Late life depression with cognitive impairment: Evaluation and treatment
Consuelo H Wilkins1,2, Jose Mathews2, Yvette I Sheline21Department of Medicine (Division of Geriatrics and Nutritional Science); 2Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USAAbstract: Older adults with depression often present with signs and symptoms indicat...
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doaj-28e14567a9524ca08d2269802e9e56f62020-11-24T22:49:22ZengDove Medical PressClinical Interventions in Aging1178-19982008-09-01Volume 451572279Late life depression with cognitive impairment: Evaluation and treatmentConsuelo H WilkinsJose MathewsYvette I ShelineConsuelo H Wilkins1,2, Jose Mathews2, Yvette I Sheline21Department of Medicine (Division of Geriatrics and Nutritional Science); 2Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USAAbstract: Older adults with depression often present with signs and symptoms indicative of functional or cognitive impairment. These somatic symptoms make evaluating and treating depression in older adults more complex. Late life depression (LLD), depression in adults over the age of 65, is more frequently associated with cognitive changes. Cognitive impairment in LLD may be a result of the depressive disorder or an underlying dementing condition. Memory complaints are also common in older adults with depression. There is a wide range of cognitive impairment in LLD including decreased central processing speed, executive dysfunction, and impaired short-term memory. The etiology of cognitive impairment in LLD may include cerebrovascular disease, a significant risk factor for LLD, which likely interrupts key pathways between frontal white matter and subcortical structures important in mood regulation. Because depressive symptoms often coexist with dementia, it is important to determine the temporal relationship between depressive symptoms and cognitive change. If depressive symptoms pre-date the cognitive impairment and cognitive symptoms are mild and temporary, LLD is the likely etiology of the cognitive impairment. If cognitive changes appear prior to depressive symptoms and persist after LLD is successfully treated, an underlying dementia is more likely. Clinicians should be exclude common conditions such as thyroid disease which can contribute to depressive symptoms and cognitive impairment prior to treating LLD. Both antidepressants and psychotherapy can be effective in treating LLD. Subsequent evaluations following treatment should also reassess cognition.Keywords: late life depression, cognitive impairment, diagnosis, treatment, cognitionhttps://www.dovepress.com/late-life-depression-with-cognitive-impairment-evaluation-and-treatmen-peer-reviewed-article-CIA |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Consuelo H Wilkins Jose Mathews Yvette I Sheline |
spellingShingle |
Consuelo H Wilkins Jose Mathews Yvette I Sheline Late life depression with cognitive impairment: Evaluation and treatment Clinical Interventions in Aging |
author_facet |
Consuelo H Wilkins Jose Mathews Yvette I Sheline |
author_sort |
Consuelo H Wilkins |
title |
Late life depression with cognitive impairment: Evaluation and treatment |
title_short |
Late life depression with cognitive impairment: Evaluation and treatment |
title_full |
Late life depression with cognitive impairment: Evaluation and treatment |
title_fullStr |
Late life depression with cognitive impairment: Evaluation and treatment |
title_full_unstemmed |
Late life depression with cognitive impairment: Evaluation and treatment |
title_sort |
late life depression with cognitive impairment: evaluation and treatment |
publisher |
Dove Medical Press |
series |
Clinical Interventions in Aging |
issn |
1178-1998 |
publishDate |
2008-09-01 |
description |
Consuelo H Wilkins1,2, Jose Mathews2, Yvette I Sheline21Department of Medicine (Division of Geriatrics and Nutritional Science); 2Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USAAbstract: Older adults with depression often present with signs and symptoms indicative of functional or cognitive impairment. These somatic symptoms make evaluating and treating depression in older adults more complex. Late life depression (LLD), depression in adults over the age of 65, is more frequently associated with cognitive changes. Cognitive impairment in LLD may be a result of the depressive disorder or an underlying dementing condition. Memory complaints are also common in older adults with depression. There is a wide range of cognitive impairment in LLD including decreased central processing speed, executive dysfunction, and impaired short-term memory. The etiology of cognitive impairment in LLD may include cerebrovascular disease, a significant risk factor for LLD, which likely interrupts key pathways between frontal white matter and subcortical structures important in mood regulation. Because depressive symptoms often coexist with dementia, it is important to determine the temporal relationship between depressive symptoms and cognitive change. If depressive symptoms pre-date the cognitive impairment and cognitive symptoms are mild and temporary, LLD is the likely etiology of the cognitive impairment. If cognitive changes appear prior to depressive symptoms and persist after LLD is successfully treated, an underlying dementia is more likely. Clinicians should be exclude common conditions such as thyroid disease which can contribute to depressive symptoms and cognitive impairment prior to treating LLD. Both antidepressants and psychotherapy can be effective in treating LLD. Subsequent evaluations following treatment should also reassess cognition.Keywords: late life depression, cognitive impairment, diagnosis, treatment, cognition |
url |
https://www.dovepress.com/late-life-depression-with-cognitive-impairment-evaluation-and-treatmen-peer-reviewed-article-CIA |
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