Problematik der Beurteilung depressiver Symptome Demenzkranker

Barbara Schneider; Bernhard Weber; Konrad Maurer; Lutz Frölich

doi:10.1055/s-2002-22042

Psychiatrische Praxis, Table of Contents

Psychiatr Prax 2002; 29(2): 76-82
DOI: 10.1055/s-2002-22042

Originalarbeit

Problematik der Beurteilung depressiver Symptome Demenzkranker

Difficulties in the Evaluation of Depressive Symptoms in Patients with DementiaBarbara Schneider¹ , Bernhard Weber¹ , Konrad Maurer¹ , Lutz Frölich¹

¹Zentrum der Psychiatrie, Klinik für Psychiatrie und Psychotherapie I, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main

Abstract

Zusammenfassung

Eine depressive Begleitsymptomatik ist bei allen Demenzerkrankungen häufig zu beobachten und erfordert eine adäquate Behandlung. Zwar sind depressive Symptome signifikant häufiger bei vaskulärer Demenz als bei Alzheimer-Demenz, aber Schweregrad und Symptomprofil der Depression sind unabhängig von der Ätiologie der Demenz. Es werden Instrumente zur Erfassung und Schweregradeinstufung depressiver Symptome vorgestellt, die häufig bei Demenzkranken verwendet werden oder speziell für Demenzkranke entwickelt wurden. Beispiele hierfür sind „Dementia Mood Assessment Scale” und „Cornell Scale for Depression in Dementia”. Die grundsätzlichen Probleme psychopathologischer Selbst- und Fremdbeurteilung bei Demenzerkrankungen und mögliche Fehlbeurteilungen von somatischen Symptomen werden besprochen.

Abstract

Depressive symptoms are often found in dementia (up to 86 %). Therefore, adequate treatment is necessary. Depressive symptoms appear significantly more often in vascular dementia than in dementia in Alzheimer's disease, but severity and profile of depressive symptomatology are independent of the etiology of dementia. The aim of this review is to help clinicians to select appropriate psychometric instruments to identify and measure depressive symptomatology in dementia. Frequently used scales are described, e.g. the Dementia Mood Assessment Scale and the Cornell Scale for Depression in Dementia - specific scales developed for rating severity of depression in dementia - and the Geriatric Depression Screening Scale. Methodological problems and limitations of psychopathological assessment in dementia caused by restriction of self-report, information gathered by collateral sources, manifestations of age and interference of somatic symptoms are discussed.

