In the clinic of Professor V.L. Minutes to see patients with Alzheimer’s disease and concomitant diseases
Currently, the number of patients suffering from Alzheimer’s disease is growing. In Russia, during the crisis and a decrease in the ability to pay of people, in particular patients, there is a decrease in the life expectancy of people. Scientists have noticed an increase in the number of people with Alzheimer’s disease in developed countries, while at the age of 85, 50% of people suffer from this disease.
Depression occurs in 30-50% of patients with Alzheimer’s disease. It is depression that can explain passivity, the need for care, the tendency towards an unsuccessful course of dementia, the risk of death. Sometimes in Alzheimer’s disease, depression cannot be detected, especially when cognitive impairment is predominant. Both Alzheimer’s disease and depression have common clinical symptoms that are difficult to differentiate. For example, symptoms such as apathy, decreased libido, decreased appetite, sleep disturbances – they can be both in Alzheimer’s disease and in depression. Many patients with Alzheimer’s disease and depression have physical manifestations, anxiety, and feelings of sadness or sadness, less characteristic of old age depression and Alzheimer’s disease.
When interviewing a patient, fluctuations in activity, recurrent depression should alert the doctor and contribute to early detection of depression. Depression of old age is characterized by feelings of guilt, dysphoria, suicidal thoughts, dysphoria. For dementia, daytime sleepiness, decreased interest, weakness, psychomotor disturbances, decreased social activity. Sometimes depression, particularly reactive depression, is a trigger for Alzheimer’s disease. The diagnosis is complicated by the fact that depression can be counted as a manifestation of the onset of Alzheimer’s disease. There is no evidence in the scientific literature on the efficacy and tolerability of antidepressants such as escitolapram and mirtazapine .
In recent years, under observation, many side effects have been noted when prescribing antidepressants, an aggravation of the course of somatic diseases, including cardiovascular diseases, in the treatment of depression in Alzheimer’s disease.
Based on the experience of the clinic of Professor V.L. Just a minute in Moscow, citalopram and escitalopram are among the most suitable antidepressants. The initial dose of citalopram is 10 mg, escilopram is 5 mg. The effect of treatment with these drugs appears late, in the fourth to eighth week. But if, after three months of treatment with drugs from the pharmacological group of serotonin reuptake inhibitors (SSRIs), the effect is not observed, you should switch to drugs from another pharmacological group. But due to the large number of complications, melipramine and amitriptyline should not be prescribed .
It has been noticed that communication of people with Alzheimer’s disease and depression with their peers significantly improves the condition. In the clinic of Dr. V.L. Minutko in Moscow found that cognitive stimulation with the help of special programs improves not only the condition of the patients’ cognitive sphere, but also helps to overcome depression.
The condition of patients improves with light therapy , music therapy, multisensory stimulation. But electroconvulsive therapy for Alzheimer’s disease, accompanied by depression, is best avoided, since there are risks and risks of delirium.