Introduction     Diagnosis of Mild Cognitive Impairment and Alzheimer's Disease Karen L. Bell, M.D.     Treatment Strategies for Dementia and Mild Cognitive Impairment Mary Sano, Ph.D.     Treatment of Depression, Agitation, and Psychosis in Dementia Davangere P. Devanand, M.D.     Common Symptoms       Data on Symptoms       Data on Treatment       Choosing a Drug       Assessing Depression       Treatment of Depression     Recognition of Vascular Dementia, Dementia with Lewy Bodies, and Frontotemporal Dementia Lawrence S. Honig, M.D., Ph.D.     Neuropsychology of Mild Cognitive Impairment, Alzheimer's Disease, Dementia with Lewy Bodies, and Frontotemporal Dementia Penne Sims, Ph.D.     Neuroimaging in Dementia Scott A. Small, M.D.     Genetics of Neurodegenerative Disease: Alzheimer's Disease, Frontotemporal Dementia Jennifer Williamson-Catania, M.S.     Legal and Ethical Issues for Patients with Dementia Daniel G. Fish, Esq.     Posttest         Accreditation     Reference List     Acknowledgements		Treatment of Depression, Agitation, and Psychosis in Dementia Davangere P. Devanand, M.D. Treatment of Depression   My neuropsychologist colleagues will say that neuropsychological testing always helps in treating depression in patients with cognitive impairment, and most of the time that it is true. However, its impact is not clear in patients who have very subtle problems. Depressed patients have a problem receiving information, but whatever information the patient is able to attend to and concentrate on is retained and intact. A demented patient, however, will recite back the information you give without much difficulty in attention or concentration but cannot recall it later. This is the distinction that neuropsychologists try to tease out with the testing, but again there is a fair amount of overlap. Testing cannot give you absolute certainty; it can give you a guideline. In a study we published on treatment of depression in people with mild cognitive impairment, we found that depression improved, but often cognition did not improve, indicating that this may be a prodrome to dementia. For treating depression in patients with dementia, some studies show that SSRIs and other drugs work, while in some the differences are not very dramatic. In most patients SSRIs elicit a mild response. Since evidence for efficacy of SSRIs is limited and placebo response is very high, as you might imagine with depression, how do you choose a treatment? Look at prior response in family members to the drugs you are considering, and look at the possible side effects. Unlike with antipsychotics, you can use standard doses of SSRIs in patients with dementia. SSRIs and Venlafaxine can cause gastrointestinal and sexual side effects. Tricyclic antidepressants are rarely used because of cardiac and anticholinergic effects, but you may consider using them in a severely depressed patient.       PREVIOUS | NEXT