Full Text

References

Literatur

1 Katzman R. The prevalence and malignancy of Alzheimer's disease. A major killer. Arch Neurol. 1976; 33 217-218
2 Blazer D, Williams C D. Epidemiology of dysphoria and depression in an elderly community population. Br J Psychiatry. 1980; 137 439-444
3 Gurland B, Dean L, Cross P, Golden R. The epidemiology of depression and dementia in the elderly: The use of multiple indicators of these conditions. In: Cole JD, Barrett JE (eds) Psychopathology in the Aged. New York; Raven Press 1980
4 Blazer D G, Hughes D C, George L K. The epidemiology of depression in an elderly community population. Gerontologist. 1987; 27 281-287
5 Malhendra B. Depression and dementia: The multi-faceted relationship. Psychol Med. 1985; 15 227-236
6 Weissman M M, Leaf P J, Tischler G L, Blazer D G, Karno M, Bruce M L, Florio L P. Affective disorders in five United States communities. Psychol Med. 1988; 18 141-153
7 Bickel H. Demenzen in höherem Lebensalter: Schätzungen des Vorkommens und der Versorgungskosten. Z Gerontol Geriatr. 2001; 34 108-115
8 Alzheimer A. Über eine eigenartige Erkrankung der Hirnrinde. Allgemeine Zeitschrift für Psychiatrie und Psychisch-Gerichtliche Medicin. 1907; 64 146-148
9 Bucht G, Adolfsson R. The comprehensive psychopathological rating scale in patients with dementia of the Alzheimer type and multi-infarct dementia. Acta Psychiatr Scand. 1983; 68 263-270
10 Cummings J L, Miller B, Hill M J, Neshkes R. Neuropsychiatric aspects of multi-infarct dementia and dementia of the Alzheimer type. Arch Neurol. 1987; 44 389-393
11 Merriam A D, Aronson M K, Gaston P, Wey S L, Katz I. The psychiatric symptoms of Alzheimer's disease. J Am Geriatr Soc. 1988; 36 7-12
12 Wragg R E, Jeste D V. Overview of depression and psychosis in Alzheimer's disease. Am J Psychiatry. 1989; 146 577-587
13 Rubin E H, Kinscherf D A. Psychopathology of very mild dementia of the Alzheimer type. Am J Psychiatry. 1989; 146 1017-1021
14 Mackenzie T B, Robiner W N, Knopman D S. Differences between patient and family assessments of depression in Alzheimer's disease. Am J Psychiatry. 1989; 146 1174-1178
15 Lazarus L W, Newton N, Cohler B, Lesser J, Schweon C. Frequency and presentation of depressive symptoms in patients with primary degenerative dementia. Am J Psychiatry. 1987; 144 41-45
16 Devanand D P, Jacobs D M, Tang M X, Castillo-Castaneda C D, Sano M, Marder K, Bylsma F W, Brandt J, Albert M, Stern Y. The course of psychopathologic features in mild to moderate Alzheimer's disease. Arch Gen Psychiatry. 1997; 54 257-263
17 Weiner M F, Edland S D, Luszczynski H. Prevalence and incidence of major depression in Alzheimer's disease. Am J Psychiatry. 1994; 151 1006-1009
18 Lopez O L, Boller F, Becker J T, Miller M, Reynolds C F. Alzheimer's disease and depression: neuropsychological impairment and progression of the illness. Am J Psychiatry. 1990; 147 855-860
19 Reifler B V, Larson E, Hanley R. Coexistence of cognitive impairment and depression in geriatric outpatients. Am J Psychiatry. 1982; 139 623-626
20 Reding M, Haycock J, Blass J. Depression in patients referred to a dementia clinic. A 3-year prospective study. Arch Neurol. 1985; 42 894-896
21 Teri L, Wagner A W. Assessment of depression in patients with Alzheimer's disease: concordance among informants. Psychol Aging. 1991; 6 280-285
22 Rovner B W, Broadhead J, Spencer M, Carson K, Folstein M F. Depression and Alzheimer's disease. Am J Psychiat. 1989; 46 350-353
23 Harwood D G, Ownby R L, Barker W W, Duara R. The factor structure of the Cornell Scale for Depression in dementia among probable Alzheimer's disease patients. Am J Geriatr Psychiatry. 1998; 6 212-220
24 Chen J C, Borson S, Scalan J M. Stage-specific prevalence of behavioral symptoms in Alzheimer's disease in a multi-ethnic community sample. Am J Geriatr Psychiatry. 2000; 8 123-133
