Cited by 312Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsTreatment of Major Depression

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Depression—an underrecognized target for prevention of dementia in Alzheimer’s disease

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Dafsari, Forugh S., Jessen, Frank·2020·Translational Psychiatry

Abstract

It is broadly acknowledged that the onset of dementia in Alzheimer’s disease (AD) may be modifiable by the management of risk factors. While several recent guidelines and multidomain intervention trials on prevention of cognitive decline address lifestyle factors and risk diseases, such as hypertension and diabetes, a special reference to the established risk factor of depression or depressive symptoms is systematically lacking. In this article we review epidemiological studies and biological mechanisms linking depression with AD and cognitive decline. We also emphasize the effects of antidepressive treatment on AD pathology including the molecular effects of antidepressants on neurogenesis, amyloid burden, tau pathology, and inflammation. We advocate moving depression and depressive symptoms into the focus of prevention of cognitive decline and dementia. We constitute that early treatment of depressive symptoms may impact on the disease course of AD and affect the risk of developing dementia and we propose the need for clinical trials.

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Crossref · 10.1038/s41398-020-0839-1

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Fig. 1 The relationship between depression and cognitive decline throughout the development and clinical course of Alzheimer‘s disease (AD). Depression can occur in three different stages in relation to the process of neurodegeneration in AD. Depression can be a predisposing risk factor occuring before the onset of AD pathology. It might also be an early sign of neurodegenerative changes or a prodromal symptom with or without cognitive deficits. Finally, it may occur at the more advanced dementia stage of AD. In every stage depression is an important accelerating factor contributing to the clinical progression and conversion from a preclinical state to MCI and to dementia.
Fig. 1 The relationship between depression and cognitive decline throughout the development and clinical course of Alzheimer‘s disease (AD). Depression can occur in three different stages in relation to the process of neurodegeneration in AD. Depression can be a predisposing risk factor occuring before the onset of AD pathology. It might also be an early sign of neurodegenerative changes or a prodromal symptom with or without cognitive deficits. Finally, it may occur at the more advanced dementia stage of AD. In every stage depression is an important accelerating factor contributing to the clinical progression and conversion from a preclinical state to MCI and to dementia.CC BY · PubMed Central
Fig. 2 Impact of HPA axis dysregulation in depression on AD pathology. HPA axis: hypothalamic-pituitary-adrenal axis, GR: glucocorticoid receptor, APP: amyloid precursor protein, BDNF: brain-derived neurotrophic factor, AD: Alzheimer’s disease.
Fig. 2 Impact of HPA axis dysregulation in depression on AD pathology. HPA axis: hypothalamic-pituitary-adrenal axis, GR: glucocorticoid receptor, APP: amyloid precursor protein, BDNF: brain-derived neurotrophic factor, AD: Alzheimer’s disease.CC BY · PubMed Central
Fig. 3 Impact of inflammation in depression on AD pathology. APP: amyloid precursor protein, BDNF: Brain-derived neurotrophic factor, AD: Alzheimer’s disease.
Fig. 3 Impact of inflammation in depression on AD pathology. APP: amyloid precursor protein, BDNF: Brain-derived neurotrophic factor, AD: Alzheimer’s disease.CC BY · PubMed Central
Fig. 4 Impact of neurotransmitter imbalance in depression on AD pathology. 5-HT: 5-Hydroxytryptamine, DA: Dopamin, BDNF: Brain-derived neurotrophic factor, AD: Alzheimer’s disease.
Fig. 4 Impact of neurotransmitter imbalance in depression on AD pathology. 5-HT: 5-Hydroxytryptamine, DA: Dopamin, BDNF: Brain-derived neurotrophic factor, AD: Alzheimer’s disease.CC BY · PubMed Central
Fig. 5 Impact of depression-related mechanisms on AD pathology. AD: Alzheimer’s disease, HPA: Hypothalamic-pituitary-adrenal axis.
Fig. 5 Impact of depression-related mechanisms on AD pathology. AD: Alzheimer’s disease, HPA: Hypothalamic-pituitary-adrenal axis.CC BY · PubMed Central

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Metadata

Authors
Dafsari, F. S., & Jessen, F.
Affiliations
University of Cologne (DE)
Corresponding author
Dafsari, Forugh S.
Venue
Translational Psychiatry
Published
2020-05-20
Volume
10
Issue
1
Pages
160-160
ISSN
2158-3188 (ISSN-L)
OpenAlex
W3028374504
Cited by
312
References
121
Citations by year
2026: 38 · 2025: 65 · 2024: 68 · 2023: 56 · 2022: 44 · 2021: 33 · 2020: 6
FWCI
5.75
Type
journal article
Language
en
Open access
Locations
  • Translational Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
  • DZNE Pub (publishedVersion, other-oa)
  • MPG.PuRe (Max Planck Society) (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Keywords
depression, Alzheimer's disease, dementia prevention, cognitive decline, depressive symptoms, antidepressants, neurogenesis, amyloid burden, tau pathology, neuroinflammation, risk factors, early treatment
MeSH terms
Alzheimer Disease, Depression, Humans, Life Style, Risk Factors, Cognitive Dysfunction

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