The Difficult Distinction Between Affective Disorders and Mild Cognitive Deterioration

Abstract

Mild cognitive impairments and affective symptoms, such as depression, and anxiety are very common and often co-occurring in elderly people. In clinical practice, the differentiation between a primary affective disorder and mild cognitive impairments (e.g., as an early symptom of cognitive deterioration) is very difficult, as both syndromes are largely overlapping in clinical presentation. Etiological heterogeneity, however, leads to differences in clinical course and prognosis. In this chapter, we will mainly focus on the clinical manifestation and the clinical distinction between affective and cognitive problems, as we think this should be the starting point of any evaluation of patients with cognitive and affective symptoms. Furthermore several plausible mechanisms are described for the explanation of the complex interplay between depression and mild cognitive impairments (due to Alzheimer's disease). In addition, the pharmacological and non-pharmacological management of affective symptoms and mild cognitive impairment, and the differences in intended targets for both conditions are discussed. The thorough workup and the applicability of several important biomarkers available in the differential diagnosis of the diseases are out of the scope of this chapter.