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6ПСИХОЛОГИЧЕСКИЕ НАУКИ
DEMENTIA AND DEPRESSION
SH. V. VASHADZE
MD, PhD, ass. professor, Batumi State University after Shota Rustaveli.
M. D. KEKENADZE
Ph.D. Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospital (UCLH), Queen Square, London, United Kingdom.
D. V. KAJAIA Clinical Director.Clinic Medical Center
MARINA SHAVIANIDZE
MD, PhD, ass. professor Batumi State University after Shota Rustaveli, Georgia
Abstract
The number of cases of dementia in 2010 has consisted of 35.6 million people in the whole world. The purpose of the study diagnosis of depression and dementia: Based on clinical observation, given the medical history and the objective information, analysis of the clinicalfeatures of depressive disorders in patients, to study depression and dementia on the localization of the lesion, where have been studied 250 patients from the age of 50 to 70 years. There were examined 120 men and 130 women to identify depression by the Beck depression scale. To identify the focus of the lesion, there were used methods of neuroimaging - computer or magnetic resonance imaging (CT or MRI). Diagnosis was established according to NINCDS-ADRDA criteria .For the diagnosis of dementia there was used: "A brief scale of assessment of mental status" (Mini-Mental State Examination) [5]. The final score is displayed by summing the results for each of the items.
Depressive disorders were detected in 220 persons (79 women and 141 men). The middle age was 66.4 years. Depressive disorders, identified in which there are no violations of cognitive functions; with a mild depressive episode (MDE) was observed in 4, with moderate -3. With heavy (HDE) - 8. Depressive disorders were revealed in patients with pre-cognitive impairment; with a mild depressive episode (MDE) was observed in 5, with moderate - 8, with severe (SDE) -12. Depressive disorders in patients with slight dementia: with a mild depressive episode (MDE) was observed in 35, with moderate - 15, with severe (SDE) - 37. Depressive disorders in patients with slight dementia: with a mild depressive episode (MDE) was observed in 4, with moderate - 21, with severe (SDE) -32. Depressive disorders in patients with dementia, severe dementia: with mild depressive episode (MDE) was observed in 16, with moderate - 8, with heavy (HDE) - 11.
The path morphological picture is characterized (with the help of non-neuroimaging methods) by cerebral atrophy, the mass and volume of the brain are reduced by 15 (6%). Atrophy 70 (28%) of the cerebral cortex with expansion of the ventricles 15 (6%). The atrophic process is strongly expressed in the occipital 45 (18%), temporal andfrontal region 105 (42%), as well as in the place with this left hemisphere lesion in 105 (42%), stem structures - 75 (30%), blood circulation disorders in the cerebellum in 70 (28%). Depressive disorders were detected in patients whose mass and brain volume were reduced (using non-neuroimaging methods) with a mild depressive episode (MDE) was observed in 2, with moderate in 3, with severe (SDE) -10. Depressive disorders were found in patients who had atrophy of the cerebral cortex (using non-neuroimaging methods) with a mild depressive episode (MDE) observed in 5, with moderate in 10, with severe (SDE) -35. Patients with ventricular
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dilatation (with the help of non-neuroimaging methods) with a mild depressive episode (MDE) were observed in 5, with moderate in 6, with severe (SDE) -4. In patients, the atrophic process strongly is expressed in the occipital region with a mild depressive episode (MDE) was observed in 15, with moderate in 12, with severe (SDE) -8. In patients, the atrophic process is strongly expressed in the temporal and frontal regions with a mild depressive episode (MDE) was observed in 5, with moderate in 20, with severe (SDE) -80. Depression and cognitive deficits are seen as two relatively independent manifestations. According to our data, a severe cognitive deficit is in patients with lesions of the frontal lobes, whereas depression is mainly associated with dysfunction of the temporal structures.
In the time of depression, cognitive impairment appears simultaneously with the onset of the disease and it progresses faster. In the time of dementia the depression occurs after the appearance of intellectual disorders. Thus, depression can be one of the first manifestations of developing dementia. The rehabilitation ofpatients with dementia and depression are the most important medical problem. Treatment of dementia is an actual medical problem of modern medicine.
