Naarding Paul, Schoevers Robert A, Janzing Joost G E, Jonker Cees, Koudstaal Peter J, Beekman Aartjan T F
Spatie, Center for Mental Health, PO box 926, 7300 BD Apeldoorn and Department of Psychiatry, University Medical Center St. Radboud, Nijmegen, The Netherlands.
J Affect Disord. 2005 Oct;88(2):155-62. doi: 10.1016/j.jad.2005.07.002.
If specific symptom profiles of depressive disorders in the elderly are related to a specific etiology, this could have implications for everyday clinical practice. We hypothesized that a "motivational" profile, with symptoms such as psychomotor change, loss of interest and loss of energy, could clinically separate patients with predominantly vascular or degenerative risk indicators from patients with inflammatory risk indicators.
A total of 4051 subjects participated in a study on mental health problems in community-dwelling elderly. Information on psychiatric symptoms, demographic and medical status, previous history and family history was obtained. We distinguished three subgroups according to predominant somatic risk-indicators; vascular, degenerative and inflammatory groups.
Motivational symptoms were associated with vascular or degenerative risk-indicators for depression; psychomotor change with both indicators; loss of energy with vascular, though also with the inflammatory indicator, and thinking/concentration disturbance with the degenerative indicator. The so-called mood symptoms of depression, especially thoughts of death, were more strongly related with the inflammatory risk-indicator. Melancholic symptoms like appetite and sleep disturbances were more strongly associated with the inflammatory risk-indicator.
Etiological classification was not confirmed by additional investigations such as laboratory findings or MRI brain scans.
This study showed that in patients with a late-life depression specific symptoms of the depressive disorder may reflect the predominant underlying pathogenic mechanism.
