Article

Depression associated with dementia with Lewy bodies (DLB) and the effect of somatotherapy

Clinical Neuroscience, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
Psychogeriatrics (Impact Factor: 1.22). 07/2009; 9(2):56-61. DOI: 10.1111/j.1479-8301.2009.00292.x
Source: PubMed

ABSTRACT Dementia with Lewy bodies (DLB) is a common type of dementia. It is difficult to make an initial diagnosis of DLB because of a variety of early symptoms, including psychosis-like and depressive states. In this study, we examined the characteristic depressive symptoms of the prestage of DLB and the efficacy and safety of somatotherapy for depression accompanying DLB.
Subjects in the study were 167 consecutive clinical cases aged 50 years or more, hospitalized at Tsukuba University Hospital from December 2002 to September 2007. At the time of admission, patients were diagnosed with certain types of mood disorders according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision. For each subject, a series of neuropsychological tests, along with a standard psychiatric and neurological assessment and biological examinations, were conducted. Using the data from these exams, we diagnosed probable and possible DLB according to the criteria for dementia with Lewy bodies established by McKeith et al. 1 We compared patients' depressive symptoms according to the Hamilton Depression Scale, and distinguished between patients with depression associated with DLB and those with other mood disorders. 2 We also examined the efficacy and safety of somatotherapy (electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS)) for patients with drug therapy-resistant depression associated with DLB.
1 The characteristic symptoms of patients with DLB were classified into two groups: psychotic and non-psychotic. The former consisted of patients with states such as delusion and agitation, and the latter included patients exhibiting psychomotor retardation, loss of insight and hypochondriasis. 2 Eight DLB patients with therapy-resistant depression underwent ECT. After ECT, significant improvement was observed, with no remarkable safety hazards. Six patients with drug therapy-resistant DLB underwent TMS. TMS appears to be an effective, safe remedy for this kind of patient.
A total of 13.8% of patients came to be re-diagnosed as having DLB as a consequence of a thorough examination after admission. Patients with depression associated with DLB were classified into psychotic and non-psychotic clusters. ECT and TMS are effective and safe therapeutic tools for drug therapy-resistant depression observed in DLB patients.

Download full-text

Full-text

Available from: Fumihiko Yasuno, Jul 04, 2014
1 Follower
 · 
152 Views
 · 
34 Downloads
  • Source
    • "However, elderly patients with depression often have somatic and/or psychiatric disease, an atypical clinical picture, and sensitivity to environmental or psychological factors [2] and are often resistant to pharmacotherapy or show adverse effects with antidepressants. In such cases, electroconvulsive therapy (ECT) can become an important option [1]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In the field of psychogeriatrics, the differential diagnosis of depression and dementia, as well as the treatment of depression and comorbid dementia, is an important issue. In this paper, the authors present the case of a 72-year-old woman with Cotard's syndrome and frontotemporal dementia (FTD) who was admitted to a psychiatric hospital with delusions of negation accompanied by depressive symptoms. Pharmacotherapy over a 2-year hospitalization was unsuccessful, and she was subsequently transferred to our university hospital. A total of 18 sessions of electroconvulsive therapy released her from psychomotor inhibition, appetite loss, and Cotard's delusions. The indication for electroconvulsive therapy in patients with dementia is discussed.
    10/2012; 2012:627460. DOI:10.1155/2012/627460
  • [Show abstract] [Hide abstract]
    ABSTRACT: One of the more recently recognized problems in treatment of patients with Parkinson’s disease (PD) is development of cognitive dysfunction and, in many cases, frank dementia. As patients with PD live longer, because of improved care and treatment of motor symptoms, dementia in PD is becoming a major contributor to morbidity in the illness. Prevalence studies suggest that up to 30% of patients with PD develop dementia. Dementia in PD patients is often a multifactorial condition. Neuropathologic changes caused by PD itself may cause memory loss. However, some patients with PD and memory decline also have pathologic changes that are more consistent with Alzheimer’s disease. Many PD patients have a mix of the two types of pathology. Other factors, such as underlying illnesses, medication side effects, and interaction of therapeutic agents, may contribute to cognitive changes in PD patients. Predictors of development of dementia in PD include advancing age and severity of neurologic symptoms, which may interact with one another to produce this effect. Recent work suggests that tobacco use also may increase risk of PD dementia, despite its possible protective effect against development of PD itself. Presence of psychiatric illness, especially depression, may interfere with cognition and exacerbate memory loss. Reduction in the dose of dopaminergic agents and of other medications may be helpful in partially improving cognitive function in some cases. The balance between improvement of motor function and preservation of cognitive abilities must be weighed, and it is important for clinicians to discuss this trade-off with patients and their families. At this time, there is no US Food and Drug Administration-approved pharmacologic treatment for dementia in PD. However, medication used to treat Alzheimer’s disease, such as acetylcholinesterase inhibitors, may slow progression of memory loss in some PD patients. Based on work from small double-blind studies, open-label trials, and case reports, cholinesterase inhibitors may be tried for treatment of dementia in PD, as long as the patient and caregivers understand that these agents are being used on an off-label basis. Surgical intervention, such as deep brain stimulation of the subthalamic nucleus or globus pallidus internus, although useful for treatment of motor symptoms in some PD patients, does not improve cognitive function in most cases and may actually worsen cognition in patients with pre-existing dementia. There is no specific exercise regimen or dietary guidelines for patients with PD who develop dementia. However, patients should be encouraged to lead a healthy lifestyle; this may improve overall well-being, which could impact positively on cognition function. Similarly, although assistive devices have not been developed for people with PD who have memory loss, any aid that increases mobility will probably improve mental and physical function. Clinicians should be mindful of the increased caregiver burden posed by PD patients who also have dementia. They should intervene appropriately to prevent caregiver distress and “burn out.” Herbal and nutritional supplements have not been shown in clinical trials to be beneficial for treatment of any type of dementia, and thus are not recommended for PD patients with cognitive decline.
    Current Treatment Options in Neurology 06/2004; 6(3):201-207. DOI:10.1007/s11940-004-0012-9 · 2.18 Impact Factor
  • Medical Hypotheses 08/2010; 75(2):139-40. DOI:10.1016/j.mehy.2010.05.001 · 1.07 Impact Factor
Show more