Key words: dementia. Depression, rehabilitation
BACKGROUND
The number of cases of dementia in 2010 has consisted of 35.6 million people in the whole world. Dementia is a source of stress for relatives of patients and to those who serve these patients. The purpose of the study diagnosis of depression and dementia: Based on clinical observation, given the medical history and the objective information, analysis of the clinical features of depressive disorders in patients, to study depression and dementia on the localization of the lesion,
MATERIAL AND METHODS
where have been studied 250 patients from the age of 50 to 70 years. There were examined 120 men and 130 women to identify depression by the Beck depression scale. The Beck depression scale (Beck depression inventory - BDI) is one of the most common questionnaires for detecting depression (sleep disturbance, mood background, self-awareness, somatic symptoms, suicidal thoughts, etc.). 0-7 - absence of depression; 8-12 - mild depression; 13-17 - moderate depression; 1829 - severe depression; 30 and more - very serious disorder. To identify the focus of the lesion, there were used methods of neuroimaging - computer or magnetic resonance imaging (CT or MRI). Diagnosis was established according to NINCDS-ADRDA criteria .For the diagnosis of dementia there was used: "A brief scale of assessment of mental status" (Mini-Mental State Examination) [5]. The final score is displayed by summing the results for each of the items. The maximum in this test can be 30 points, which corresponds to the optimal state of cognitive functions. The lower is the total score, much more is expressed the cognitive deficit. The results of the test can be interpreted as: 2830 points - there are no violations of cognitive functions, 24-27 points - pre-cognitive impairment; 20-23 points - mild dementia; 11-19 points - moderate degree dementia; 0-10 points - severe dementia. The path morphological picture is characterized (with the help of non-neuroimaging methods) by cerebral atrophy, the mass and brain volume are reduced by 15 (6%) Atrophy 70 (28%) of the cerebral cortex with expansion of the ventricles 15 (6%). The atrophic process is strongly expressed in the occipital 45 (18%), temporal and frontal region 105 (42%), and in the place with this lesion of the left hemisphere in 70 (28%). According to our studies about the scale "Mini-Mental State Examination" (28-30 points) - there are no violations of cognitive functions in 5 (2%); 24-27 points - pre-cognitive impairment in 35 (14%); 20-23 points - dementia of mild degree in 85 (35%) With mild dementia, patients forget recent events. Intellectual reduction manifests itself in solving problems in daily activities and in the sphere of professional activity (especially among intellectuals) patients live independently, maintain personal hygiene, it is not violated the recognition of people, they have personality traits. 11-19 points - moderate dementia was detected in 68 (27%). In patients with moderate dementia - there is a significant deterioration in memory for current events. The new information is only remembered for a short time. It is not solved simple everyday events. It is violated motor speech, personal characteristics, retained the skills of elementary self-care, patients poorly
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observe the rules of personal hygiene. The patient's independent existence is possible, but difficult; patients need to look after their loved ones. According to our data, 0-10 points - severe dementia was detected in 55 (22%).
Sxema 1. Depression in the patients
In patients with severe dementia, the deep amnesia with complete disorientation of time and place, as well as in one's own personality, speech, and walking is disrupted. It is violated daily activity, self-service skills, appearing of an enuresis. Patients need constant support and care; patients can not comply with the minimum requirements for personal hygiene. By the time of marasmus speech is completely broken, complete loss of skills of self-service; there is no control over defecation and urination. Patients are riveted to bed do not take food and are cachectic. Patients with depression showed many complaints about problems with memory, attention, difficulty in performing intellectual tasks, they think about suicide. Their self-esteem is reduced. According to our data, the patients with severe depression, has decrease in mood which is detected in 78%, decrease in appetite in 89%, loss of body weight in 67%, sleep disorders (insomnia or hypersomnia) in 95%, psychomotor agitation or inhibition in 85%, fatigue in 45 %, the presence of suicidal thoughts in 45% Depressive disorders were detected in 220 persons (79 women and 141 men). The middle age was 66.4 years. Depressive disorders, identified in which there are no violations of cognitive functions; with a mild depressive episode (MDE) was observed in 4, with moderate -3. With heavy (HDE) - 8.
Depressive disorders were revealed in patients with pre-cognitive impairment; with a mild depressive episode (MDE) was observed in 5, with moderate - 8, with severe (SDE) -12. Depressive disorders in patients with slight dementia: with a mild depressive episode (MDE) was observed in 35, with moderate - 15, with severe (SDE) - 37. Depressive disorders in patients with moderate dementia: with a mild depressive episode (MDE) was observed in 4, with moderate - 21, with severe (SDE) -32. Depressive disorders in patients with dementia, severe dementia: with mild depressive episode (MDE) was observed in 16, with moderate - 8, with heavy (HDE) - 11. Scheme 2 relation between dementia and depression
A patient with dementia in pre-cognitive impairment and with mild dementia tries to hide his cognitive problems, believes that he has no problems. Depression is more often diagnosed in patients with mild dementia than with severe dementia, which is associated with the difficulty of detecting depression on the background of severe dementia. The degree of depression in the same patient against the background of the progression of dementia is changeable. Depression can be considered as a continuation of dementia. It is known that the symptoms of depression can outpace the signs of dementia within the developing disease for several years. Manifestations of depression in the elderly can also be chronic pain syndromes. The path morphological picture is characterized (with the help of non-neuroimaging methods) by cerebral atrophy, the mass and volume of the brain are reduced by 15 (6%). Atrophy 70 (28%) of the cerebral cortex with expansion of the ventricles 15 (6%). The atrophic process is strongly expressed in the occipital 45 (18%), temporal and frontal region 105 (42%), as well as in the place with this left hemisphere lesion in 105 (42%), stem structures - 75 (30%), blood circulation disorders in the cerebellum in 70 (28%). Depressive disorders were detected in patients whose mass and brain volume were reduced (using non-neuroimaging methods) with a mild depressive episode (MDE) was observed in 2, with moderate in 3, with severe (SDE) -10.
