ABSTRACT
References 708
Major depression in the elderly is often accompanied by cognitive impairment. Although estimates vary, studies have shown that combined depression and cognitive dysfunction is present in roughly 25 per cent of subjects (Arve et al., 1999). In addition, the number of community residents with both depressive symptoms and impaired cognition doubles every five years after the age of 70 years. In some cases, the syndromes of depression and cognitive impairment may be related to the same underlying disorders (e.g. vascular dementia, hypothyroidism), whereas in other cases depression and cognitive impairment may be relatively independent, and simply coexist. Differential diagnosis and treatment decisions can be complicated because depressive cognitive changes can be severe, incipient dementia often has physical and cognitive symptoms that overlap with depression, and the two can coexist (Bayles et al., 1987). The relationships between the prominent cerebrovascular changes, other structural abnormalities, specific forms of cognitive dysfunction, and increased risk for developing dementias in geriatric depression have yet to be reconciled. The varied and most current findings suggest that there are likely multiple pathways to poor cognitive outcomes (Butters et al., 2008).
