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Am J Psychiatry 1992; 149:305-317
Copyright © 1992 by American Psychiatric Association
Update on the dementia spectrum of depression
VO Emery and TE Oxman
Department of Psychiatry, Dartmouth Medical School, Lebanon, NH 03756.
OBJECTIVE: The primary focus of this review is to examine the usual
dichotomy between depressive dementia as functional and reversible and
degenerative dementia as organic and irreversible. METHOD: The authors
propose viewing depression, cognitive impairment, and degenerative dementia
as intersecting continua. They define five prototypical groups along these
continua: 1) major depression without depressive dementia, 2) depressive
dementia, 3) degenerative dementia without depression, 4) depression of
degenerative dementia, and 5) independent co-occurrence of degenerative
dementia and depression. Clinical, neuropsychological, and neurobiological
studies comparing these groupings were identified by a computerized
literature search covering the past 20 years. References were selected for
review if they compared at least two groups. Degenerative dementia was
limited to the Alzheimer type. RESULTS: No studies clearly included all
five of the prototypical groups. There are methodological problems with
each type of research reviewed, but the consensus of the research is that
severe cognitive impairment of depression is associated with a variety of
organic abnormalities. Depending on the length of follow-up, depressive
dementia may not be as reversible as previously thought. CONCLUSIONS: The
continuum viewpoint encourages longitudinal clinical follow-up for early
detection and alleviation of incipient depressive and dementing symptoms.
Hypotheses of overlapping pathophysiological mechanisms rather than
differential diagnosis become an important research focus. The authors
discuss three different types of relationships for future research: 1)
interactions, 2) consequences of disease or treatment, and 3) necessary but
not sufficient pathophysiology.
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