Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-27T00:12:00.566Z Has data issue: false hasContentIssue false
  • English
  • Français

The Differentiation Between Depression and Dementia in the Very Old

Published online by Cambridge University Press:  14 November 2008

Hanfried Helmchen  and
Michael Linden
Michael Linden
Affiliation:
Department of Psychiatry, Free University of Berlin, Eschenallec 3, D-14050 Berlin, Germany.
Get access Rights & Permissions [Opens in a new window]

Abstract

Key questions in the psychiatric understanding of elderly people are the development of psychiatric morbidity, its phenomenology in old age, the differentiation between ‘normal’ and ‘pathological’ ageing, the interrelatedness of different types of mental disorders, their relation to somatic morbidity, and their consequences in daily life. Under the hypothesis of the de-differentiation of psychopathological features in old age, the relation between depression and dementia is studied. Contrary to most gerontopsychiatric research, the Berlin Aging Study (BASE) permits an analysis of these questions in a heterogeneous and primarily non-clinical community population. Initial data from the first 360 intake assessments and the first 156 intensively studied participants of BASE are presented. Results show that, even in very old individuals, depression and dementia still exhibit clearly distinctive psychopathological features. Prevalence rates in consecutive age groups show an age-related increase for dementia but not for depression. Nevertheless dementia and depression do not seem to be fully independent, because our data indicate a masking or extinction of depressive symptoms by dementia. Finally, both disorders have a similarly significant negative impact on independence, comparable to that of somatic morbidity.

Type
Research Article
Information
Ageing & Society , Volume 13 , Issue 4 , December 1993 , pp. 589 - 617
Copyright
Copyright © Cambridge University Press 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (ed.) 1987. Diagnostic and Statistical Manual of Mental Disorders, DSM-III-R. American Psychiatric Association, Washington D.C.Google Scholar
Andres, R. 1985. Mortality and obesity: the rationale for age specific height-weight tables. In Andres, R., Bierman, E. L. and Hazzard, W. R. (eds), Principles of Geriatric Medicine. McGraw Hill, New York.Google Scholar
Angst, J. 1990. Recurrent brief depression: a new concept of depression. Pharmaco-psychiatry, 23, 63–66.CrossRefGoogle ScholarPubMed
Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie (ed.) 1981. Das AMDP-System. Springer, Berlin.Google Scholar
Baltes, M. M., Mayr, U., Borchelt, M., Maas, I. and Wilms, H. U. 1993. Everyday competence in old and very old age: an interdisciplinary perspective. Ageing and Society, 13, 657–680.CrossRefGoogle Scholar
Baltes, M. M. and Wahl, W. W. 1987. Dependence in ageing. In Carstensen, L. L. and Edelstein, B. A. (eds), Handbook of Clinical Gerontology. Pergamon, New York.Google Scholar
Baltes, M. M. and Wilms, H. U. 1991. Everyday competence in the very old: exploring the life space. Poster presented at the 44th Annual Scientific Meeting of the Gerontological Society of America,San Francisco.Google Scholar
Baltes, P. B. 1987. Theoretical propositions of life-span developmental psychology: On the dynamics between growth and decline. Developmental Psychology, 23, 611–626.CrossRefGoogle Scholar
