9th multidisciplinary international
Conference of Biological Psychiatry
«Stress and Behavior»
Proceedings of the 9th International Multidisciplinary Conference «Stress and behavior» Saint-Petersburg, Russia, 16-19 May 2005 Editor: Allan V. Kalueff, PhD
6. GENERAL QUESTIONS: PSYCHIATRY OF STRESS
DEPRESSION CO-MORBID WITH ALZHEIMER- S DISEASE: THE ROLE OF STRESS FACTORS
E.V. Ponomareva Mental Health Research Centre RAMS, Moscow, Russia Alzheimer«s disease (AD) is the common cause of memory, intellectual and psychical activity disorders in the elderly. Symptoms of depression in AD patients vary widely, and are observed during various stages of AD in 30—45% of patients. High frequency of depression in AD causes diagnostic hardships, also stressing actuality of this problem. Psychogenic depression may often be a provoking factors in AD, stimulating pathogenesis. The present study aimed to assess clinical features of depression in AD patients and their influence on AD progression and correlation with stress factors (SF). For this, clinical (psychopathological, psychometrical, follow/up) and neurovisual (MRI) analyses were used. Subjects were 43 AD patients with co-morbid depressive disorders (DD): 31 women (72%) and 12 men (28%) aged 48—85 years (mean 66.5). Mild dementia was diagnosed in 12 (28%), moderate dementia in 19 (44%) and severe dementia in 12 patients (28%). 25 patients (58.2%) had presenile, and 18 (41.8%) senile AD. Only in 7 cases (16.3%) depression was first diagnosed, whereas 83.7% experienced DD prior to AD. At mild dementia, DD were first time revealed in 33.7% cases, and in 66.7% they were also observed at the stage of Mild Cognitive Impairment (MCI). For moderate dementia, DD was first time revealed in 15.8% cases vs. 36.8% at mild dementia. In 47.4% cases DD was seen at all three stages of AD development (MCI, mild, moderate dementia). All patients with severe dementia also had DD at earlier stages of AD. Overall, AD patients experienced 106 episodes of DD, with maximal level for the mild dementia (35.8%) stage. For moderate dementia, DD occurred in 29.2% vs. 23.6% (MCI) and 11.4% (severe dementia). Other forms included: agitated (41.5%), tearful (27.3%), drearily (15.1%), apathic (8.5%), dysphonic (4.8%), and hypochondric (2.8%) DD. Agitated and drearily depression of different severity were predominant types of DD at all stages of AD except severe dementia, for which tearful (58.3%) and apathic (25%) DD were predominant. In the structure of depressive episode vital disorders occurred in 75.8% cases, also: delirium (13.7%), suicidal thoughts (7.1%), and hallucinations (3.4%). SF preceded DD in 76.5% cases. In 15.9%, loss of job (dismissal, pension retirement), and also hospitalization played a role of SF. In 13.6%, DD was seen as reaction on low self-realization. Reaction on death of an intimate person or on conflict situation in family or with neighbors were equally seen (11.3%). In 9%, it was a reaction on somatic disease (especially surgery), physical and emotional overloading, divorce, money loss (e.g., bank crisis) preceding DD. During retrospective and follow up analyses, we found that almost all patients suffered by co-morbid DD preceding SF showed altered severity of disease and quicker cognitive deficits. Drug therapy of DD in patients with mild and moderate dementia in 87.6% cases improved situation also reducing cognitive deficits.
Conclusions. DD co-morbid with AD occur at all stages of dementia, most often occurring at mild, moderate and MCI stages. Psychopathologic structure of co-morbid DD is different. Agitated and drearily depressions occur most often vs. rare tearful, apathic, hypochondric and dysphoric DD. SF generally precede development of agitated, drearily and tearful (rather than apathic and dysphonic) DD. SF were preceded by clinical manifestation of AD in 76.5% cases; and accelerated disease progress in 98% cases.
Psychopharmacol. Biol. Narcol. 2005. Vol. 5, N 2. P. 926-927
Psyhopharmacology & biological narcology