Alzheimer's disease is a progressiv...

Alzheimer's disease is a progressive disorder with a substantial impact onward patients and their families. Approximately 90 percent of patients with Alzheimer's disease have an form of neuropsychiatric disorder, mostly commonly depression. Approximately 20 to 25 percent of patients with Alzheimer's disease have major depression, and another 20 to 30 percent have other depressive syndrome In patients with Alzheimer's disease, depression can have a substantially negative impact onward quality of life and ability to perform activities of daily living (ADLs), and can increase the likelihood of physical aggression, being discharged from assisted-living facilities, entering nursing abiding-places at earlier stages, and greater caregiver tonnage Current studies on the benefit of treating depression in patients with Alzheimer's disease are limited according to the small numbers treated and short follow-up periods. Lyketso and associates studied the safety and effectiveness of sertraline in the treatment of major depression in patients with Alzheimer's disease. They also evaluated the secondary benefits of depression reduction in this treatment regimen.

Patients who had a diagnosis of probable Alzheimer's disease based upon established criteria and a score of 10 or more forward the Mini-Mental State Examination were listed in this randomized, placebo-controlled, parallel, 12-week trial. They also had to adapted the diagnosis of major depressive disorder based forward criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed and be in stable physical health. Before initiation of the cogitation each participant's depression was rated using the Hamilton Depression Rating Scale. Patients were assigned randomly to receive placebo or sertraline starting at 25 mg by day and titrating up to a maximum dosage of 150 mg through day or the highest tolerated dosage. Follow-up evaluation was performed each three weeks during the research and adverse effects and affairs were recorded at each follow-up engagement Main outcome measures included the rejoinder rate to treatment and changes in the various scales performed at baseline.

Among the patients taking sertraline, 38 percent (nine patients) had a undiminished response, and 46 percent (11 patients) had a partial answer The response rates were significant when compared with the rejoinder rates of patients in the placebo assemblage There were no significant differences in Mini-Mental State Examination scores between the couple groups at the end of the application of mind Full or partial responders in the sertraline treatment assign places to had significantly better ratings in succession ADLs, behavior disturbances, and caregiver stres when compared with the placebo form into groups Few patients in the sertraline treatment dispose dropped out of the application of mind because of adverse effects, and there were no significant differences in the rate of adverse affairs between patients taking sertraline and those taking placebo.

The authors close that sertraline is superior to placebo in the treatment of major depression in patients with Alzheimer's disease. Reduction of depression in this form into groups is associated with a reduction in behavior disturbances, improvement in the ability to perform ADLs, and reduction of caregiver stres Treatment of depression with sertraline does not improve cognitive function.

Lyketso CG et al. Treating depression in Alzheimer disease. Efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS. Arch Gen Psychiatry July 2003;60:737-46

EDITOR'S NOTE: In the tradition of mind-body interaction in all medical illnesses, Lyketso and associates institute that treating depression in patients with Alzheimer's disease can have a significant impact forward the well-being of these patients. They also establish that treatment of depression can cut down caregiver stress. This reduction in stres can improve quality of life in those who provide care for patients with Alzheimer's disease. Caregiver issues related to patients who have Alzheimer's disease can be overwhelming. This reflection suggests a way to cut short this stress by treating the underlying depression of patients with Alzheimer's disease.--K.E.M.

COPYRIGHT 2004 American Academy of Family Physicians

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