Comorbid Depression in Dementia on Psychogeriatric Nursing Home Wards: Which Symptoms are Prominent?

doi:10.1097/JGP.0b013e31819a806f

The American Journal of Geriatric Psychiatry

Volume 17, Issue 7, July 2009, Pages 565-573

https://doi.org/10.1097/JGP.0b013e31819a806f Get rights and content

Objective:

To provide insight into the prevalence and clinically relevant symptoms of comorbid depression among dementia patients in psychogeriatric nursing home wards, to enhance depression recognition.

Design:

Cross-sectional analyses of multicenter diagnostic data.

Setting:

Psychogeriatric wards of Dutch nursing homes.

Participants:

Five hundred and eighteen residents with dementia.

Measurements:

1) Diagnosis of depression in dementia (Provisional Diagnostic Criteria for Depression of Alzheimer disease [PDC-dAD]), 2) dementia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-PC), and 3) stage of dementia (Geriatric Depression Scale).

Results:

The point prevalence of comorbid depression in dementia (Stages 2–6) on psychogeriatric nursing home wards was 19%. “Depressed mood,” “irritability,” and “fatigue” were the most prevalent depressive symptoms. Residents taking antidepressants at the time of the PDC-dAD depression diagnosis showed more depressive symptoms than residents who were not. The mean number of depressive symptoms was 5.6 (SD 1.84), which did not differ between the dementia stages. Also, no differences were found in the point prevalence of the shown symptoms between dementia stages.

Conclusion:

Irritability was put forward by the developers of the PDC-dAD, as one of the specific symptoms of depression in Alzheimer disease. This study shows that irritability is one of the most prevalent depressive symptoms in psychogeriatric nursing home residents diagnosed with comorbid depression. Irritability should therefore alert caregivers to the presence of depression and could help early recognition. The high-prevalence rate of comorbid depression in dementia in this setting justifies attention to early recognition and intervention.

Section snippets

Sample

Data come from the preintervention phase of a psychosocial intervention study for dementia sufferers with depression on 16 psychogeriatric wards of Dutch nursing homes.¹⁸

The nursing homes in the intervention study had applied in response to an invitation letter from NIVEL and VU University Medical Centre. Nine nursing homes participated each with two comparable psychogeriatric wards. In eight homes, all residents from the 16 participating wards were systematically screened and diagnosed with

Prevalence of Comorbid Depression and Dementia

To gain insight into the point prevalence of comorbid depression in demented residents (Stages 2–6) of Dutch psychogeriatric nursing home wards, we performed two steps: screening for possible depression of all residents in the participating wards (Step 1) and diagnosis of depression, dementia, and dementia stage (Step 2). Figure 1 shows a flowchart with the results of these steps. In total, 518 residents were in the participating wards at the time the screening for possible depression took

Reflections on the Main Findings

Using the PDC-dAD, we found a point prevalence of 19% comorbid depression in dementia among residents with dementia severities 2–6 in Dutch psychogeriatric nursing home wards. This rate is comparable with the depression rate of 22% in residents of Dutch somatic nursing home wards using DSM-IV criteria for major and minor depression²⁴ and the rate of 20% comorbid depression and dementia found by Zuidema et al.¹⁷ in Dutch psychogeriatric nursing home wards using the NPI-NH-depression subscale.