25 Haupt M, Kurz A, Pollmann S, Romero B. Psychopathologische Störungen bei beginnender Alzheimerscher Krankheit. Fortschr Neurol Psychiatr. 1992; 60 3-7
26 Haupt M, Janner M, Ebeling S, Stierstorfer A, Kretschmar C. Presentation and stability of noncognitive symptom patterns in patients with Alzheimer disease. Alzheimer Dis Assoc Disord. 1998; 12 323-329
27 Wetterling T. Organische psychische Störungen (hirnorganische Psychosyndrome). Pathogenese - Diagnose - Therapie. Darmstadt; Steinkopff 2002
28 Reisberg B, Ferris S H. A clinical scale for symptoms of psychosis in Alzheimer's disease. Psychopharmacol Bull. 1985; 21 101-106
29 Folstein M, Folstein S, McHugh P R. Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. J Psychiat Res. 1975; 12 189-198
30 Jorm A F, Van Duijn C M, Chandra V, Fratiglioni L, Graves A B, Heyman A, Kokmen E, Kondo K, Mortimer J A, Rocca W A, Shalat S L, Soininen H, Hofman A. for the EURODEM Risk Factors Research Group . Psychiatric history and related exposures as risk factors for Alzheimer's disease: a collaberative re-analysis of case-control studies. Int J Epidemiol. 1991; 20, Suppl 2 43-47
31 Chen P, Ganguli M, Mulsant B H, DeKosky S T. The temporal relationship between depressive symptoms and dementia. Arch Gen Psychiatry. 1999; 56 261-266
32 Reifler B V, Larson E, Teri L, Poulsen M. Dementia of the Alzheimer's type and depression. J Am Geriatr Soc. 1986; 34 855-859
33 Speck C E, Kukull W A, Brenner D E, Bowen J D, McCormick W C, Teri L, Pfanschmidt M L, Thompson J D, Larson E B. History of depression as a risk factor for Alzheimer's disease. Epidemiology. 1995; 6 366-369
34 Devanand D P, Sano M, Tang M C, Taylor S, Gurland B J, Wilder D, Stern Y, Mayeaux R. Depressed mood and the incidence of Alzheimer's disease in the elderly living in the community. Arch Gen Psychiatry. 1996; 53 175-182
35 Salzman C, Shader R I. Depression in the elderly: I. Relationship between depression, psychological defence mechanisms, and physical illness. J Am Geriatr Soc. 1978; 26 253-260
36 Baldwin B. Depressive Erkrankungen. In: Förstl H (Hrsg) Lehrbuch der Gerontopsychiatrie. Stuttgart; Enke 1997: 408-410
37 Miller N E. The measurement of mood in senile brain disease: examiner ratings and self reports. In: Cole JO, Barrett JE (eds) The Psychopathology in the Aged. New York; Raven Press 1980
38 Cummings J L. Dementia and depression: an evolving enigma. J Neuropsychiatry. 1989; 1 236-242
39 Kiloh L G. Pseudo-dementia. Acta Psychiat Scand. 1962; 37 336-351
40 Lauter H, Dame S. Depressive disorders and dementia: a clinical view. Acta Psychiat Scand. 1991; 366, Suppl 40-46
41 Migliorelli R, Teson A, Sabe L, Petracchi M, Leiguarda R, Starkstein S E. Prevalence and correlates of dysthymia and major depression among patients with Alzheimer's disease. Am J Psychiatry. 1995; 152 37-44
42 Feher E P, Mahurin R K, Inbody S B, Crook T H, Pirozzolo F J. Anosognosia in Alzheimer's Disease. Neuropsychiatr Neuropsychol Behav Neurol. 1991; 4 136-146
43 Devanand D P, Nelson J P. Concurrent depression and dementia: implications and treatment. J Clin Psychiatry. 1985; 46 389-392
44 Fischer P, Simanyi M, Danielczyk W. Depression in dementia of the Alzheimer type and in multi-infarct dementia. Am J Psychiatry. 1990; 147 1484-1487
45 Pearlson G D, Ross C A, Lohr W D, Rovner B W, Chase G A, Folstein M F. Association between family history of affective disorder and the depressive syndrome of Alzheimer's disease. Am J Psychiatry. 1990; 147 452-456
46 Möller H J. Möglichkeiten und Grenzen von Selbstbeurteilungsskalen zur Verlaufsbeurteilung depressiver Symptomatik im Rahmen der Therapie-Evaluation. In: Baumann U, Fähndrich E, Stieglitz RD, Woggon B (Hrsg) Veränderungsmessung in Psychiatrie und Klinischer Psychologie. Theoretische, methodische und empirische Beiträge. München; Profil-Verlag 1990: 307-328
