age) with and without dementia and depression. Overall, Backman, et al. found no differences between depressed patients and healthy old controls or between patients with AD and depression and those with AD alone.Backman, et al explained this finding as follows Symptoms of depression which are most likely to exert negative set up on memory embroil motivational and attention factors like lack of interest, loss of energy, concentration difficulties etc. Some amount of memory impairment is already depict among AD patients as a result of similar symptoms like lack of interest, loss of energy etc associated with dementia. Therefore, a diagnosis of major depression may not cause further impairment of memory in persons suffering from AD.Backman, et al also suggested that although depression influences memory performance in normal ripening indi viduals, in dementia, this effect seems to be overshadowed by the neurodegenerative changes of AD itself . Backman, et al reached a conclusion that since such symptoms are more likely to be part of normal aging in the 90s compared with earlier decades, the effects of major depression on memory would be more paramount among younger old persons(in7-8th decade of life) as compared to the oldest old(in 9-10th decade of life).Tests for Differentiating Alzheimers disease and Depression. Utility of the Fuld profile in the differentiation of AD and depression Bornstein, Termeer, Longbrake, Heger, & northeastern (1989) have examined the incidence of Fuld profile in a sample of patients diagnosed to be suffering from major depression. Fulds profile refers to a pattern of performance on the Wechsler Adult Intelligence Scale-Revised (WAIS-R) that appears to be associated with cholinergic deficits and thus is found to be associated with Alzheimers disease (Bornstein, et al).Since a large numbe r of patients with AD have been seen to show negative profiles, a negative profile does not grow that AD is not present. Bornstein, et al. have suggested that one should not rely on the results obtained from Fuld profile to make a diagnosis of AD. A diagnosis of AD should be made only after a thorough medical exam and neurological history and a actualize neuropsychological examination. According to Bornstein, et al this profile was significantly less frequent in the depressed patients as compared to that reported in previous studies in Alzheimers disease patients.The study by Bornstein, et al does provide some support regarding the diagnostic specificity of the Fuld profile in diagnosis of depression. Although this study and previous data are encouraging, considerable further investigation is needed to document the specificity and diagnostic contribution of this profile for diagnosis of depression. Measurement of a potential biological marker in the CSF increase CSF concentration s of phosphorylated brain protein called tau protein, has been seen in patients with Alzheimers disease. Phosphorylated tau protein (ptau) has been suggested as a biomarker for Alzheimers disease.Since the levels of this protein are not elevated in patients with depression, measurement of this biological marker in cerebrospinal fluid (CSF) can diagnose patients with AD and thus help in differentiating them from those suffering from depression. (Vernon 2003). Treatment of Depression in Alzheimers Disease Patient Treatment of Alzheimers disease has proved to be quite difficult. . The disease is progressive and use of drugs (like cholinesterase inhibitors) just help in bringing about a little improvement (20-30%) in cognitive symptoms (Zepf 2005).However the drugs used for improving cognitive functions have no effect on the depressive symptoms. Treatment of depression moldiness form an important part of the overall intercession of this disease. This is so as treatment of depression in patients with Alzheimers disease can have a significant impact on the well-being of these patients as well as their care givers Lyketsos, et al. 2003 (as cited in Miller 2004). Continuing research is taking place in order to treat depression in AD patients. Many drugs have been tried to treat depression among patients with AD.Drugs like tricyclic antidepressants often used in cases of depression without AD are usually avoided in patients with AD, owing to their anticholinergic properties (Zepf, 2005). Lyketsos et al, 2003 (as cited in Miller 2004) showed the drug sertraline (selective seratonin uptake inhibitor) to be much superior as compared to placebo in treatment of depression in patients with AD. According to regular army Today (Society for advancement of education) the drug sertraline (Zoloft) significantly improves the quality of life and prevents disruption in daily activities for patients of Alzheimers disease with depression.Use of this drug has been shown to lessen the behavioral disturbances and improve the activities of daily living but has no effect on patients cognitive abilities, such as thinking, memory and learning. Conclusion Despite the great deal of research which has recently taken place in the field of Alzheimers disease with depression, more research is settle down required in this field as the physicians are mollify are not clear about the pathophysiology of AD or about the exact prevalence of depression in patients of AD or its etiology.The questions of whether depression and dementia are similar or different, whether one leads to the other or whether their coexistence has any etiological significance are far from resolved. The complete knowledge and understanding in this field will help the physicians in developing effective treatment strategies for care of such patients. Once the psychologists are able to understand the risk factors for coexistent depression in dementia and find its effective cure, they would be able to signif icantly improve the quality of life of the patients as well as their care providers and greatly make out the health care costs.Several questions regarding the management of depression in AD still need to be answered. The comparative efficacy of anti-depressants from various classes still needs to be explored by performing larger clinical trials. Role of non-pharmacological methods for treatment of depression also needs to be explored. Further research and studies are required in early to address these topics. The number of studies at present is quite small and the need for further investigation in future persists. References Backman, L. , Massing, L. , Forsell, Y. , & Viitanen, M. (1996). Episodic Remembering in apopulation-based Sample of Nonagenarians Does major depression incense the memory deficits seen in alzheimers disease? Psychology and Aging, 2(4),649-657. Bornstein, R. A. , Termeer, J. , Longbrake, K. , Heger, M. , & North, R. (1989). WAIS-R Cholinergic Deficit compose in Depression. Psychological Assessment, 1(4), 342-344. Fahlander, K. , Berger, A. K. , Wahlin, A. ,& Backman, L. (1999). Depression does not aggravate the episodic memory deficits associated with alzheimers disease. Neuropsychology, 13 (4), 532-538. Gilley,D. W. , Wilson R. S. , Fleischman D. A. , Harrison, D. W. , Goetz, C.G. , & Tanner, C. M. (1995). Impact of Alzheimers-Type Dementia and Information Source on the Assessment of Depression. Psychological Assessment, 7(1), 42-48. Miller, E. K. (2004). Depression in patients with Alzheimers disease. American Family Physician. 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