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Receipt of Eye Care Services among Medicare Beneficiaries with and without Dementia
2020, Ophthalmology
Citation Excerpt :
We classified dementia beneficiaries using methods described previously, with “prevalent dementia” defined as dementia documented during the look-back period, “incident dementia” defined as a dementia diagnosis first recorded after the end of the look-back period but before receiving eye care services, and “no dementia” defined as no recorded dementia diagnosis or a diagnosis first recorded after receiving eye care after the end of the look-back period.31 Other clinical comorbidities, including depression,35 diabetic retinopathy, age-related macular degeneration, and glaucoma, were also identified by presence of ICD-9-CM codes (Table S1, available at www.aaojournal.org) in the look-back period for each beneficiary. We used Charlson Comorbidity Index (determined using ICD-9-CM codes and modified to exclude dementia) to account for general systemic health (Table S1, available at www.aaojournal.org) and Rural-Urban Commuting Area codes to determine rural versus urban settings for each beneficiary’s geographic residence during the look-back period.36
To examine the relationship between dementia status and receipt of eye care among US Medicare beneficiaries.
Retrospective, claims-based analysis.
A 20% representative sample of Medicare beneficiaries who received care between January 1, 2006, and December 31, 2015.
Dementia was identified from diagnosis codes documented in a beneficiary’s first 3 years of observed Medicare enrollment. Eye care visits were identified from provider specialty codes on each encounter claim. We used multivariable Cox proportional hazards regression models with time-varying covariates to compare the likelihood of receiving eye care between beneficiaries with and without dementia. All models were adjusted for potential confounders, including demographics, urban/rural residence, systemic health (Charlson Index), and ocular comorbidities.
Hazard ratio (HR) and 95% confidence interval (CI) for (1) being seen by any eye care provider (ophthalmologist or optometrist); (2) being seen by an ophthalmologist specifically; and (3) receiving cataract surgery (among beneficiaries with ophthalmologist encounters).
A total of 4 451 200 beneficiaries met inclusion criteria; 3 805 718 (85.5%) received eye care during the study period, and 391 556 (8.8%) had diagnosed dementia. Some 73.4% of beneficiaries diagnosed with dementia saw an eye care provider during the study period and 55.4% saw an ophthalmologist versus 86.7% and 74.0% of beneficiaries, respectively, without dementia diagnoses. Compared with those without dementia diagnoses, beneficiaries with diagnosed dementia had lower likelihood of seeing any eye care provider (adjusted HR, 0.69; 95% CI, 0.69–0.70) and were less likely to see an ophthalmologist (adjusted HR, 0.55; 95% CI, 0.55–0.55). Among the subset of beneficiaries who did see ophthalmologists, those with diagnosed dementia were also less likely to receive cataract surgery than beneficiaries without diagnosed dementia (HR, 0.62; 95% CI, 0.62–0.63) and less likely to receive a cataract diagnosis (18% vs. 82%).
US Medicare beneficiaries diagnosed with dementia are less likely to receive eye care than those without diagnosed dementia. Depending on visual acuity and functional status, this may have implications for injury prevention, physical and cognitive function, and quality of life. Further work is needed to identify barriers to receiving eye care, determine eye care services and settings that provide greatest value to patients with dementia, and implement measures to improve access to appropriate eye care.
Development and Validation of a Short Version of the Cornell Scale for Depression in Dementia for Screening Residents in Nursing Homes
2016, American Journal of Geriatric Psychiatry
Citation Excerpt :
A possible explanation for this positive outcome for the CSDD-4 is that the four items in the shorter version (anxiety, sadness, lack of reactivity to pleasant events, and irritability) are more easily observable than other items such as suicidal thoughts and early morning awakening. Verkaik et al.37 reported that depressed mood, irritability, and fatigue were the most prevalent depressive symptoms. Irritability is one of the most prevalent depressive symptoms in psychogeriatric nursing home residents diagnosed with comorbid depression.37
To develop and validate a short version of the Cornell Scale for Depression in Dementia (CSDD-19) for routine detection of depression in nursing homes.
Australian nursing homes.
A series of cross-sectional studies were conducted involving: 1) descriptive analysis of pooled data from five nursing home studies that used the CSDD-19 (N = 671) to identify patterns of responses and missing data on individual CSDD items; 2) analysis of four of the five studies (N = 556) to assess CSDD-19 for unidimensionality, item fit, and differential item functioning using Rasch modeling to develop a shorter version, the CSDD-4; 3) validation of the CSDD-4 against the DSM-IV using the fifth study of 115 residents and through expert consultations; and 4) evaluation of the clinical utility of CSDD-4 using an independent cohort of 92 nursing home residents.
Four items from the original CSDD-19 were found to be most suitable for depression screening: anxiety, sadness, lack of reactivity to pleasant events, and irritability. The CSDD-4 highly correlated with the original scale (N = 474, r = 0.831, p < 0.001), with acceptable internal consistency (Cronbach's alpha = 0.70). At the cutoff score of less than 2, sensitivity and specificity of CSDD-4 were 81% and 51%, respectively, for the independent cohort (N = 92), of whom 50% had dementia. The CSDD-4 had an area under the curve (AUC) of 0.73 (z = 3.47, p < 0.001), which was compatible with the CSDD-19 (AUC = 0.69, z = 2.89, p < 0.01).
The CSDD-4 is valid for routine screening of depression in nursing homes. Its adoption is feasible and practical for nursing home staff, and may facilitate more comprehensive assessment and management of depression in nursing home residents.
A long-term longitudinal follow-up of depressed patients treated with ECT with special focus on development of dementia
2016, Journal of Affective Disorders
In this study, the long term effects of ECT on patients with depression were investigated through repeated rCBF and EEG measures as well as clinical characteristics over several years. The aim of the investigation was to establish an association with the eventual development of dementia.
A cohort of forty-nine patients (21 men and 28 women) with a mean age of 61 years underwent ECT. A subsequent evaluation from medical records and three rating-scales for diagnosis of Alzheimer´s disease (AD), fronto-temporal dementia (FTD), and for vascular dementia (VaD), revealed that 17 patients (8 men and 9 women), had developed dementia. These cases were compared to the 32 patients (13 men and 19 women), who had not developed dementia.
Initially, the dementia group, compared to those without dementia, showed a lower hemispheric CBF (left side; p=.029, right side; p=.033), and a lower mean occipital EEG frequency (p=.048). After the first ECT-series, an increase in general disorientation (p=.015), personal disorientation (p=.009), and subsequently, spatial disorientation (p=.021), were seen in the dementia group. There were no differences in the clinical response or remissions after treatment in the groups.
The small sample-size, which did not allow for the comparison of characteristics between different dementias.
Depressed older patients who later developed dementia showed lower hemispheric mean level of CBF and EEG mean frequency before ECT and higher personal and spatial disorientation following ECT.
The course of depressive symptoms as measured by the Cornell scale for depression in dementia over 74 months in 1158 nursing home residents
2015, Journal of Affective Disorders
Citation Excerpt :
The other symptoms of sleep disruption varied more in prevalence, incidence and persistence rates. Verkaik found “disruption of sleep” to be the least prevalent depressive symptom in a nursing home study (Verkaik et al., 2009). In the present study there were no significant changes in the odds of the symptoms of sleep disruption at the CSDD being present when adjusting for the level of CDR.
Depressive symptoms and depression are common in nursing home residents. However, longitudinal studies of depression in nursing home residents are scarce and the sample sizes are small. This study aimed to investigate the course of depressive symptoms as measured by the Cornell Scale for Depression in Dementia (CSDD) and associated explanatory demographic and clinical variables.
A longitudinal study over 74 months of 1158 nursing home residents aged 50 years and older from twenty six nursing homes in Norway where data was collected at five time points.
“Irritability” was the most prevalent, incident and persistent CSDD symptom. Compared with the baseline assessment, the likelihood of the mood symptoms “suicidal ideation,” “pessimism” and “delusions” being present was lower at all subsequent assessments. This persisted after adjusting for the severity of dementia. The severity of depression as measured by CSDD decreased over 74 months when adjusting for relevant resident variables. Poorer physical health, higher number of medications, more severe dementia and use of antidepressants were associated with higher depression score.
Depression and dementia were not diagnosed according to standardized diagnostic criteria. The use of CSDD did not include a clinician׳s interview with the patient. This could have implications for the generalization of the results.
This study adds important knowledge about the long-term course of depressive symptoms and depression for residents in nursing homes, and underlines the importance to pay close attention to the overlap between depression and dementia symptoms when evaluating depression in this setting.
N-methyl-d-aspartate glutamate receptor (NMDA-R) antibodies in mild cognitive impairment and dementias
2014, Neuroscience Research
The N-methyl-d-aspartate glutamate receptor (NMDA-R) plays a central role in learning and memory and has therefore a potential role in the pathophysiology of neuropsychiatric disorders. Recently, we detected NMDA-R autoantibodies in aged healthy volunteers without neuropsychiatric disorders.
Since studies showing the involvement of NMDA-R antibodies in mild cognitive impairment and different forms of dementia are rare, we examined NMDA-R antibodies (Abs) in serum of 46 patients with Alzheimer's disease (AD), 26 patients with subcortical ischemic vascular dementia (SIVD), 18 patients with frontotemporal dementia (FTD), 11 patients with Lewy body disease (LBD) and 33 patients with mild cognitive impairment (MCI) and in 21 healthy aged, gender-matched volunteers. While IgM and/or IgA NMDA-R Abs were present in all groups, IgG was only detected in one AD sample. Seropositivity could be correlated with the presence of co-symptoms: MCI and AD patients suffering from depression and AD and SIVD patients with a psychosis were almost all NMDA-R Ab positive.
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Palliative Care in Advanced Dementia
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View all citing articles on Scopus