47 Möller H J, Zerssen D. Psychopathometrische Verfahren. II. Standardisierte Beurteilungsverfahren. Nervenarzt. 1983; 54 1-16
48 Ihl R, Frölich L. Die Reisberg-Skalen GDS, BCRS, FAST. Weinheim; Beltz-Test 1991
49 Lehfeld H, Reisberg B, Finkel S, Kanowski S, Wied V, Pittas J, Robert P H, Hulla F, Heininger K, Erzigkeit H. Informant-rated activites-of-daily living (ADL) assessments: results of a study of 141 items in the USA, Germany, Russia and Greece from the International ADL Scale Development Project. Alzheimer Disease and Associated Disorders. 1997; 11S4 39-44
50 Knesevich J W, Martin R L, Berg L, Danziger W. Preliminary report on affective symptoms in the early stages of senile dementia of the Alzheimer's type. Am J Psychiatry. 1983; 140 233-235
51 Paykel E S, Norton K RW. Self-report and clinical interview in the assessment of depression. In: Sartorius N, Ban TA (eds) Assessment of depression. Berlin, Heidelberg, New York; Springer 1986
52 Loreck D J, Bylsma F W, Folstein M F. The Dementia Signs and Symptoms Scale. Am J Geriatr Psychiatry. 1994; 2 60-74
53 Katz I. Diagnosis and treatment of depression in patients with Alzheimer's disease and other dementias. J Clin Psychiatry. 1998; 59, Suppl 9 38-44
54 Moye J, Robiner W N, Mackenzie T B. Depression in Alzheimer patients: discrepancies between patient and caregiver reports. Alzheimer Dis Assoc Disord. 1993; 7 187-201
55 Cummings J L, Mega M, Gray K, Rosenberg-Thompson S, Carusi D A, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994; 44 2308-2314
56 Burke W J, Rubin E H, Morris J C, Berg L. Symptoms of „depression” in dementia of the Alzheimer type. Alzheimer Dis Assoc Disord. 1988; 2 356-362
57 Göbel H, Kipp J, Struwe B. Symptomatik der Altersdepression und die Diagnose der Depression nach ICD-10 - erste Ergebnisse einer Vergleichsuntersuchung. In: Radebold H, Hirsch RD, Kipp J, Kortus R, Stoppe G, Struwe B, Wächtler C (Hrsg) Depressionen im Alter. Darmstadt; Steinkopff 1997
58 Bonin-Guillaume S, Clement J P, Chassain A P, Leger J M. Evaluation psychometrique de la depression du sujet age: quels instruments? Quelles perspectives d'avenir?. Encephale. 1995; 21 25-34
59 Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23 56-61
60 Linden M, Borchelt M, Barnow S, Geiselmann B. The impact of somatic morbidity on the Hamilton Depression Rating Scale in the very old. Acta Psychiatr Scand. 1995; 92 150-154
61 Silverstone P H. Measuring depression in the physically ill. International Journal of Methods of Psychiatric Research. 1991; 1 3-12
62 Sunderland T, Alterman I S, Yount D, Hill J L, Tariot P N, Newhouse P A, Mueller E A, Mellow A M, Cohen R M. A new scale for the assessment of depressed mood in demented patients. Am J Psychiatry. 1988; 145 955-959
63 Camus V, Schmitt L. Ousset PJ, Micas M. Depression et demence: contribution a la validation francaise de deux echelles de depression: „Cornell Scale for Depression in Dementia” et „Dementia Mood Assessment Scale”. L'Encephale. 1995; 21 201-208
64 Sunderland T, Minichiello M. Dementia Mood Assessment Scale. Int Psychogeriatr. 1996; 8, Suppl 3 329-331
65 Fredriksen K, Tariot P, De Jonghe E. Minimum Data Set Plus (MDS+) scores compared with scores from five rating scales. J Am Geriatr Soc. 1996; 44 305-309
66 Onega L L, Abraham I L. Factor structure of the Dementia Mood Assessment Scale in a cohort of community-dwelling elderly. Int Psychogeriatr. 1997; 9 499-457
67 Alexopoulos G S, Abrams R C, Young R C, Shamoian C A. Cornell Scale for Depression in Dementia. Biol Psychiatry. 1988; 23 271-284
68 Mack J L, Patterson M B. The evaluation of behavioral disturbances in Alzheimer's disease: the utility of three rating scales. J Geriatr Psychiatry Neurol. 1994; 7 101-117
69 Logsdon R G, Teri L. Depression in Alzheimer's disease patients: caregivers as surrogate reporters. J Am Geriatr Soc. 1995; 43 150-155
