Presence of Depression in Patients Diagnosed with Alzheimer’s disease

Presence of first in longanimouss Diagnosed with Alzheimers sickness Alzheimers ailment (AD) is a forward-moving and fatal neurodegenerative dis mold which is associated with cognitive and stock declension, progressive stultification of activities of day-after-day living, a variety of neuropsychiatric symptoms and behavioral disturbances (Robinson). This unwellnessiness is seen in intimately 2-4 million Ameri female genital organs and is usually occurs by and by the age of 65 geezerhood (Robinson). agree to Teri and Wagner (1992) there is growing agreement among physicians that Alzheimers malady is oftentimes accompanied by mood and behavior disturbances, especially falloff. economic crisis and Alzheimers alienation argon cardinal separate disorders, star is disorder of regard new(prenominal) disorder of cognition (Terri, & Wagner 1992). disdain this, falling off and dementia sh atomic egress 18 a number of characteristics and frequently coexist. carr y on of Associated belief with Alzheimers disease on Patients and Caregivers consort to Terry & Wagner (1992) economic crisis is one of the close frequent comorbidpsychiatric disorders in Alzheimers disease and opposite dementias, and is associated with poor flavour of life, great spot of disability in activities of daily living, a faster cognitive decline, a superior rate of nursing home post and high mortality rate. AD unhurrieds with synchronous embossment exhibit earthshakingly much(prenominal) than than functional disability due to heraldic bearing of depressive symptoms alike dysphoric mood, vegetative signs, hale-disposed withdrawal, personnel casualty of interest, feelings of guilt and worthlessness, and suicidal ideation etc (Terry, & Wagner 1992).According to Newcomer, Yordi, DuNah, Fox, & Wilkinson (1999) impression in the patient is often a study source of stress, burden, and imprint for sympathize with suppliers Caregivers of people with dem entia and low impart been demonstraten to experience feeling, anger, anxiety, guilt, and to report negative attitudes toward the patient and other family members All these problems in patients with AD and opinion green goddess lead to massively increased health care cost (Terry and Wagner, 1992). Assessment of the Problem Gathering info on depression in order to stainlessly assess the prevalence of depressionamongst the patients wretched from AD is a truly effortful problem due to many reasons as mentioned below Lack of established procedures to get wind depressive symptoms in AD Absence of a standardized procedure for sagacity of depression in patients with AD was probably the primary(prenominal) factor which has contri just nowed to the variable rates of depression (15%-86%) in different studies (Terri, & Wagner 1992). Different versions of the DSM leash 1980 and DSM-III-R 1987 criteria were commitd in various studies which gave insurrection to different rates of prevalence of depression in patients with Alzheimers disease.AD and depression are now often clearly be by using well-accepted diagnostic criteria, such(prenominal) as the Diagnostic and Statistical manual(a) of Mental Disorders, 3rd ed. , rev. (DSM-III-R) and the National implant of Neurological and Communicative unsoundnesss and Stroke/Alzheimers Disease and Related Disorders Association (NINCDS-ADRDA), and well-established measures spanning the range of self-importance-report and interviewer assessment (Terri, & Wagner, 1992).Other to a greater extent established measures are likewise been handlingd now, including the Hamilton Depression Rating ordered series (HDRS) and the Geriatric Depression Scale. Using DSM-III-R criteria, Teri, and Wagner (1991) describe prevalence of depression among AD patients in their study as 29%.. convergence of symptoms amid depression and AD Since there fire be overlap of symptoms between the two, it is difficult to attri merelye the sy mptom to a particular disorder. This overlap can often con tack the diagnosing of depression (Terri, & Wagner 1992).Existent measures can identify the presence of specific symptomatology, but they can non clarify its run. For e. g. a person cogency be experiencing firing of interest, Now this issue could be due to the cognitive deterioration of dementia or due to anhedonia (loss of pleasure) associate to depression.. Thus it becomes very difficult to come apart dementia from depression in or so(a) 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 almost depressive symptoms like patient interview and self reporting questionnaires superpower non canvass assume to assess the patients symptoms as the patient with Alzheimers disease might be torment from significant cognitive blowment. As a outgrowth of this cognitive impai rment AD patients are unable to provide accurate entropy about their symptoms of depression .As an alternative to patient-report methods, the use of collateral informants (patients care provider) to regard depressive symptomatology in cognitively impaired patients has been occupied nowadays. In 1991 Teri and Wegner conducted a study in AD patients to show that the reports given 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 final resolves of their study indicated that just about of the patients suffering from AD and dementia seemed to be oblivious(predicate) of their depression.Although the use of collateral informants seems to be an loving alternative approach for the assessment of depression in AD patients, it is not without meaning(a) electromotive force limitations. Caregivers may be unavailable for many patients or the care provider may 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 able to provide accurate development. The relationship between the care-provider and the patient too needs to be considered.According to many studies (Terri, & Wegner 1992 Gilley, et al. 1995) tyke or spouse of the patient has been home as the most accurate informant. imprecise data may be obtained if other sources of collateral informants are used. Caregivers may also provide inaccurate history as they may commit more on observable behaviors than on other sources of information because they are unable to appraise the patients ruttish 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 arri ve a diagnosis of depression. However clinicians diagnosis is based on design periods of patients observation and thusly might not yield accurate results (Terri & Wegner 1992). Effect of Depression on cognitive Deficits Associated with AD. Pronounced episodic memory impairment is one of the cardinal manifestations of AD. Depression on its own is also related with some union of memory loss.Since both depression and AD remove