Depressive syndromes in dementia

Background: Depressive syndromes in dementia are common, treatment is chall enging 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 Con sensus Conference on Dementia. Methods: A number of Medline searches were p erformed (most recently updated in October 2000) using the subject categori es dementia and depression, or apathy or emotional]ability and other releva nt articles were also reviewed. The background article was edited and amend ed at the Consensus Conference on Dementia. Final recommendations appearing in the summary article by Patterson et al were accepted by the group conse nsus 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 d ementia. While clear-cut depressive disorder is increased in this populatio n, sub-syndromal disorders are even more common and cause considerable dist ress. Antidepressant treatment may improve the quality of life in depressed , demented people, although it is less successful than in those without cog nitive impairment and carries more risk of iatrogenic effects. Conclusions: Physicians should be alert to the presence of depressive syndromes in deme ntia. Depressive illness should be treated and, when necessary, referral sh ould be made to an appropriate specialist. Treatment must minimize iatrogen ic effects. Although there is some support for treatment of syndromes that do not meet criteria for depressive disorder or dysthymia, the first line o f intervention in these situations should involve nonpharmacological approa ches.