Depressive symptoms, frailty and cognitive performance in an older population with dementia: a single center study

Depression and dementia are among the most prevalent and debilitating conditions in elderly patients, often coexisting in the same individual, but the relationship between these two conditions remains complex and poorly understood. Although they do not meet the criteria for major depressive disorder, patients with dementia often exhibit depressive symptoms as part of the behavioral and psychological symptoms of dementia (BPSD). These symptoms, however, manifest differently in dementia patients compared to younger individuals with depression. In dementia, atypical symptoms such as apathy, anxiety, sleep disturbances, and appetite changes are more prevalent alongside the depressed mood. These depressive symptoms can have a significant negative impact on both patients and their caregivers, affecting the quality of life and increasing caregiving burden. Furthermore, previous literature suggests a correlation between frailty and cognitive decline, other studies between frailty and depression. This may be suggesting an intercorrelation between frailty, depressive, symptoms and cognitive decline, but few studies have explored this relationship in elderly patients with dementia. Antidepressants are considered the first-line therapeutic option for dementia patients with depressive symptoms, although the evidence supporting the efficacy of antidepressants in this population remains limited. We conducted a longitudinal retrospective single center study on patients older than 65, consecutively referred to our outpatient clinics dedicated to cognitive impairment disorders and behavioral disturbances. Each patient underwent comprehensive geriatric and cognitive assessment at each visit. Aim of this study is to evaluate the possible correlation between the depressive symptoms (including atypical symptoms such as sleep disturbances, appetite changes, and apathy), frailty, and cognitive impairment in a cohort of dementia patients, as well as the effect of antidepressants on these variables. In this study, 293 dementia patients (mean age = 83.4 years) were evaluated for depressive symptoms, frailty, and cognitive decline at baseline and 12-month follow-up. Depressive symptoms were present in 67% of patients, with depressive patients being significantly younger and having higher comorbidity scores. Patients with depressive symptoms were associated with worse frailty at follow-up. Functional decline, particularly in complex activities of daily living, was more pronounced in the depressive group. There were no significant changes in depressive symptoms over time, though anxiety increased slightly. Medication use, including antidepressants, acetylcholinesterase inhibitors, and NMDA antagonists, shifted during follow-up, with significant increases in vortioxetine and trazodone prescriptions. The results underscore the complex interaction between depression, frailty, and cognitive decline in dementia patients. Further research is needed to explore these relationships and the long-term efficacy of treatments.