The quest for distinction between old-age depression and dementia

Summary lationship and differences between old-age depression and dementia are examined. Elements of complexity emerged when results from studies of different methodologies and based on divergent hypotheses were compared. Depression and dementia can be considered as concomitant unrelated clinical entities, each one with its own specific causal and symptomatic features or two moments of the same entity. In this case, depression can be considered either a risk factor for a subsequent dementia or a precursor for it linked to dementia by the same common pathophysiological features. Psychological assessment has a very useful and practical role when employed in the clinical field for quantifying the intensity and specificity of cognitive and mood disorders in the single patient. Examples of quantitative and qualitative differences in the cognitive assessment of depression and dementia patients are described. Changes in the internal structure of subjective evaluations and of patterns of objective memory scores have been demonstrated as examples of the careful approach which should be adopted in the psychological assessment of these patients. The choice of intervention and the identification of the most likely future clinical course can be heavily based on the psychological evaluation. More problematic and methodologically complex is the role of the psychological tools when longitudinal studies must be carried out. Many technical details must be clarified before a specific psychological measure might be safely employed in such a study. In these studies, this factor of complexity does not affect only psychological measures but should be considered for every type of measurement which should be chosen.