Baltes, P. B. and Baltes, M. M. 1990. Psychological perspectives on successful ageing: the model of selective optimization with compensation. In Baltes, P. B. and Baltes, M. M. (eds), Successful Ageing: Perspectives from the Behavioural Sciences, pp. 1–34. Cambridge University Press, New York.CrossRefGoogle Scholar
Baltes, P. B. and Baltes, M. M. 1992. Gerontologie: Begriff, Herausforderung und Brennpunkte. In Baltes, P. B. and Mittelstrass, J. E. (eds), Zukunft des Alterns und gesellschaftliche Entwicklung. De Gruyter, Berlin.Google Scholar
Baltes, P. B., Mayer, K. U., Helmchen, H. and Steinhagen-Thiessen, E. 1993. The Berlin Aging Study (BASE): Overview and Design. Ageing and Society, this issue.CrossRefGoogle Scholar
Ben-Arie, O., Swartz, L. and Dickman, B. J. 1987. Depression in the elderly living in the community: its presentation and features. British Journal of Psychiatry, 150, 169–174.Google Scholar
Berg, L. 1988. Mild senile dementia of the Alzheimer type: diagnostic criteria and natural history. Mount Sinai Journal of Medicine, 55, 87–96.Google Scholar
Bergener, M. 1991. Zur Diagnostik und Therapie depressiver Syndrome im höheren Lebensalter. Schweizer Rundschau Medizinischer Praxis, 80, 139–141.Google Scholar
Blazer, D. 1989. Depression in late life. Current Opinion in Psychiatry, 2, 515–519.CrossRefGoogle Scholar
Blazer, D. 1989. Depression in the elderly. New England Journal of Medicine, 320, 164–166.CrossRefGoogle ScholarPubMed
Blazer, D. 1991. Clinical features in depression in old age: a case for minor depression. Current Opinion in Psychiatry, 4, 596–599.CrossRefGoogle Scholar
Blazer, D. and Williams, C. D. 1980. Epidemiology of dysphoria and depression in an elderly population. American Journal of Psychiatry, 137, 439–444.Google Scholar
Blazer, D., Hughes, D. C. and George, L. K. 1987. The epidemiology of depression in an elderly community population. Gerontologist, 27, 281–287.CrossRefGoogle Scholar
Blessed, G., Black, S. E., Butler, T. and Kay, D. W. 1991. The diagnosis of dementia in the elderly. A comparison of CAMCOG (the cognitive section of CAMDEX), the AGECAT program, DSM-III, the Mini-Mental State Examination and some short rating scales. British Journal of Psychiatry, 159, 193–198.CrossRefGoogle ScholarPubMed
Cohen, C. I., Crosby, M. and Zeman, D. 1988. The role of labelling processes in the assessment of geriatric depression. International Journal of Geriatric Psychiatry, 3, 209–217.CrossRefGoogle Scholar
Cooper, B. and Bickel, H. 1989. Prävalenz und Inzidenz von Demenzerkrankungen in der Altenbevölkerung. Nervenarzt, 60, 472–482.Google Scholar
Copeland, J. R. M., Kelleher, M. J., Kellett, J. M., Gourlay, A. J., Gurland, B. J., Fleiss, J. L. and Sharpe, L. 1976. A semi-structured clinical interview for the assessment of diagnosis and mental state in the elderly. The Geriatric Mental State Schedule: I. Development and reliability. Psychological Medicine, 6, 439–449.CrossRefGoogle ScholarPubMed
Copeland, J. R., Davidson, I. A., Dewey, M. E., Gilmore, C., Larkin, B. A., McWilliam, C., Saunders, P. A., Scott, A., Sharma, V. and Sullivan, C. 1992. Alzheimer's disease, other dementias, depression and pseudodementia: prevalence, incidence, and three-year outcome in Liverpool. British Journal of Psychiatry, 161, 230–239.CrossRefGoogle ScholarPubMed
Dilling, H., Mombour, W. and Schmidt, M. H. (eds) 1991. Internationale Klassifikation psychischer Störungen, ICD-10. Huber, Berlin.Google Scholar
