Comorbid Depression in Dementia on Psychogeriatric Nursing Home Wards: Which Symptoms are Prominent?

Objective: To provide insight into the prevalence and clinically relevant symptoms of comorbid depression among dementia patients in psychogeriatric nursing home wards, to enhance depression recognition. Design: Cross-sectional analyses of multicenter diagnostic data. Setting: Psychogeriatric wards of Dutch nursing homes. Participants: Five hundred and eighteen residents with dementia. Measurements: 1) Diagnosis of depression in dementia ( Provisional Diagnostic Criteria for Depression of Alzheimer disease [PDC-dAD]), 2) dementia ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-PC), and 3) stage of dementia ( Geriatric Depression Scale). Results: The point prevalence of comorbid depression in dementia ( Stages 2-6) on psychogeriatric nursing home wards was 19%. Depressed mood, irritability, and fatigue were the most prevalent depressive symptoms. Residents taking antidepressants at the time of the PDC-dAD depression diagnosis showed more depressive symptoms than residents who were not. The mean number of depressive symptoms was 5.6 (SD 1.84), which did not differ between the dementia stages. Also, no differences were found in the point prevalence of the shown symptoms between dementia stages. Conclusion: Irritability was put forward by the developers of the PDC-dAD, as one of the specific symptoms of depression in Alzheimer disease. This study shows that irritability is one of the most prevalent depressive symptoms in psychogeriatric nursing home residents diagnosed with comorbid depression. Irritability should therefore alert caregivers to the presence of depression and could help early recognition. The high-prevalence rate of comorbid depression in dementia in this setting justifies attention to early recognition and intervention. (Am J Geriatr Psychiatry 2009; 17:565-573)