Depression associated with dementia with Lewy bodies (DLB) and the effect of somatotherapy

Abstract

Background: Dementia with Lewy bodies (DLB) is a common type of dementia. It is difficult to make an initial diagnosis of DLB because of a variety of early symptoms, including psychosis-like and depressive states. In this study, we examined the characteristic depressive symptoms of the prestage of DLB and the efficacy and safety of somatotherapy for depression accompanying DLB. Methods: Subjects in the study were 167 consecutive clinical cases aged 50 years or more, hospitalized at Tsukuba University Hospital from December 2002 to September 2007. At the time of admission, patients were diagnosed with certain types of mood disorders according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision. For each subject, a series of neuropsychological tests, along with a standard psychiatric and neurological assessment and biological examinations, were conducted. Using the data from these exams, we diagnosed probable and possible DLB according to the criteria for dementia with Lewy bodies established by McKeith et al. 1 We compared patients' depressive symptoms according to the Hamilton Depression Scale, and distinguished between patients with depression associated with DLB and those with other mood disorders. 2 We also examined the efficacy and safety of somatotherapy (electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS)) for patients with drug therapy-resistant depression associated with DLB.

Brain Stimulation in the Treatment of Late-Life Severe Mental Illness Other than Unipolar Nonpsychotic Depression

“…Six patients received rTMS daily for 10 days according to the following protocol: a train of 140 pulses at 1 Hz delivered to the right dorsolateral prefrontal cortex at 110% motor threshold and repeated 3 times per day with a 30-second inter-train interval, followed by a train of 50 pulses at 10 Hz delivered to the left dorsolateral prefrontal cortex at 100% motor threshold and repeated 15 times per day with a 25-second inter-train interval. Patients experienced a significant reduction in HDRS scores from a mean of 24.0 (SD = 8.0) before rTMS to a mean of 11.0 (SD = 5.9) after rTMS (p < 0.005) (15). It was noted that that patients who received ECT had a treatment-resistant depression as defined by failing at least two antidepressants trials.…”

Neuroinflammation, Neurodegeneration, and Depression

“…Depression commonly occurs in neurodegenerative diseases such as Alzheimer's disease (de Souza et al 2010; Raskind 2008; Teng et al 2008; Zec and Burkett 2008), Parkinson's disease (Gómez-Esteban et al 2009; Kulisevsky et al 2008; Simuni and Sethi 2008; Stella et al 2008), Lewy body disease (Fritze et al 2011; Takahashi et al 2009; Yamane et al 2011), and Huntington's disease (Paulsen et al 2005; Perlis et al 2010), but it has been suggested that depression itself, particularly in late life, may be an indication of latent neurodegeneration (Burgut et al 2006). An association has been seen between late-life depressed mood, anhedonia, apathy, anergia and higher lacunars volume in white matter, suggestive of a role of subcortical ischemic vascular disease in the pathogenesis of such late-life mood disorders (Lavretsky et al 2008).…”

Effectiveness of Electroconvulsive Therapy for Depression and Cotard’s Syndrome in a Patient with Frontotemporal Lobe Dementia

“…The conundrum is that both disorders sometimes coexist, can sometimes succeed each other, and hence can often confuse clinicians [1–3]. Even though we do not have sufficient clinical tools to cure dementia, depression is thought to be treatable.…”

“…However, elderly patients with depression often have somatic and/or psychiatric disease, an atypical clinical picture, and sensitivity to environmental or psychological factors [2] and are often resistant to pharmacotherapy or show adverse effects with antidepressants. In such cases, electroconvulsive therapy (ECT) can become an important option [1]. …”