The prevalence, diagnosis and treatment of depression in dementia patients in chronic care facilities in the last six months of life.
Evers M M, Samuels S C, Lantz M, Khan K, Brickman A M, Marin D B;
Commented by , 20 Jun 2002
Aim of the study
To assess retrospectively the prevalence, diagnosis and treatment of depression in dementia patients and normal controls in nursing homes, in the last 6 months of life.
Method
The authors reviewed case note data on 279 dementia patients and 24 normal controls from New York State brought to autopsy through an Alzheimer's Disease Research Centre.
They diagnosed depression on DSM-III-R criteria, and collected data on antidepressant, anxiolytic and hypnotic medication. Dementia severity during the last 6 months of life was assessed with the Clinical Dementia Rating (CDR) scale.
Results
Major depression was prevalent among both dementia patients (29%) and controls according to post-mortem diagnosis. 21% of dementia patients had been diagnosed with depression during life. However, only half of these had received antidepressant medication.
10/40 demented patients with depression, and 8/25 controls with major depression were receiving anxiolytics and/or hypnotics. Gender ethnicity, and severity of dementia did not have a significant impact on treatment decisions.
The prevalence and diagnosis of depression was lower in more severely demented patients.
Discussion
Depression can be difficult to diagnose in elderly institutionalised people with dementia due to communication difficulties and the 'blurring' of biological features of depression. Despite being retrospective research, this study lends further support to the literature that suggests depression is underdiagnosed and undertreated in patients with co-morbid dementia, confirmed at post-mortem.
The authors suggest implementation of a depression education programme both for nursing home staff and attending physicians/psychiatrists.