Downes, J. J., Davies, A. D. M. and Copeland, J. R. M. 1988. Organization of depressive symptoms in the elderly population: Hierarchical patterns and Guttmann Scales. Psychobiology and Ageing, 3, 367–374.CrossRefGoogle Scholar
Eaton, W. W. and Kessler, L. G. 1981. Rates of symptoms of depression in a national sample. American Journal of Epidemiology, 114, 528–538.CrossRefGoogle ScholarPubMed
Emery, V. O. and Oxman, T. E. 1992. Update on the dementia spectrum of depression. American Journal of Psychiatry, 149, 305–317.Google ScholarPubMed
Evans, D. A., Funkenstein, H., Albert, N. S., Scherr, P. A., Cook, N. R., Chown, M. J., Herbert, L. E., Hennekens, C. H. and Tailer, J. O. 1989. Prevalence of Alzheimer disease in a community population in older people. Journal of the American Medical Association, 18, 2551–2556.CrossRefGoogle Scholar
Fedoroff, J. P., Starkstein, S. E., Parikh, R. M., Price, T. R. and Robinson, R. G. 1991. Are depressive symptoms nonspecific in patients with acute stroke? American Journal of Psychiatry, 148, 1172–1176.Google ScholarPubMed
Fogel, B. S. 1990. Major depression versus organic mood disorder: a questionable distinction. Journal of Clinical Psychiatry, 51, 53–56.Google ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. 1975. Mini Mental State: a practical method of grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle Scholar
Fratiglioni, L., Grut, M., Forsell, Y., Viitanen, M., Grafstöm, M., Holmen, K., Ericsson, K., Bäckman, L., Ahlbom, A. and Winblad, B. 1991. Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex and education. Neurology, 41, 1886–1892.CrossRefGoogle Scholar
Freeborn, D. K., Pope, C. R., Mullooly, J. P. and McFarland, B. H. 1990. Consistently high users of medical care among the elderly. Medical Care, 28, 527–540.CrossRefGoogle ScholarPubMed
Fried, L. P. and Wallace, R. B. 1992. The complexity of chronic illness in the elderly -from clinic to community. In Wallace, R. B. and Woolson, R. F. (eds), The Epidemiologic Study of the Elderly. Oxford University Press, Oxford.Google Scholar
Frierson, R. L. 1991. Suicide attempts by the old and very old. Archives of International Medicine, 151, 141–144.CrossRefGoogle ScholarPubMed
Fuhrer, R., Antonucci, T. C., Gagnon, M., Dartigues, J. F., Barberger-Gateau, P. and Alperovitch, A. 1992. Depressive symptomatology and cognitive functioning: an epidemiological survey in an elderly community sample in France. Psychological Medicine, 22, 159–172.CrossRefGoogle Scholar
Gerok, W. and Brandtstädter, J. 1992. Normales, krankhaftes und optimales Altern: Variations- und Modifikationsspielräume. In Baltes, P. B. and Mittelstraß, J. (eds), Zukunft des Alterns und gesellschaftliche Entwicklung. De Gruyter, Berlin.Google Scholar
Gillis, L. S. and Zabow, A. 1982. Dysphoria in the elderly. South African Medical Journal, 62, 410–413.Google ScholarPubMed
Grau, L. and Padgett, D. 1988. Somatic depression in the elderly: a sociocultural perspective. International Journal of Geriatric Psychiatry, 3, 201–207.CrossRefGoogle Scholar
Gurland, B. J., Teresi, J., Smith, W. M., Black, D., Hughes, G. and Edlavitch, S. 1988. Effects of treatment for isolated systolic hypertension on cognitive status and depression in the elderly. Journal of the American Geriatric Society, 36, 1015–1022.CrossRefGoogle ScholarPubMed