Depressive disorders were found in patients who had atrophy of the cerebral cortex (using non-neuroimaging methods) with a mild depressive episode (MDE) observed in 5, with moderate in 10, with severe (SDE) -35. Patients with ventricular dilatation (with the help of non-neuroimaging methods) with a mild depressive episode (MDE) were observed in 5, with moderate in 6, with severe (SDE) -4. In patients, the atrophic process strongly is expressed in the occipital region with a mild depressive episode (MDE) was observed in 15, with moderate in 12, with severe (SDE) -8. In patients, the atrophic process is strongly expressed in the temporal and a frontal region with a mild depressive episode (MDE) was observed in 5, with moderate in 20, with severe (SDE) -80. According to our data, a high depression is observed in patients with moderate and mild dementia.
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Scheme 3 dementia and brain radiology results
In some studies, more than 90% of patients with the onset of depression in old age had vascular changes with non-neuroimaging. [3.4.5] Depression and cognitive deficits are seen as two relatively independent manifestations. According to our data, a severe cognitive deficit is in patients with lesions of the frontal lobes, whereas depression is mainly associated with dysfunction of the temporal structures. The main expression of depression in people with dementia is: aggressiveness, agitation, irritability, negativism, refusal of food. The diagnosis of depression does not exclude the diagnosis of dementia, and the diagnosis of dementia does not exclude the diagnosis of depression. Depression and dementia often combine and mask each other.
The Patients with dementia need to control depression and in patients with depression, especially in the elderly, it is necessary to do neuropsychological testing (MMSE) for the prevention of dementia.
In elderly patients it is difficult to differentiate depression from atrophic processes of the brain; there are no complaints of patients regarding abandonment and loneliness which appear on the foreground. On the other hand, there are complaints regarding disorientation, loss of memory, difficulties of concentrating attention. Sometimes these disorders are not symptoms of dementia, but are associated with depression. In the time of depression, cognitive impairment appears simultaneously with the onset of the disease and it progresses faster. In the time of dementia the depression occurs after the appearance of intellectual disorders. Thus, depression can be one of the first manifestations of developing dementia.
The depression accompanies the dementia almost constantly with asthenia. The rehabilitation of patients with dementia and depression are the most important medical problem. Treatment of dementia is an actual medical problem of modern medicine.
Research has shown that MDE, moderate and SDE type of depressions are prevalent among patients with have slight and moderate dementia.
In moderate dementia, approximately both MDE and SDE dementias are equal and decently high. Although, it's at the lowest point among patients who did not have dementia.
Therefore, SDE is more prevalent with patients who were noticed to have atrophic changes in frontal and temporal lobes. As well as, the ones who have atrophic changes in cerebral cortex. On the other hand, MDE's is more prevalent among patients who have ventricular changes. In addition to patients who have decreased mass and volume of brain.
REFERENCE
1. Ш. Вашадзе. Депрессивные расстройства у больных цереброваскулярной патологией. Ж. Неврологический международный журнал. Киев. Украина .№6 (16) 44-47. 2007
2. Livingston, G; Sommerlad, A; Orgeta, V; Costafreda, SG; Huntley, J; Ames, D; Ballard, C; Banerjee, S; Burns, A; Cohen-Mansfield, J; Cooper, C; Fox, N; Gitlin, LN; Howard, R; Kales, HC; Larson, EB; Ritchie, K; Rockwood, K; Sampson, EL; Samus, Q; Schneider, LS; Selb^k, G; Teri, L; Mukadam, N (19 July 2017). "Dementia prevention, intervention, and care.". Lancet. PMID 28735855. doi:10.1016/S0140-6736(17)31363-6.
3. Harrison, Jennifer K; Stott, David J; McShane, Rupert; Noel-Storr, Anna H; Swann-Price, Rhiannon S; Quinn, Terry J (2016-11-21). "Using a structured questionnaire (the IQCODE) to detect individuals who may go on to develop dementia". The Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd011333.pub2. Archived from the original on 2016-1126.url=http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011333.pub2/abstract%7C
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