70 Alexopoulos G S, Abrams R C, Young R C, Shamoian C A. Use of the Cornell Scale in non-demented patients. J Am Geriatr Soc. 1988; 36 230-236
71 Roth M. The natural history of mental disorder in old age. J Ment Sci. 1955; 101 281-301
72 Mohs R C, Rosen W G, Greenwald B S, Davis K L. Neuropathologically validated scales for Alzheimer's disease. In: Crook T, Ferris S, Bartus R (eds) Assessment in Geriatric Psychopharmacology. New Canaan, CT; Mark Powley Associates 1983
73 Greenwald B S, Mathe A A, Mohs R C, Levy M I, Johns C A, Davis K L. Cortisol and Alzheimer's disease, II: Dexamethasone suppression, dementia severity, and affective symptoms. Am J Psychiatry. 1986; 143 442-446
74 Vida S, Des Rosiers P, Carrier L, Gauthier S. Depression in Alzheimer's disease: receiver operating characteristic analysis of the Cornell Scale for Depression in Dementia and the Hamilton Depression Scale. J Geriatr Psychiatry Neurol. 1994; 7 159-162
75 Katona C LE, Aldridge C R. The dexamethasone suppression test and depressive signs in dementia. J Affect Disord. 1985; 8 83-89
76 Yesavage J, Brink T, Rose T L, Lum O, Huang V, Adey M, Leirer V O. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiat Res. 1983; 17 37-49
77 Brink T L, Yesavage J A, Lum O, Heersema P, Adey M, Rose T L. Screening tests for geriatric depression. Clinical Gerontologist. 1982; 1 37-44
78 Zung W WK. A self-rating depression scale. Arch Gen Psychiatry. 1965; 12 56-62
79 Burke W J, Houston M J, Boust S J, Roccaforte W H. Use of the Geriatric Depression Scale in Dementia of the Alzheimer's type. J Am Geriatr Soc. 1989; 37 856-860
80 Feher E P, Larrabee G J, Crook T H. Factors attenuating the validity of the Geriatric Depression Scale in a dementia population. J Am Geriatr Soc. 1992; 40 906-909
81 McGivney S A, Mulvihill M, Taylor B. Validating the GDS depression screen in the nursing home. J Am Geriatr Soc. 1994; 42 490-492
82 Gilley D W, Wilson R S. Criterion-related validity of the Geriatric Depression Scale in Alzheimer's disease. J Clin Exp Neuropsychol. 1997; 19 489-499
83 Hoyl M F, Alessi C A, Harker J O, Josephson K R, Pietruszka F M, Koelfgen M, Mervis J R, Fitten L J, Rubenstein L Z. Development and Testing of a Five-Item Version of the Geriatric Depression Scale. JAGS. 1999; 47 873-878
84 van Marwijk H W, Wallace P, de Bock G H, Hermans J, Kaptein A A, Mulder J D. Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale. Br J Gen Pract. 1995; 393 195-199
85 Nitcher R L, Burke W J, Roccaforte W H, Wengel S P. A collateral source version of the Geriatric Depression Rating Scale. Am J Geriatr Psychiatry. 1993; 1 143-152
86 Burke W J, Roccaforte W H, Wengel S P, McArthur-Miller D, Folks D G, Potter J F. Disagreement in the reporting of depressive symptoms between patients with dementia of the Alzheimer Type and their collateral sources. Am J Geriatr Psychiat. 1998; 6 308-319
87 Beck A T, Ward C H, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4 561-571
88 Radloff L S. The CES-D Scale. A self-report depression scale for research in the general population. Applied Psychological Measurement. 1977; 1 385-401
89 Gottlieb G L, Gur R E, Gur R C. Reliability of psychiatric scales in patients with Dementia of the Alzheimer type. Am J Psychiat. 1988; 145 857-860
90 Lewisohn P M, Seeley J R, Roberts R E, Allen N B. Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychol Aging. 1997; 12 277-287
91 Wagle A C, Ho L W, Wagle S A, Berrios G E. Psychometric behaviour of BDI in Alzheimer's disease patients with depression. Int J Geriatr Psychiatry. 2000; 15 63-69
92 Montgomery S, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 126 382-389
93 Copeland J RM, Dewey M E, Griffith-Jones H M. A computerized psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGETAT. Psychol Med. 1986; 16 89-99
94 Roth M, Tym E, Mountjoy C Q, Huppert F A, Hendrie H, Verma S, Goddard R. CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry. 1986; 149 698-709
