Significant Rates of Major Depressive Disorder Found in Dementia

Patients with dementia had an increased prevalence of major depressive disorder (MDD) in a meta-analysis published in the Journal of Clinical Psychiatry. The meta-analysis found a pooled MDD prevalence rate of 15.9% (95% CI, 12.6% to 20.1%) among patients with dementia aged 58.7 to 87.8 years.

The meta-analysis examined 9421 studies appearing in MEDLINE, Embase, and PsychInfo. Of these studies, 55 met the necessary criteria for review. All included study participants met diagnostic criteria for both dementia and MDD at the time of the study. The meta-analysis excluded data regarding dementia patients with subclinical depression symptoms.

Prevalence rates in the analyzed studies were diverse, varying from 0.0% to 91.8%. The pooled prevalence rate of 15.9% was considered to be consistent with the results of a previous meta-analysis of 25 similar studies of depression in dementia. The previous meta-analysis determined a pooled prevalence rate of 12.7%.

Results revealed that 24.7% (95% CI, 17.6 to 34.6) of patients with vascular dementia had depression, compared with 14.8% (95% CI, 11.5 to 19.1) of patients with Alzheimer disease and 21.5% (95% CI, 10.5 to 43.9) of patients with dementia with Lewy bodies. Among patients with mild dementia, 22.1% (95% CI, 15.7% to 30.9%) had depression, compared with 11.6% (95% CI, 6.9% to 19.7%) of patients with moderate dementia.

The researchers acknowledged that inconsistent diagnostic criteria might be a barrier to determining the prevalence of depression. Further studies and meta-analyses are needed to understand prevalence rates fully. Subclinical depression is also prevalent among patients with dementia, and it could affect patient outcomes. A broader examination of the prevalence of depression symptoms among patients with dementia is needed.

Researchers concluded that “the high prevalence of [depression in dementia] has important clinical implications and supports recommendations that clinicians should be vigilant for MDD in dementia.” The meta-analysis also found that the current screening tools and diagnostic criteria for MDD are sufficient for effectively diagnosing MDD in most patients with dementia.

Disclosures: Dr Seitz has been involved as a site investigator for clinical research trials sponsored by Roche. Drs Asmer, Kirkham, Ismail, and Ms Newton, Elbayoumi, and Leung have no conflicts to disclose.

Reference

Asmer MS, Kirkham J, Newton H, et al. Meta-analysis of the prevalence of major depressive disorder among older adults with dementia [published online July 31, 2018]. J Clin Psychiatry.  doi:10.4088/JCP.17r11772