Abstract
Neuropsychiatric disorders such as dementia and depression are common in the elderly. After the age of 85, the prevalence of dementia is 30%, that of depression 10%, and that of psychotic symptoms 10%. The lifetime prevalence of depression approaches 50% in women and 25% in men. Cognitive dysfunction is common both in depression and in individuals with psychotic symptoms, and it is the core manifestation in dementia disorders, such as Alzheimer’s disease. Cognitive symptoms are also included in the criteria for major depression in the DSM-IV. There is controversy about whether depression is a risk factor for dementia, but depression is common in individuals with dementia. Cognitive dysfunction in elderly individuals may also be caused by prodromal symptoms of dementia. Cerebrovascular diseases are also common in the elderly and are related to both cognitive impairment and depression. Vascular cognitive impairment is a term encompassing vascular causes of cognitive impairment, including dementia. The two most common cerebrovascular diseases are stroke and ischemic white matter lesions (WMLs). Stroke and ischemic WMLs increase the risk for dementia and depression. The latter is a reason for the introduction of the concept of vascular depression in the elderly. However, most depressions in the elderly are not related to vascular disease. Adding to the complexity, associations between cerebrovascular and neuropsychiatric disorders may also go in the opposite direction, as several studies report that depression may increase the risk for stroke. There is thus a complex interaction between depression, dementia, and vascular diseases. It is important to detect neuropsychiatric syndromes in patients with cardiovascular diseases as this has implications for their management and prognosis. Vascular disorders and risk factors are also important to detect as they are targets for prevention of dementia and depression.
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Skoog, I. (2010). Neuropsychiatric Aspects of Vascular Cognitive Impairment. In: Miyoshi, K., Morimura, Y., Maeda, K. (eds) Neuropsychiatric Disorders. Springer, Tokyo. https://doi.org/10.1007/978-4-431-53871-4_11
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