Perceptual and Motor Skilk, 1991, 73, 1032. O Perceptual and Motor Skills 1991
GERIATRIC DEPRESSION SCALE: CONSISTENCY OF DEPRESSIVE SYMPTOMS OVER TIME ' JEROME A. YESAVAGE
Veterans Administration Medical Center, Palo Alto, CA Summary.-The following is a comment on the importance of the 1991 finding by
I. L. Abraham of the unchanging nature of depressive symptoms over time: one concludes that such patients wlll not change untess major interventions, both pharmacologic or psychosocial, can be made. The paper by Abraham makes an important point about the consistency of clinical signs of depression in elderly persons over time (1991). Undiagnosed and untreated depression in elderly individuals account for about 20% of suicides, while elderly persons only represent 12% of the total US population (American Psychiatric Association, 1988). As the current data suggest, the problem of depression does not appear to remit spontaneously in these patients. One wonders why. I t may be that the biochemistry of depression is such that it predisposes to a consistent picture over time (see Alexopoulos, 1988; Allen & Blazer, 1991; Nakra & Grossberg, 1990 for reviews). We now know that the brain is not as metabolically active in old age as it is in earlier years. Decreased cerebral blood flow has been observed in patients with late-onset depression as opposed to younger depressed persons. There is also evidence from studies of late-onset depressives that suggests structural abnormalities. These findings have important implications for neurotransmitter synthesis and metabolism since synthesis and reuptake of amine neurotransmitters is energy-dependent. It is not surprising that studies of elderIy persons have shown a decrease in brain concentrations of biogenic amine neurotransmitcers such as serotonin, dopamine, and norepinephrine, and their metabolites. Along with reduced neurotransmitters, a reduction of certain adrenergic receptor binding sites has been found in some elderly persons. These deficits taken together may predispose elderly persons to the development of primary depression. Given the extensive evidence for a biochemical predisposition to depression in elderly individuals, Abraham's finding of relatively consistent measures of depression over time is quite believable. It is likely that biochemical scacus of such patients will nor change unless major interventions are made. Such interventions m~ghtbe both pharmacologic and psychosocial. One may conclude that unless depression is both dugnosed and treated in such elderly populations, little will be done to alleviate the problem of suicide among elderly persons.
REFERENCES ABRAHAM, I. L. (1991) The Geriatric Depression Scale and Hopelessness Index: longitudinal psychometric data on frail nursing home residents. Perceptual and Motor Skills, 1991, 72, 875-880. ALEXOPOULOS, G . S. (1988) Psychosis and depression in the elderly. Psychiatric Clinics of North America, 11, 101-115. ALLEN, A , , & BLAZER,D. G. (1991) Mood disorders. In J. Sadavoy, L. W. Lazarus, & L. F. Jarvik (Eds.), Comprehetrsive review of geriatric psychiatry. Washington, DC: American Psychiatric Press. Pp. 337-352. AMERICAN PSYCHIATRIC ASSOCIATION. (1988) Mental health of the elderly. Baltimore, MD: Author. NAKRA,B. R., & GROSSBERG, G. T. (1990) Mood disorders. In D. Bienenfeld (Ed.), Verwoerdtk clinical geropsychiatry. Baltimore, MD: Wllliams & Wilkins. Pp. 107-124. Accepted November 27, 1991. 'Address correspondence to J. A. Yesavage, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305.
GERIATRIC DEPRESSION SCALE: CONSISTENCY OF DEPRESSIVE SYMPTOMS OVER TIME ' JEROME A. YESAVAGE
Veterans Administration Medical Center, Palo Alto, CA Summary.-The following is a comment on the importance of the 1991 finding by
I. L. Abraham of the unchanging nature of depressive symptoms over time: one concludes that such patients wlll not change untess major interventions, both pharmacologic or psychosocial, can be made. The paper by Abraham makes an important point about the consistency of clinical signs of depression in elderly persons over time (1991). Undiagnosed and untreated depression in elderly individuals account for about 20% of suicides, while elderly persons only represent 12% of the total US population (American Psychiatric Association, 1988). As the current data suggest, the problem of depression does not appear to remit spontaneously in these patients. One wonders why. I t may be that the biochemistry of depression is such that it predisposes to a consistent picture over time (see Alexopoulos, 1988; Allen & Blazer, 1991; Nakra & Grossberg, 1990 for reviews). We now know that the brain is not as metabolically active in old age as it is in earlier years. Decreased cerebral blood flow has been observed in patients with late-onset depression as opposed to younger depressed persons. There is also evidence from studies of late-onset depressives that suggests structural abnormalities. These findings have important implications for neurotransmitter synthesis and metabolism since synthesis and reuptake of amine neurotransmitters is energy-dependent. It is not surprising that studies of elderIy persons have shown a decrease in brain concentrations of biogenic amine neurotransmitcers such as serotonin, dopamine, and norepinephrine, and their metabolites. Along with reduced neurotransmitters, a reduction of certain adrenergic receptor binding sites has been found in some elderly persons. These deficits taken together may predispose elderly persons to the development of primary depression. Given the extensive evidence for a biochemical predisposition to depression in elderly individuals, Abraham's finding of relatively consistent measures of depression over time is quite believable. It is likely that biochemical scacus of such patients will nor change unless major interventions are made. Such interventions m~ghtbe both pharmacologic and psychosocial. One may conclude that unless depression is both dugnosed and treated in such elderly populations, little will be done to alleviate the problem of suicide among elderly persons.
REFERENCES ABRAHAM, I. L. (1991) The Geriatric Depression Scale and Hopelessness Index: longitudinal psychometric data on frail nursing home residents. Perceptual and Motor Skills, 1991, 72, 875-880. ALEXOPOULOS, G . S. (1988) Psychosis and depression in the elderly. Psychiatric Clinics of North America, 11, 101-115. ALLEN, A , , & BLAZER,D. G. (1991) Mood disorders. In J. Sadavoy, L. W. Lazarus, & L. F. Jarvik (Eds.), Comprehetrsive review of geriatric psychiatry. Washington, DC: American Psychiatric Press. Pp. 337-352. AMERICAN PSYCHIATRIC ASSOCIATION. (1988) Mental health of the elderly. Baltimore, MD: Author. NAKRA,B. R., & GROSSBERG, G. T. (1990) Mood disorders. In D. Bienenfeld (Ed.), Verwoerdtk clinical geropsychiatry. Baltimore, MD: Wllliams & Wilkins. Pp. 107-124. Accepted November 27, 1991. 'Address correspondence to J. A. Yesavage, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305.