been be to result in memory deficits, it may be hypothesized that the simultaneous occurrence of both these diseases would furnish to the memory problems resulting from AD alone (Terry & Wagner 1992). more neuropathological and clinical studies open attempted to put whether the existence of one disorder predisposes an unmarried to the development of the other and whether the cognitive deficits seen in AD become more articulate if the person also suffers from depression.The results of the study performed by Fahlander, Berger & Wahlin (1999) indicated t hat depression does not further impair episodic memory performance in patients with AD. This result was in agreement with a prior search done by Backman, Hassing, Forsell, and Viitanen (1996) who determined the co morbidity set up 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 demoralize patients and heavy old controls or between patients with AD and depression and those with AD alone.Backman, et al explained this purpose as follows Symptoms of depression which are most likely to exert negative do on memory include motivational and attention factors like lack of interest, loss of energy, concentration difficulties etc. Some amount of memory impairment is already put in 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 modal(prenominal) aging individuals, in dementia, this heart and soul 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 habitual aging in the 90s compared with earlier ecstasys, the effects of major depression on memory would be more prevalent 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 indite in the note of AD and depression Bornstein, Termeer, Longbrake, Heger, & North (1989) have examined the incidence of Fuld indite in a sample of patients diagnosed to be suffering from major depression. Fulds profile refers to a drill of performance on the Wechsler Adult knowledge Sca le-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 commodious number of patients with AD have been seen to show negative profiles, a negative profile does not prove 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 and neurologic history and a consummate neuropsychological examination. According to Bornstein, et al this profile was significantly less frequent in the depressed patients as compared to that reported in foregoing studies in Alzheimers disease patients.The study by Bornstein, et al does provide some house regarding the diagnostic specificity of the Fuld profile in diagnosis of depression. Although this study and previous data are encouraging, considerable further investigation is inevitable to atomic number 101ument the specificity and diagnostic contribution of this profile for diagnosis of depression. Measurement of a potential biological fool in the CSF change magnitude CSF concentrations 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 marvellous in patients with depression, measurement of this biological marker in cerebrospinal fluid (CSF) can diagnose patients with AD and thus service 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 livery about a little service (20-30%) in cognitive symptoms (Zepf 2005).However the drugs used for improve c ognitive functions have no effect on the depressive symptoms. Treatment of depression essential form an important part of the overall intervention of this disease. This is so as manipulation of depression in patients with Alzheimers disease can have a significant electrical shock on the well-being of these patients as well as their care givers Lyketsos, et al. 2003 (as cited in moth 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 economic consumption inhibitor) to be much superior as compared to placebo in treatment of depression in patients with AD. According to the States Today (Society for improvement of education) the drug sertraline (Zoloft) significantly improves the grapheme 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, remembering and learning. induction Despite the great deal of research which has recently taken place in the field of view of Alzheimers disease with depression, more research is lock necessary in this field as the physicians are even 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 aetiologic significance are far from resolved. The complete knowledge and rendering in this field will help t he 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 significantly improve the quality of life of the patients as well as their care providers and greatly reduce 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 perform larger clinical trials. Role of non-pharmacological methods for treatment of depression also needs to be explored. Further research and studies are required in future to address these topics. The number of studies at present is quite teeny 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 Nona genarians Does major depression change 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 Profile in Depression. Psychological Assessment, 1(4), 342-344. Fahlander, K. , Berger, A. K. , Wahlin, A. ,& Backman, L. (1999). Depression does not provoke 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. Retrieved on 8 Nov 2006 from http//www. findarticles. com/p/articles/mi_m3225/is_3_69/ai_112915116 Newcomer, R. , Yordi, C. , DuNah, R. , Fox, P. , & Wilkinson, A. (1999). Ef fects of the Medicare alzheimers disease demonstration on caregiver burden and depression The medicare alzheimers disease demonstration program. Health Services Research.Retrieved on 8 Nov 2006 from http//www. findarticles. com/p/articles/mi_m4149/is_3_34/ai_55610150 Robinson, R. Alzheimers disease. Encyclopedia of Medicine. Retrieved on 8 Nov 2006 from http//www. findarticles. com/p/articles/mi_g2601/is_0000/ai_2601000053 Teri, L. , & Wagner, A. W. (1991). Assessment of depression in patients with Alzheimers Disease Concordance among informants. psychology and Aging, 6(2), 280-285. Teri, L. , & Wagner, A. (1992). Alzheimers disease and depression. Journal of Consulting and Clinical Psychology, 60(3), 379-391. USA Today. (Society for advancement of education). (2003).Antidepressant slows patient decline Alzheimers Disease. Retrieved on 8 Nov 2006 from http//www. findarticles. com/p/articles/mi_m1272/is_2701_132/ai_109085096 Vernon, H. (2003). Hemoxymeds diagnostic test in developme nt is helpful in differentiating patients with Alzheimers disease from patients with geriatric major depression. Business wire. Retrieved on 8 Nov 2006 from http//www. highbeam. com/doc/1G1-97485997. html Zepf, B. (2005). Drug therapy for patients with Alzheimers disease. American family physicians Retrieved on 8 Nov 2006 from http//www. findarticles. com/p/articles/mi_m3225/is_10_71/ai_n13790924.