Häfner, H. 1992. Psychiatrie des höheren Lebensalters. In Baltes, P. B. and Mittelstralß, J. (eds), Zukunft des Alterns und gesellschaftliche Entwicklung. De Gruyter, Berlin.Google Scholar
Hagnell, O., Lanke, J., Rorsmann, B. and Öjesjöt, L. 1981. Does the incidence of age psychosis decrease? Neuropsychobiology, 7, 201–211.CrossRefGoogle ScholarPubMed
Hamilton, M. 1986. HAMD. In CIPS (ed.), Internationale Skalen für Psychiatrie. Beltz, Weinheim.Google Scholar
Harper, R. G., Kotik-Harper, D. and Kirby, H. 1990. Psychometric assessment of depression in an elderly general medical population. Over- or under-assessment? Journal of Nervous Mental Disease, 178, 113–119.CrossRefGoogle Scholar
Harrison, R., Savla, N. and Kafetz, K. 1990. Dementia, depression and physical disability in a London borough: a survey of elderly people in and out of residential care and implications for future developments. Age and Ageing, 19, 97–103.CrossRefGoogle Scholar
Hasin, D. and Link, B. 1988. Age and recognition of depression: implications for a cohort effect in major depression. Psychological Medicine, 18, 683–688.CrossRefGoogle ScholarPubMed
Hauser, R. and Wagner, G. 1992. Altern und Soziale Sicherung. In Baltes, P. B. and Mittelstraß, J. (eds), Zukunft des Alterns und gesellschaftliche Entwicklung. De Gruyter, Berlin.Google Scholar
Hautzinger, M. 1988. Die CES-D Skala. Ein Depressionsmeßinstrument für Untersuchungen in der Allgemeinbevölkerung. Diagnostica, 34, 167–173.Google Scholar
Helmchen, H. 1989. Psychiatric consequences of physical illness - Clinical aspects: discussion. In Öhman, R., Freeman, H. L., Holmkvist, A. F. and Nielzen, S. (eds), Interaction between Mental and Physical Illness. Springer, Berlin.Google Scholar
Helmchen, H. 1992. Klinik und Therapie depressiver Störungen im höheren Lebensalter. In: Häfner, H. and Hennerici, M. (eds), Psychische Krankheiten und Hirnfunktion im Alter. Gustav Fischer, Stuttgart.Google Scholar
Herrath, D., v. 1992. Benzodiazepin-Verordnungen, vom Verschreibungsmißbrauch zur Abhängigkeit. Der Arzneimittelbrief, 26, 49–52.Google Scholar
Jaspers, K. 1913. Allgemeine Psychopathologie. Springer, Berlin.Google Scholar
Jones, E. M. and White, A. J. 1990. Mental health and acquired hearing impairment: A review. British Journal of Audiology, 24, 3–9.CrossRefGoogle ScholarPubMed
Jorm, A. F., Korten, A. E. and Henderson, A. S. 1987. The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatrica Scandinavica, 76, 465–479.CrossRefGoogle ScholarPubMed
Kennedy, G. J., Kelman, H. R., Thomas, C., Wisniewski, W., Metz, H. and Bijur, P. E. 1989. Hierarchy of characteristics associated with depressive symptoms in an urban elderly sample. American Journal of Psychiatry, 146, 220–225.Google Scholar
Kennedy, G. J., Kelman, H. R. and Thomas, C. 1991. Persistence and remission of depressive symptoms in late life. American Journal of Psychiatry, 148, 174–178.Google ScholarPubMed
Kessler, R. C., Foster, C., Webster, P. S. and House, J. S. 1992. The relationship between age and depressive symptoms in two national surveys. Psychology and Ageing, 7, 119–126.CrossRefGoogle ScholarPubMed
Kiloh, L. G. 1961. Pseudo-dementia. Acta Psychiatrica Scandinavica, 37, 336–351.Google Scholar
Klein, L. E., Roca, R. P., McArthur, J., Vogelsang, G., Klein, G. B., Kirby, S. M. and Folstein, M. 1985. Diagnosing dementia, univariate and multivariate analyses of the mental state examination. Journal of the American Geriatric Society, 33, 483–488.CrossRefGoogle Scholar
