Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The dexamethasone suppression test (DST) was performed on 21 patients with dementia of the Alzheimer type (DAT), 11 patients with multi-infarct dementia (MI) and 14 healthy controls. Twelve of the DAT patients and eight of the MI patients showed abnormal lack of suppression, compared with just one member of the control group. Abnormal DST was related to dementia as such and not to age or depression, or to levels of CSF monoamine metabolites. Basal serum prolactin concentrations were not increased.
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PMID:Dexamethasone suppression test and serum prolactin in dementia disorders. 662 41

Eighty-five patients referred to a dementia clinic in a prosperous suburban setting were followed for as long as 48 months. Progressive dementia occurred in 55 of the 56 patients in whose cases it was predicted. Three-year mortality rates were 83 per cent for multi-infarct dementia, 57 per cent for mixed vascular plus Alzheimer dementia, and 37 per cent for Alzheimer disease. The differences in death rates among the different diagnostic groups support the validity of the clinical distinctions drawn. A subspecialty clinic can accurately identify progressive intellectual impairment in the elderly. The data suggest that patients who have depression complicating organic brain disease are at risk for progressive intellectual impairment, even if not demented when first seen. Intellectual deterioration appears to be a poor prognostic sign in older people.
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PMID:Follow up of patients referred to a dementia service. 670 7

Contrary to prevailing medical belief, dementia is generally not caused by arteriosclerosis of cerebral vessels. There may be, in fact, as many as 50 different causes. While the two major types of dementia, Alzheimer's disease and multi-infarct dementia, are irreversible, perhaps 20 per cent of dementias are secondary to treatable causes, and are reversible. The most important of these is the pseudodementia of depression, which can be easily missed without a high degree of suspicion. Tips on the differential diagnosis of Alzheimer's disease, multi-infarct dementia, and pseudodementia are discussed, as are other causes of dementia secondary to various diseases or therapy.
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PMID:The differential diagnosis of dementia. 675 52

The activity of the noradrenergic marker enzyme dopamine-beta-hydroxylase was measured in brains removed postmortem from control patients and patients with Alzheimer's disease. Enzyme activity was decreased in the frontal and temporal cortices and hippocampus in patients with Alzheimer's disease, but was within the normal range in patients with depression, multiinfarct dementia, and terminal coma.The decrease in enzyme activity in Alzheimer's disease may reflect an abnormality of cortical noradrenergic fibres in some patients with the disease.
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PMID:Reduced dopamine-beta-hydroxylase activity in Alzheimer's disease. 677 29

Despite the enormous medical and psychiatric importance of mental illness among the elderly, clinicians generally are not trained in the phenomenology and presentation of the major mental disorders that occur primarily in this age group. The authors describe the presenting symptoms and course of four conditions--senescent forgetfulness, primary degenerative dementia (considered as the confusional phase and dementia phase), geriatric depression, and multi-infarct dementia--with emphasis on differential diagnosis. The clinical examination of the patient is the most important feature of any diagnostic and assessment program; because of the wide prevalence and in many ways unique aspects of mental illness among the elderly, all but the smallest psychiatric programs should have at least one clinician who specializes in assessment of geriatric problems.
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PMID:Diagnosis and assessment of the older patient. 705 16

We examined the prevalence of major depression, depressed mood/anhedonia, and subjective and neurovegetative symptoms of depression that were unaccompanied by depressed mood/anhedonia in patients with clinically-diagnosed Alzheimer's disease (AD) and multi-infarct dementia (MID). The specificity of subjective and neurovegetative depressive symptoms for depressed mood in dementia was examined, as was the impact on depression of clinical variables such as family history, patient age, and dementia severity. Subjects were 105 outpatients who met DSM-III-R criteria for AD (n = 67) or MID (n = 38). Depressed mood/anhedonia was frequently noted in both the AD (40.3%) and MID (34.2%) groups. One or more depressive symptoms, not accompanied by depressed mood/anhedonia, were also common in AD and MID (49.3% and 36.8%, respectively). Major depression was relatively uncommon in AD (10.5%) but was noted more frequently in MID (29.0%). Among AD patients, neurovegetative symptoms of depression were not any more common in patients with depressed mood/anhedonia than in those without depressed mood/anhedonia. Subjective symptoms of depression were also not significantly associated with depressed mood/anhedonia. The study highlights the importance of viewing major depression, depressed mood-anhedonia, and other depressive symptoms (subjective and neurovegetative) as separate entities in AD and MID.
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PMID:Depressive symptoms in Alzheimer's disease and multi-infarct dementia. 779 81

