Treatment Methods for Depressive Cognitive Disorder
It is possible to treat pseudodementia, also known as Depressive Cognitive Disorder, in two ways, which are pharmacological and non-pharmacological.
Selective Serotonin Reuptake Inhibitors (SSRIs): Studies acknowledge the selective serotonin reuptake inhibitors (SSRIs) as the primary treatment for depression in dementia, as cholinergic side effects (cognitive disorder included) are less prevalent in SSRIs.
Selective Norepinephrine Reuptake Inhibitors (SNRIs): It’s the treatment method that follows SSRIs. It includes venlafaxine, desvenlafaxine, duloxetine. This class of drugs is considered to be safe in geriatric individuals.
Cholinesterase Inhibitors: These drugs were found to cure subsyndromal depression in dementia patients. They have positive effects both on improving cognitive traits and on the behavioral symptoms of dementia.
Zolmitriptan: This is a 5-HT-1B agonist, which was found to be effective in the treatment of depression and associated cognitive disorder. It manifests its effects by changing the serotonergic receptors.
Vortioxetine: It has a multimodal effect mechanism. Agonist in 5-HT1A receptors, partial agonist in 5-HT1B, and 5-HT3 receptor antagonist. The latest data confirm its effectiveness in the treatment of depression, along with cognitive deficiencies. Its adverse effects resemble SSRIs.
- Transcranial Magnetic Stimulation (TMS) Treatment: The TMS treatment, which is particularly effective in resistant depression, is effective in the group of depressions that cannot tolerate medication. Studies have shown that rTMS is a promising noninvasive technique for reducing cognitive problems in treatment-resistant depression.
- Electroconvulsive therapy (ECT):It is safe and effective in depression, and other disorders that lead to cognitive disorders. ECT limits the cognitive damage associated with the dementia-related major depressive disorder in the elderly. Studies have shown significant improvements both in mood and cognition in depressive patients with dementia. Although it leads to confusion as a side effect, this condition can be reduced by limiting the frequency of administering ECT to one or twice a week.
- Interpersonal/Behavioral Approaches: Both strategies are associated with significant improvements in patients and family members. Particularly, the treatment administered for the caregiver is a critical factor in the treatment of the patient having depression associated with cognitive disorders.
- Healthy Habits
- Diet: Researchers found out that people who keep a “healthy” diet routine are less likely to be depressed.
- Regular Exercise: When activities like yoga and meditation are performed on a regular basis, the positive effects of daily exercise on brain-derived neurotrophic factor (BDNF) have been observed to provide protection against depressing disorders.
- Omega-3 fatty acids: It leads to mood regulation by regulating the serotonergic and dopaminergic neurotransmitters. It also has an anti-inflammatory effect.
Depressive cognitive disorder can cause difficulties for diagnosis, as it may be related to a number of reasons with several etiologies. These cases show the symptoms of a major depressive disorder associated with a cognitive disorder.
As a result, a comprehensive analysis, evaluation of cognition, and laboratory tests are needed to understand the causes of the depressive cognitive disorders in a person. Thus, inter-professional collective activity is significant for the early diagnosis and treatment of depressive cognitive disorders. For instance, if an elderly person has complaints of memory problems in addition to behavioral disorders, the clinician must take into account the difference of depressive cognitive disorders. In the treatment, the polypharmacy and drug interactions, which cause difficulties for the group of advanced ages, must be taken into consideration.
Noninvasive treatment methods (relational/behavioral therapy, TMS) can be taken into account in the treatment plan. Besides, the treatment objectives must cover the creation of a healthy and stable living space, which includes the rehabilitation of the caregiver as well.
An inter-professional team strategy is of great importance for improving the results related to depressive cognitive disorders, and for minimizing undesirable situations.
– Sekhon, S., & Marwaha, R. (2020). Depressive Cognitive Disorders (Pseudodementia). StatPearls [Internet].
– Marra, H. L. D., Myczkowski, M. L., Memória, C. M., Arnaut, D., Ribeiro, P. L., Mansur, C. G. S., Alberto, R. L., Bellini, B. B., da Silva, A. A. F., Tortella, G., de Andrade, D. C., Teixeira, M. J., Forlenza, O. V., & Marcolin, M. A. (2015). Transcranial magnetic stimulation to address mild cognitive impairment in the elderly: A randomized controlled study. Behavioural Neurology, 2015, Article 287843.
– Emek-Savaş DD, Yerlikaya D, Yener GG (2018). Saat Çizme Testinin İki Farklı Puanlama Sisteminin Türkiye Normları ve Geçerlik-Güvenirlik Çalışması. Turk J Neurol. 24:143-152 DOI:10.4274/tnd.26504.
– Nöropsikolojik Değerlendirmelerde Zeka Testleri – Dikkat Ve Yürütücü İşlev Testleri, Gelişim Testleri – Bellek. Prof. Dr. Özgür Öner.
– Korkmaz NÇ ve Bilek F. (2018). Parkinson Hastalarında Bilişsel (Kognitif) Bozuklukların Değerlendirilmesi. TFD Nörolojik Fizyoterapi Grubu Bülteni. 4(10):1-11.
– Parkinson Hastalarında Bilişsel (Kognitif) Bozuklukların Değerlendirilmesi. Doç. Dr. Nilüfer Çetişli Korkmaz, Uzm. Fzt. Furkan Bilek.