ABSTRACT
The differential diagnosis includes symptoms directly attributable to the physical illness, an adjustment disorder, mood changes associated with delirium and a dementing process. The relationship between physical illness and affective disorders, particularly depression, is a complex and fascinating one. A cognitive assessment of the patient is important, particularly in older patients with depressive symptoms. Chronic pain is a common symptom in older people presenting to health services in both primary and secondary care. The key issue in assessment, as in many other chronic medical conditions, is having a high index of suspicion for depression in patients with Parkinson's disease. Patients with Parkinson's disease and depression will obviously have many of the social difficulties common to many older people and assessments of their needs should include finances, housing, aids and adaptations required and opportunities for social interaction and availability of practical support and care.
