Executive functioning deficits are seen before severe memory loss in the early stages of subcortical vascular cognitive impairment.
Major depression is widely observed in patients with vascular dementia. Severe depression is more common in persons with vascular dementia than in those with Alzheimer's disease. Elderly patients with dementia may not admit to a depressed mood and may be socially withdrawn with decreased psychomotor activity. Suicidal thoughts or intent, passive wishes to die, and feeling that life is not worthwhile is seen in these patients, and they should be followed closely. Suicide attempts were observed in less than 1% of patients with dementia, but those attempts were often associated with depression. Often, patients in the early stages of cognitive impairment, such as an inability to do what were once simple calculations, may understand this inability. Their recognition of this can be depressing and lead to suicidal behavior. Patients who are early in their memory loss and who are experiencing a decrease in executive function are in danger of taking their lives by suicide. This is particularly important to consider if they have had relatives or friends with dementia; they have witnessed firsthand the devastation of the disorder and may wish to avoid that.
Patients with vascular dementia commonly experience mood and behavioral changes. In some patients with lacunar state and Binswanger disease, such problems may be more prominent than intellectual deficits.
Clinicians can perform a Mini-Mental State Examination depression screen using the DSM-5 criteria, the GDS, or the Cornell Scale for Depression in Dementia. Clinicians should directly ask patients about suicidal or homicidal ideation (thoughts or ideas), intent, and plan.
For more on vascular dementia presentation, read here.
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Cite this: Stephen Soreff. Fast Five Quiz: Are You Familiar With These Conditions Associated With Depression? - Medscape - Dec 16, 2019.