This study was funded by ZonMw, the Netherlands Organization for Health Research and Development (project no. 5401.0001).

The authors declare no conflict of interest.

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Regular Research ArticlesComorbid Depression in Dementia on Psychogeriatric Nursing Home Wards: Which Symptoms are Prominent?

Objective:

Design:

Setting:

Participants:

Measurements:

Results:

Conclusion:

Section snippets

Sample

Prevalence of Comorbid Depression and Dementia

Reflections on the Main Findings

Am J Geriatr Psychiatry

J Am Med Dir Assoc

Am J Geriatr Psychiatry

Clin Geriatr Med

Am J Geriatr Psychiatry

J Am Med Dir Assoc

J Psychiatr Res

Am J Geriatr Psychiatry

Health care utilization in dementia patients with psychiatric comorbidity

Gerontologist

Mortality in Alzheimer's disease: a comparative prospective Korean study in the community and nursing homes

Int J Geriatr Psychiatry

Omgaan met dementerende bewoners voor verzorgenden in het verpleeghuis [How Caregivers in Nursing Homes Deal with Dementia Patients.]

Prevalence of depression and depression recognition in nursing homes

Soc Psychiatry Psychiatr Epidemiol

Diagnostic and Statistical Manual of Mental Disorders. DSM-IV

Major and minor depression in Alzheimer's Disease: prevalence and impact

J Neuropsychiatry Clin Neurosci

Depression in subjects with and without dementia: a comparison using GMS-AGECAT

Int J Geriat Psychiatry

Regular Research Articles
Comorbid Depression in Dementia on Psychogeriatric Nursing Home Wards: Which Symptoms are Prominent?