Dementia, delirium and depression are the 3 most prevalent mental disorders in the elderly. While dementia and depression are prevalent in the community, hospitals and nursing homes, delirium is seen most often in acute care hospitals. Much of the management of these syndromes is undertaken by primary care physicians rather than psychiatrists. Therefore, it is imperative that generalist physicians be adept at recognising, evaluating and managing patients with these syndromes. Because no diagnostic tests are pathognomonic of these syndromes, the differential diagnosis hinges on a careful clinical evaluation. The first step is to recognise which of the syndromes is present. Dementia is defined by a chronic loss of intellectual or cognitive function of sufficient severity to interfere with social or occupational function. Delirium is an acute disturbance of consciousness marked by an attention deficit and a change in cognitive function. Depression is an affective disorder evidenced by a dysphoric mood, but the most pervasive symptom is a loss of ability to enjoy usual activities. It is important to recognise that these syndromes are not mutually exclusive, as dementia frequently coexists with delirium and depression. Furthermore, physical diagnoses, such as chronic obstructive lung disease, congestive heart failure, stroke and endocrine disorders, are frequently associated with depressive symptoms. Given this, a comprehensive evaluation is mandatory. Laboratory tests are necessary to exclude concurrent metabolic, endocrine and infectious disorders, and drug effects. Imaging studies should be obtained selectively in patients with signs and symptoms, such as focal neurological findings and gait disturbances, which are suggestive of structural lesions: stroke, subdural haematoma, normal pressure hydrocephalus and brain tumours. Appropriate management involving pharmacological and nonpharmacological measures will result in significant improvement in most patients with these syndromes. Potentially offending drugs should be discontinued. In delirious patients the underlying illness must be treated concomitantly with the use of psychotropics, if necessary. Although no current medications have been shown to have a significant effect on the functional status of patients with the 2 most common causes of dementia, Alzheimer's disease and multi-infarct dementia, the management of concomitant illness in these patients may result in improved function for as long as a year. Tacrine, an anticholinesterase inhibitor, improves cognitive function slightly in selected patients with Alzheimer's disease over short periods. Finally, the treatment of depression with medications or electroconvulsive therapy (ECT) results in significant reductions in mortality and morbidity.
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PMID:Differential diagnosis of dementia, delirium and depression. Implications for drug therapy. 785 69

The authors surveyed the prevalence of depression and dementia in the elderly in Ohira town in Japan from 1989 to 1990. The total population of this town was 26,712, with 2,778 people aged 65 and above, constituting 10.4% of the total population. The prevalence of dementia (n = 128) was 6.1% and that of major depression (n = 9) was 0.4%, according to the DSM-III-R criteria. The prevalence of a depressive state which did not fulfill the criteria for major depression (n = 55) was 2.4%. The patients with multi-infarct dementia (n = 49) suffered from depression (42.8%) more frequently than those with dementia of the Alzheimer type (11.1%). The rate of depression coexisting with dementia increased with aging, while the rate of depression without dementia did not change in all the age groups.
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PMID:Epidemiological survey of dementia and depression among the aged living in the community in Japan. 789 13

Literature of the past ten years is reviewed to examine psychosocial, psychiatric, organic, and general medical causes of psychotic symptoms in persons over age 65. Being bedfast with poor caretaker relationships and being socially isolated are risk factors for psychosis among elderly persons. A thorough history is essential to differential diagnosis. Psychiatric causes to be ruled out include schizophrenia; depression, including mania; dementia and delirium; paranoid state; and late-life delusional disorder. Perhaps the most common etiology is cognitive impairment, generally attributable to Alzheimer's disease or multi-infarct dementia. Organic or toxic etiologies need to be ruled out, especially in persons with visual hallucinations. Drug toxicity, a structural brain lesion, or a subtle seizure disorder should be considered. If symptoms are not alleviated when psychosocial triggers or underlying toxic, organic, or medical causes are addressed, patients may respond to supportive therapy and low doses of high-potency neuroleptics. The clinician should keep in mind that older adults are highly sensitive to the side effects of these agents.
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PMID:The older patient with psychotic symptoms. 789 23

Interobserver agreement in the clinical diagnosis of dementia among four neurologists was evaluated. The physicians, masked to the original diagnoses, independently reviewed the clinical records of 50 outpatients consulting either the 1st University Neurology Department of Milan or the Neuropsychology Unit of the Medical Center of Veruno (Novara) for suspected cognitive impairment, during a 6-month period. The records contained patients' medical and neurological history, results of neuropsychological testing, laboratory tests, cerebral computed tomography and other investigations. For each patient, the raters had to provide both a diagnosis concerning the presence or absence of dementia and to assign an analytical diagnosis to all the dementia cases. The kappa statistic was used as a measure of interrater reliability. The level of agreement on the primary diagnosis of dementia was moderate (kappa = 0.49); with respect to the nosological diagnoses, the kappa values ranged from 0.16 for depression to 0.80 for multi-infarct dementia.
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PMID:Agreement in the clinical diagnosis of dementia: evaluation of a case series with mild cognitive impairment. 801 68


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