Features of the manifestation of depression in demented patients. Efficacy and tolerability of antidepressants

Background. Depressive disorders (DDs) are a frequent concomitant symptom in patients with Alzheimer’s disease (AD). DDs worsen the quality of life of AD patient, worsen the course of dementia. Difficulties in diagnosing DDS are associated with insufficient use of screening scales specifically designed for AD patients in the practice. Treatment of DDs should combine antidementia drugs with antidepressants. The choice of antidepressant is based on safety, good tolerability and favorable interaction with antidementia drugs. Objective. 1. Identification of the features of the manifestation of DDs in AD patients. 2. Evaluation of the diagnostic capabilities of the geriatric depression scale (GDS) and the Cornell Scale for Depression in Dementia (CSDD) in patients with mild to moderate dementia. 3. Assessment of the quality of life, cognitive status of patients during combined therapy. Methods. Dynamic clinical follow-up of 130 patients with AD (mild to moderate dementia syndrome) with DDs with an assessment of the effectiveness of combined antidepressant and antidementia therapy on the quality of life of patients. Criteria for assessing dementia according to the MMSE scale (Folstein M.F., 1975): mild dementia - 24 to 20 points, moderate dementia - 19-11 points. The study included outpatients who were referred for consultation at the City Center for Dementia Control SRITPM -a Branch of the Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, and previously followed-up by district psychiatrist or therapist; they were, divided into 2 subgroups according to the dementia severity: subgroup 1 (n=88) - with mild dementia, and subgroup 2 (n=42) - with moderate dementia. All patients received antidementia therapy for 1.4±0.4 years. Of these, 42 patients received cholinesterase inhibitors - rivastigmine patch 9.5 mg/ day (18 patients) or donepezil 10 mg/day (24 patients); 88 patients received memantine at a dose of 20 mg/day. Criteria for assessing the DD severity were carried out using the Geriatric Depression Scale (GDS). Also, the Cornell Scale for Depression in Dementia (CSDD) was used; it takes into account the data of clinical observation of the specialist and information from the caregiver, which ensures its independence from the dementia severity. Total scores on both scales at the beginning and end of therapy were analyzed. In addition, sertraline at a dose of 100 mg/day, an antidepressant from the group of selective serotonin reuptake inhibitors, was prescribed to all patients with DDs. Evaluation of the effectiveness of treatment in subgroups was carried out on the Clinical Global Impression Scale (CGI-I) after treatment with an antidepressant, and the cognitive status was evaluated according to the MMSE scale at the beginning and end of antidepressant therapy. The side effects of the therapy used were recorded. Results. DDs and dementia are often combined with each other, mutually reinforcing the impact on the patient’s daily life. For the diagnosis of DDs in AD, it is better to use screening scales specifically designed for patients with dementia and involving a survey of caregivers. Combined antidepressant therapy with antidementia drugs in the mild and moderate stages gives effect and relieves DDs (reduction of the starting total GDS score by 18.8%; CSDD by 19.2%). At the stage of mild dementia, there was a positive trend in 91% of cases (according to the doctor’s and relatives’ opinion), and at the stage of moderate dementia - in 43%.

depression, Alzheimer's disease, dementia, Geriatric Depression Scale, sertraline