Conditions of Alzheimer's & Cognitively Impaired Patients Worsened by Diagnosis-related Depression

A patient’s physical wellbeing can be heavily influenced by his or her mental wellbeing.

Particularly for neurological or cognitive disorders — which healthcare experts often advocate for treating with comprehensive, team-based care — depression or anxiety can be common in patients, and detrimental to their condition.

Nir Giladi, MD, a professor of neurology and director of the Department of Neurology and Neuroscience at Tel Aviv University, told MD Magazine that Parkinson’s disease (PD) treatment requires a team of “social workers, nurses, physical therapists, and speech and language therapists” to thoroughly treat the patient.

“We treat the depression, we treat cognitive changes, we treat urinary problems, constipation, pain,” Giladi said. “At the end of the day, it’s a motor pharmacy based on the type of symptoms that we’re trying to alleviate.”

According to a recent study, it’s particularly crucial for older patients to avoid the inherent stresses of such conditions.

Researchers at Penn Medicine in the University of Pennsylvania Health System found that older adults with either mild cognitive impairment (MCI) or mild stage Alzheimer’s disease (AD) dementia report greater depression, stress, and a lower quality of life when made aware of their own diagnosis.

Supplementally, older patients with an expectation of their disease worsening reported a lower overall satisfaction with daily life, based on metrics of cognitive problems, daily activities, physical functioning, mental wellbeing, and self-perceptions. Researchers used various scales to gauge these qualities, such as the Cognitive Difficulties Scale (CDS) and the Geriatric Depression Scale (GDS).

Patients involved in the study were 65 years of age or older, and were required to have an available study partner — a close friend or relative — who could provide personal information on the subject due to their condition. The average patient age was over 79 years old. Both a majority of MCI and AD patients reported at least some memory problems due to their condition, at 97% and 94%, respectively.

Study lead author Shana Stites (pictured), PsyD, MA, MS, a clinical psychologist in the Penn Memory Center, said these results indicate additional symptoms of anxiety or depression in PD patients who have had their diagnosis disclosed.

The results are relative to the advances in diagnosing PD and cognitive impairment. Former patients of the conditions were commonly diagnosed well into the stages of dementia or impairment. In the future of advanced care, patients may be given their prognosis before conditions even arise.

What now must improve is the doctor-patient interaction, Stites said. Patients are not just receiving diagnoses — they’re receiving information that affects their “daily life, their planning for employment and lifestyle, emotional wellbeing, and social relationships with close friends and family members,” Stites said.

“These issues need to be explicitly addressed with patients,” Stites said. “Maybe at this point we can’t prevent cognitive decline, but we certainly have effective interventions for treating depression and for managing other symptoms.”

Researchers cited potential future studies aimed at pre-clinical AD research, where clinicians are aiming to diagnose low-risk potential patients based on genes and biomarkers. The field may give them a better understanding of how individual’s self-perception and outlook on life is changed by learning their likelihood of a debilitating condition.

The study, “Awareness of Mild Cognitive Impairment and Mild Alzheimer’s Disease Dementia Diagnoses Associated With Lower Self-Ratings of Quality of Life in Older Adults,” was published online in Journal of Gerontology: Psychological Sciences last month.

A press release regarding the study was made available.

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