Krämer, W. 1992. Altern und Gesundheitswesen: Probleme und Lösungen aus der Sicht der Gesundheitsökonomie. In Baltes, P. B. and Mittelstraß, J. (eds), Zukunft des Alterns und gesellschaftliche Entwicklung. De Gruyter, Berlin.Google Scholar
Krauss, B. 1989. Epidemiologie. In Kisker, K. P., Lauter, H., Meyer, J. E., Müller, C. and Strömgren, E. (eds), Alterspsychiatrie, Psychiatrie der Gegenwart, Vol. 8, pp. 59–84. Springer, Berlin.Google Scholar
Lange, I. 1934. Seelische Störungen im Greisenalter. Münchener Medizinische Wochenschrift, 82, 1959–1964.Google Scholar
Lauter, H. 1988. Die organischen Psychosyndrome. In Kisker, K. P., Lauter, H., Meyer, J. E., Müller, C. and Strömgren, E. (eds), Organische Psychosen, Psychiatrie der Gegenwart, Vol. 6, pp. 3–56. Springer, Berlin.Google Scholar
Lauter, H. and Dame, S. 1991. Depressive disorders and dementia: the clinical view. Acta Psychiatrica Scandinavica (Supplement), 366, 40–46.Google Scholar
Lewinsohn, P. M., Rohde, P., Seeley, J. R. and Fischer, S. A. 1991. Age and depression: unique and shared effects. Psychology and Ageing, 6, 247–260.CrossRefGoogle ScholarPubMed
Linden, M., Hautzinger, M. and Hoffmann, N. 1983. Discriminant analysis of depressive interactions. Behaviour Modification, 9, 403–422.CrossRefGoogle Scholar
Linden, M., Geiselmann, B. and Borchelt, M. 1992. Multimorbidität, Multimedikation und Medikamentenoptimierung bei alten Patienten. In Lungershausen, E. (ed.), Demenz, Herausforderung für Forschung, Medizin und Gesellschaft. Springer, Berlin.Google Scholar
Livingston, G., Hawkins, A., Graham, N., Blizard, B. and Mann, A. 1990. The Gospel Oak study: prevalence rates of dementia, depression and activity limitations among elderly residents in inner London. Psychological Medicine, 20, 137–146.CrossRefGoogle ScholarPubMed
Mayer, K. U. and Wagner, M. 1993. Socio-economic resources and differential ageing: first results from the Berlin Aging Study (BASE). Ageing and Society, this issue.CrossRefGoogle Scholar
McWilliam, C., Copeland, J. R. M., Dewey, M. E. and Word, N. 1988. The Geriatric Mental State Examination as a case-finding instrument in the community. British Journal of Psychiatry, 152 205–208.CrossRefGoogle ScholarPubMed
Morris, J. C., McKeel, D. W., Storandt, M., Rubin, E. H., Price, J. L., Grant, E. A., Ball, M. J. and Berg, L. 1991. Very mild Alzheimer's disease: Informant-based clinical, psychometric, and pathological distinction from normal ageing. Neurology, 41, 469–478.CrossRefGoogle Scholar
Moss, M. S. and Lawton, M. P. 1982. Time budgets of older people: a window on four life styles. Journal of Gerontology, 37, 115–123.Google Scholar
Müller, C. 1989. Altersveränderungen vorausgegangener psychischer Erkrankungen. In Kisker, K. P., Lauter, H., Meyer, J. E., Müller, C. and Strömgren, E. (eds), Alterspsychiatrie, Psychiatrie der Gegenwart, Vol. 8, pp. 397–410. Springer, Berlin.Google Scholar
Murphy, E., Smith, R., Lindesay, J. and Slattery, J. 1988. Increased mortality rates in late-life depression. British Journal of Psychiatry, 152, 347–353.CrossRefGoogle ScholarPubMed
Myers, J. K., Weissmann, M. M., Tischler, G. L., Holzer, C. E., Leaf, P. J., Kramer, M. and Stoltzman, R. 1984. Six-month prevalence of psychiatric disorder in three communities. Archives of General Psychiatry, 41, 959–967.CrossRefGoogle ScholarPubMed
