Charles F. Reynolds

BACKGROUND: Late-life depression may increase the risk of incident dementia, in particular of Alzheimer's disease and vascular dementia. AIMS: To conduct a systematic review and meta-analysis to evaluate the risk of incident all-cause dementia, Alzheimer's disease and vascular dementia in individuals with late-life depression in population-based prospective studies. METHOD: A total of 23 studies were included in the meta-analysis. We used the generic inverse variance method with a random-effects model to calculate the pooled risk of dementia, Alzheimer's disease and vascular dementia in older adults with late-life depression. RESULTS: Late-life depression was associated with a significant risk of all-cause dementia (1.85, 95% CI 1.67-2.04, P<0.001), Alzheimer's disease (1.65, 95% CI 1.42-1.92, P<0.001) and vascular dementia (2.52, 95% CI 1.77-3.59, P<0.001). Subgroup analysis, based on five studies, showed that the risk of vascular dementia was significantly higher than for Alzheimer's disease (P = 0.03). CONCLUSIONS: Late-life depression is associated with an increased risk for all-cause dementia, vascular dementia and Alzheimer's disease. The present results suggest that it will be valuable to design clinical trials to investigate the effect of late-life depression prevention on risk of dementia, in particular vascular dementia and Alzheimer's disease.

CONTEXT: Complicated grief is a debilitating disorder associated with important negative health consequences, but the results of existing treatments for it have been disappointing. OBJECTIVE: To compare the efficacy of a novel approach, complicated grief treatment, with a standard psychotherapy (interpersonal psychotherapy). DESIGN: Two-cell, prospective, randomized controlled clinical trial, stratified by manner of death of loved one and treatment site. SETTING: A university-based psychiatric research clinic as well as a satellite clinic in a low-income African American community between April 2001 and April 2004. PARTICIPANTS: A total of 83 women and 12 men aged 18 to 85 years recruited through professional referral, self-referral, and media announcements who met criteria for complicated grief. INTERVENTIONS: Participants were randomly assigned to receive interpersonal psychotherapy (n = 46) or complicated grief treatment (n = 49); both were administered in 16 sessions during an average interval of 19 weeks per participant. MAIN OUTCOME MEASURE: Treatment response, defined either as independent evaluator-rated Clinical Global Improvement score of 1 or 2 or as time to a 20-point or better improvement in the self-reported Inventory of Complicated Grief. RESULTS: Both treatments produced improvement in complicated grief symptoms. The response rate was greater for complicated grief treatment (51%) than for interpersonal psychotherapy (28%; P = .02) and time to response was faster for complicated grief treatment (P = .02). The number needed to treat was 4.3. CONCLUSION: Complicated grief treatment is an improved treatment over interpersonal psychotherapy, showing higher response rates and faster time to response.