[Anxiety, depression and dementia]

Abstract

Approaching the demented patient needs to take into account the affective disorders, as anxiety and depression, which will appear with the dementia. The clinical symptomatology of anxiety and depression in dementia may be unusual or misleading because of the cognitive impairment: anxiety finds more expression with motor agitation than with speech, depression may be masked by behavioral disorders or somatoform symptoms. Anxiety, depression and cognitive defect are overlapped, for example the outcome of the depressive pseudo-dementia may not be as favorable regarding the cognitive dimension as usually assumed. Anxiety and depression in dementia may result from decreased function of the neurotransmission systems in the brain. Psychodynamic interpretation suggests that the dimension impairment involves narcissic defects and archaic beings. Treatment must be global, including biological therapies--as pharmacologic agents (minor tranquilizers, neuroleptics, antidepressants) and ECT--and psychological therapies, focused on affective relationships. The familial support will not be omitted.