More symptoms of depression and lower cognitive status are independently associated with a more rapid decline in the ability to handle tasks of everyday living, according to a study by Columbia University Medical Center researchers in this month's Journal of Alzheimer's Disease.
Although these findings are observational, they could suggest that providing mental health treatment for people with Alzheimer's disease might slow the loss of independence, said senior author Yaakov Stern, PhD, professor of neuropsychology (in neurology, psychiatry, psychology, the Taub Institute for Research on Alzheimer's Disease and the Aging Brain and the Gertrude H. Sergievsky Center) at CUMC.
"This is the first paper to show that declines in function and cognition are inter-related over time, and that the presence of depression is associated with more rapid functional decline," said Dr. Stern, who also directs the Cognitive Neuroscience Division of the Department of Neurology at CUMC.
Because almost half of Alzheimer's patients have depression, the researchers, who were studying the long-term association between cognitive and functional abilities in the disease, also looked at the role of depressive symptoms in disease progression. They reviewed data that tracked changes in cognition, depression, and daily functioning in 517 patients with probable Alzheimer's at NewYork-Presbyterian Hospital/Columbia, Johns Hopkins School of Medicine, Massachusetts General Hospital, and the Hôpital de la Salpêtrière in Paris, France. Patients were assessed prospectively every six months for more than 5.5 years.
"Making a prognosis for Alzheimer's disease is notoriously difficult because patients progress at such different rates," said first author Laura B. Zahodne, PhD, a postdoctoral fellow in the cognitive neuroscience division in the Department of Neurology and the Taub Institute at CUMC. "These results show that not only should we measure patients' memory and thinking abilities, we should also assess their depression, anxiety, and other psychological symptoms that may affect their prognosis."
The title of the paper is "Coupled Cognitive and Functional Change in Alzheimer's Disease and the Influence of Depressive Symptoms" (JAD Volume 34/Issue 4 (March 2013)). Devangere Devanand, MD, professor of clinical psychiatry and neurology at CUMC, co-director of the Memory Disorders Center at NewYork-Presbyterian/Columbia, and director of the Division of Geriatric Psychiatry at the New York State Psychiatric Institute, also contributed to this paper.
The study was supported by grants from the National Institute of Aging (R01 AG007370 and T32 AG00261). This research was also supported by the Irving Institute for Clinical and Translational Research at CUMC, which is supported by the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program, through grant UL1 TR000040.
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