Depressive symptoms in neurodegenerative diseases

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

Irritability

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

LBD: Lewy body dementia; PET: Positron emission tomography; SPECT: Single photon emission computed tomography.