Copyright ©The Author(s) 2015.
World J Clin Cases. Aug 16, 2015; 3(8): 682-693
Published online Aug 16, 2015. doi: 10.12998/wjcc.v3.i8.682
Table 1 Criteria for major depressive episode: DSM 5
Five (or more) of the following symptoms have been present during the same 2-wk period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood; or (2) loss of interest or pleasure
Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful)
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning
The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism)
Table 2 The cornell scale for depression in dementia
Mood-related signs
Anxiety: Anxious expression, rumination, worrying
Sadness: Sad expression, sad voice, tearfulness
Lack of reaction to present events
Irritability: Annoyed, short tempered
Behavioral disturbance
Agitation: Restlessness, hand writing, hair pulling
Retardation: Slow movements, slow speech, slow reactions
Multiple physical complaints (score 0 if gastrointestinal symptoms only)
Loss of interest: Less involved in usual activities (score only if change occurred acutely, i.e., in less than one months)
Physical signs
Appetite loss: Eating less than usual
Weight loss: (score 2 if greater than 5 pounds in one month)
Lack of energy: Fatigues easily, unable to sustain activities
Cyclic function
Diurnal variation of mood: Symptoms worse in the morning
Difficulty falling asleep: Later than usual for this individual
Multiple awakening during sleep
Early morning awakening: Earlier than usual for this individual
Ideational disturbance
Suicidal: Feels like is not worthy living
Poor self-steem: Self-blame, self-depreciation, feelings of failure
Pessimism: Anticipation of the worst
Mood congruent delusions: Delusions of poverty, illness or loss
Scoring system
A= Unable to evaluate; 0 = Absent; 1 = Mild to intermittent; 2 = Severe
score greater than; 12 = Probable depression
Table 3 Provisional diagnostic criteria for depression in Alzheimer's disease
Three or more of the following criteria over the same 2-wk period, representing a change from previous functioning:
Depressed mood (sad, hopeless, discouraged, tearful)
Decreased positive affect or pleasure in response to social contacts and activities
Social isolation or withdrawal
Disruption in appetite
Disruption in sleep
Psychomotor agitation or retardation
Fatigue or loss of energy
Worthlessness, hopelessness or excessive guilt
Recurrent thoughts of death or suicidal ideation
All criteria are met for dementia of the Alzheimer’s type
Symptoms cause distress or disruption in functioning
Symptoms do not occur exclusively during delirium
Symptoms are not due to substances (medications or drugs of abuse)
Table 4 Diagnostic criteria for Lewy bodies disease
Central feature
Progressive dementia-deficits in attention and executive function are typical
Prominent memory impairment may not be evident in the early stages
Core features
Fluctuating cognition with pronounced variations in attention and alertness
Recurrent complex visual hallucinations
Spontaneous features of parkinsonism
Suggestive features
REM sleep behavior disorder which can appear years before the onset of dementia and parkinsonism
Severe intensity to neuroleptics occurs in up to 50% of LBD patients who take them
Low dopamine transporter uptake in the brain’s basal ganglia as seen on SPECT an PET imaging scans
Supportive features
Repeated falls and syncope (fainting)
Transient, unexplained loss of consciousness
Autonomic dysfunction
Hallucinations of other modalities
Visuospatial abnormalities like depth perception, object orientation, directional sense and illusions
Other psychiatric disturbances like systematized delusions, aggression and depression
A probable LBD diagnosis require either
Dementia plus two or more core features, or
Dementia plus one core features and one or more suggestive features