95 The Canberra Interview for the Elderly: a new field instrument for the diagnosis of dementia and depression by ICD-10 and DSM-III-R. Acta Psychiatr Scand 1992 85: 105-113
96 Mohs R C, Rosen W G, Davis K L. The Alzheimer's disease assessment scale: an instrument for assessing treatment efficacy. Psychopharmacol Bull. 1983; 19 448-450
97 Rosen W G, Mohs R C, Davis K L. A new rating scale for Alzheimer's disease. Am J Psychiatry. 1984; 141 1356-1364
98 Baumgarten M, Becker R, Gauthier S. Validity and reliability of the dementia behavior disturbance scale. J Am Geriatr Soc. 1990; 38 221-226
99 Gauthier S, Baumgarten M, Becker R. Dementia Behavior Disturbance Scale. Int Psychogeriatr. 1996; 8, Suppl 3 325-327
100 Devanand D P, Miller L, Richards M, Marder K, Bell K, Mayeux R, Stern Y. Columbia University Scale for Psychopathology in Alzheimer's Disease (CUSPAD). Arch Neurology. 1992; 49 371-376
101 Tariot P N, Mack J L, Patterson M B, Edland S D, Weiner M F, Fillenbaum G, Blazina L, Teri L, Rubin E, Mortimer J A, Stern Y. the Behavioral Pathology Committee of the Consortium to Establish a Registry for Alzheimer's Disease . The Behavior Rating Scale for Dementia of the Consortium to establish a registry for Alzheimer's Disease. Am J Psychiatry. 1995; 152 1349-1357
102 Jorm A F, Mackinnon A J, Henderson A S, Scott R, Christensen H, Korten A E, Cullen J S, Mulligan R. The Psychogeriatric Assessment Scales: a multi-dimensional alternative to categorical diagnoses of dementia and depression in the elderly. Psychol Med. 1995; 25 447-460
103 Jorm A F, Mackinnon A J, Christensen H, Henderson A S, Jacomb P A, Korten A E. The psychogeriatric assessment scales (PAS): further data on psychometric properties and validity from a longitudinal study of the elderly. Int J Geriatr Psychiatry. 1997; 12 93-100
104 Mackinnon A, Mulligan R. The Psychogeriatric Assessment Scales (PAS): psychometric properties in French and German speaking populations. Int J Geriatr Psychiatry. 2001; 16 892-899
105 Ihl R, Grass-Kapanake B, Lahram P, Brinkmeyer J, Fischer S, Gaab N, Kaupmannsennecke C. Entwicklung und Validierung eines Tests zur Früherkennung der Demenz und Depressionsabgrenzung (TFDD). Fortschr Neurol Psychiatr. 2000; 68 413-422
106 Shader R I, Harmatz J S, Salzman C. A new scale for clinical assessment in geriatric populations: Sandoz Clinical Assessment-Geriatric (SCAG). J Am Geriatr Soc. 1974; 22 107-113
107 Pattin J R, Harmatz H B, Singer J M. Replicated evidence on the construct validity of the SCAG (Sandoz Clinical Assessment-Geriatric) scale. Prog Neuropsychopharmacol Biol Psychiatry. 1984; 8 293-306
108 Teri L, Truax P, Logsdon R, Uomoto J, Zarit S, Vitaliano P P. Assessment of behavioral problems in dementia: the revised memory and behavior checklist. Psychol Aging. 1992; 7 622-631
109 Spiegel R, Brunner C, Ermini-Funfschilling D, Monsch A, Notter M, Puxty J, Tremmel L. A new behavioral assessment scale for geriatric out- and in-patients: the NOSGER (Nurses' Observation Scale for Geriatric Patients). J Am Geriatr Soc. 1991; 39 339-347
110 Overall J E, Gorham D R. The Brief Psychiatric Rating Scale. Psychol Rep. 1962; 10 799-812
111 Beller S A, Overall J E. The Brief Psychiatric Rating Scale (BPRS) in geropsychiatric research, II: representative profile patterns. J Gerontol. 1984; 39 194-200
112 Pearson J L, Teri L, Reifler B V, Raskind M A. Functional status and cognitive impairment in Alzheimer's patients with and without depression. J Am Geriatr Soc. 1989; 37 1117-1121
113 Teri L, Logsdon R G. Assessment and management of behavioral disturbances in Alzheimer disease. Comp Ther. 2000; 26 169-175

Dr. Barbara Schneider

Zentrum der Psychiatrie, Klinik für Psychiatrie und Psychotherapie I · Johann-Wolfgang-Goethe-Universität

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Email: B.Schneider@em.uni-frankfurt.de