Major depression in the elderly is oen accompanied by cognitive impairment. Although estimates vary, studies show that combined depression and cognitive dysfunction is present in roughly 25% of the subjects (Arve et al., 1999). In addition, the number of community residents with both depressive symptoms and impaired cognition doubles every 5 years aer 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. Dierential diagnosis and treatment decisions can be complicated because depressive cognitive changes can be severe, incipient dementia oen can have physical and cognitive symptoms that overlap with depression and the two can coexist (Bayles et al., 1987). e relationships between the prominent cerebrovascular changes, other structural abnormalities, specic forms of cognitive dysfunction and increased risk for developing dementias in geriatric depression have yet to be reconciled. e varied and most current ndings suggest that there are likely multiple pathways to poor cognitive outcomes (Butters et al., 2008).