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Effects of Previous Major Depressive Illness on Cognition in Alzheimer Disease Patients

Received August 6, 2004; revised December 2, 2004; accepted December 13, 2004. From the Geriatric Psychiatry Branch, NIMH Bldg. 10/CRC/2E-2-5330, MSC 1274, Bethesda, MD 20892-1274. e-mail: spoorh{at}mail.nih.gov Send correspondence and reprint requests to Ms. Cannon-Spoor.
© 2005 American Association for Geriatric Psychiatry

Objective: Major Depressive Disorder (MDD) may be a risk factor for subsequent development of irreversible dementia; however, the influence of a premorbid history of MDD on the clinical course of patients diagnosed with probable Alzheimer disease (AD) has not been fully explored. Methods: Forty-three AD patients with mild-to-moderate cognitive impairment were screened for a life-long history of MDD with the Clinical Assessment of Depression in Dementia Scale. Twenty-two subjects had a history of MDD before onset of cognitive impairment, but none was suffering from an MDD episode at time of cognitive assessment. Results: After controlling for age, education, duration of illness, gender, and medication status, subjects with a history of MDD had significantly lower scores, as a group, on cognitive performance tests, including the Mini-Mental State Exam, WAIS Full-Scale and Verbal Scale I.Q., and the Initiation/Perseveration subscale of the Mattis Dementia Rating Scale. These subjects also developed symptoms of dementia at a significantly earlier age than the subjects who had no premorbid history of MDD. Conclusions: Although previous studies have shown that late-onset MDD may increase risk for subsequent dementia, the current results suggest that premorbid MDD is associated with more severe cognitive deficits during the actual course of dementia.

Key Words: Depression • Alzheimer Disease • Cognition

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