Newman, J. P. 1989. Ageing and depression. Psychology and Ageing, 4, 150–165.CrossRefGoogle Scholar
O'Connor, D. W., Pollitt, P. A. and Roth, M. 1990. Coexisting depression and dementia in a community survey of the elderly. International Psychogeriatrics, 2, 45–53.CrossRefGoogle Scholar
Paffrath, D. 1992. Arzneimittelverordnungen nach Altersgruppen. In Schwabe, U. and Paffrath, D. (eds), Arzneimittelreport. Gustav Fischer, Stuttgart.Google Scholar
Philipp, M., Buller, R., Winter, P., Schwarze, H., Delmo, C. D., Benkert, O., König, B., Faust, G., Schmaltz, B. and Zöllner, S. 1992. Diagnostik psychischer Erkrankungen und Therapieevaluation in der Arztpraxis unter Langzeitperspektive. In Helmchen, H. and Linden, M. (eds), Die jahrelange Behandlung mit Psychopharmaka. De Gruyter, Berlin.Google Scholar
Philpott, R. M. 1990. Affective disorder and physical illness in old age. International Journal of Clinical Psychopharmacology, 5 (Supplement 3), 7–20.Google ScholarPubMed
Radloff, L. S. 1977. The CES-D Scale: A self-report depression scale for research in the general population. Journal of Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
Regier, D. A., Boyd, J. H., Burke, J. D., Rae, D. S., Myers, J. K., Kramer, M., Robins, L. N., George, L. K., Karno, M. and Locke, B. Z. 1988. One month prevalence of mental disorders in the United States based on five epidemiologic catchment area sites. Archives of General Psychiatry, 45, 977–986.CrossRefGoogle ScholarPubMed
Reischies, F. M., Spiess, P., v., and Stieglitz, R. D. 1990. The symptom pattern variations of unipolar depression during life span: a cross-sectional study. Comprehensive Psychiatry, 31, 457–464.CrossRefGoogle ScholarPubMed
Rosenman, S. 1991. The validity of the diagnosis of mild dementia. Psychological Medicine, 21, 923–934.Google Scholar
Rubin, E. H., Morris, J. C., Grant, E. A. and Vendegna, T. 1989. Very mild senile dementia of the Alzheimer type, I: clinical assessment. Archives of Neurology, 46, 379–382.CrossRefGoogle ScholarPubMed
Scherr, P. A., Albert, M. S., Funkenstein, H. H., Cook, N. R., Hennetons, C. H., Branch, L. G., White, L. R., Taylor, J. O. and Evans, D. A. 1988. Correlatives of cognitive function in an elderly community population. American Journal of Epidemiology, 128, 1084–1101.Google Scholar
Schmid, A. H. 1991. The deficiency model: an exploration of current approaches to late-life disorders. Psychiatry, 54, 358–367.Google Scholar
Snaith, R. P. 1987. The concepts of mild depression. British Journal of Psychiatry, 150, 387–393.CrossRefGoogle ScholarPubMed
Steinhagen-Thiessen, E. and Borchelt, M. 1993. Health differences in advanced old age. Ageing and Society, this issue.CrossRefGoogle Scholar
Wattis, J. P. 1990. Diagnostic issues in depression in old age. International Journal of Clinical Psychopharmacology, 5 (Supplement 3), 1–6.Google ScholarPubMed
Weissman, M. M., Leaf, P. J., Tischler, G. L., Blazer, D. G., Karno, M., Bruce, M. L. and Florio, L. P. 1988. Affective disorders in five United States communities. Psychological Medicine, 18, 141–153.Google Scholar
Wells, C. E. 1979. Pseudodementia. American Journal of Psychiatry, 136, 895–900.Google ScholarPubMed
Winter, P., Philipp, M., Buller, R., Delmo, C. D., Schwarze, H. and Benkert, O. 1991. Identification of minor affective disorders and implications for psychopharmacotherapy. Journal of Affective Diseases, 22, 125–133.CrossRefGoogle ScholarPubMed