Skip to main content

Depressive symptomatology in severe dementia in a European sample: prevalence, associated factors and prescription rate of antidepressants

  • Clarissa M. Giebel (a1), Caroline Sutcliffe (a1), Anna Renom-Guiteras (a2), Seija Arve (a3), Ingalill Rahm Hallberg (a4), Maria Soto (a5), Adelaida Zabalegui (a6), Jan Hamers (a7), Kai Saks (a8) and David Challis (a1)...

Depression is a common comorbid disorder of dementia. This study explores the prevalence of and factors associated with depressive symptomatology, and antidepressant prescription rates in severe dementia across eight European countries.


In total, 414 people with severe dementia completed measures of cognition and quality of life (QoL), whilst carers completed proxy measures of activities of daily living (ADLs), depression, neuropsychiatric symptoms, QoL and comorbidity.


Findings indicated that 30% of the sample had depression, whilst the highest and lowest prevalence of depression was reported in Germany and Finland, respectively. Lower QoL, the presence of pain and more frequent neuropsychiatric symptoms were associated with depressive symptomatology, whilst no significant relationship between impairment of ADLs, comorbidity, and depression emerged. Spain and Estonia had the highest and lowest rates of antidepressant prescribing, respectively, whilst Germany had the highest discrepancy between depressive symptomatology and prescription.


The study highlights variations across countries in the prevalence of depressive symptomatology in severe dementia and prescription of antidepressants. Information about factors associated with depressive symptomatology may help to better identify and manage depression.

Corresponding author
Correspondence should be addressed to: Clarissa M. Giebel, Personal Social Services Research Unit, University of Manchester, Devonshire House, Oxford Road, M13 9PL Manchester, UK. Phone: +44-161-275-5652; Fax: +44-161-275-5790. Email:
Hide All
Alexopoulos, G. S. (1988). The Cornell Scale for Depression in Dementia: Administration & Scoring Guidelines. NY: Cornell Institute of Geriatric Psychiatry.
Alexopoulus, G. S., Abrams, R. S., Young, R. C. and Shamoian, C. A. (1988). Cornell scale for depression in dementia. Biological Psychiatry, 23, 271284.
Alzheimer's Disease International (2012). National Alzheimer and Dementia Plans Planned Policies and Activities.
Ballard, C. G., Bannister, C., Solis, M., Oyebode, F. and Wilcock, G. (1996). The prevalence, associations and symptoms of depression amongst dementia sufferers. Journal of Affective Disorders, 36, 135144.
Beerens, H. et al. (2014). Quality of life and quality of care for people with dementia receiving long term institutional care or professional home care: the European RightTimePlaceCare study. Journal of the American Medical Directors Association, 15, 5461.
Bielinski, K. and Lawlor, B. (2006). Depression in Severe Dementia in A. Burns and B. Winblad (eds) Severe Dementia. Chichester: Wiley.
Charlson, M. E., Pompei, P., Ales, K. and MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373383.
Chou, K. L. (2007). Reciprocal relationship between pain and depression in older adults: evidence from the English longitudinal study of ageing. Journal of Affective Disorders, 102, 115123.
Cohen-Mansfield, J. and Libin, A. (2005). Verbal and physical non-aggressive agitated behaviors in elderly persons with dementia: robustness of syndromes. Journal of Psychiatric Research, 39, 325332.
Conde-Sala, J. L. et al. (2014). Severity of dementia, anosognosia, and depression in relation to the quality of life of patients with Alzheimer disease: discrepancies between patients and caregivers. American Journal of Geriatric Psychiatry, 22, 138147.
Davydow, D. S., Zivin, K. and Langa, K. M. (2014). Hospitalization, depression and dementia in community-dwelling older Americans: findings from the national health and aging trends study. General Hospital Psychiatry, 36, 135141.
deMedeiros, K. et al. (2010). The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. International Psychogeriatrics, 22, 984994.
Department of Health (2009). Living Well with Dementia. A National Dementia Strategy. London: Department of Health.
Donaldson, C., Tarrier, N. and Burns, A. (1998). Determinants of carer stress in Alzheimer's disease. International Journal of Geriatric Psychiatry, 13, 248256.
Earnst, K. S. et al. (2001). Loss of financial capacity in Alzheimer's disease: the role of working memory. Aging Neuropsychology and Cognition, 8, 109119.
Folstein, M., Folstein, S. and McHugh, P. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
G8 UK (2013). G8 Dementia Summit Declaration. London: Department of Health.
Gaugler, J. E., Hovater, M., Roth, D. L., Johnston, J. A., Kane, R. L. and Sarsour, K. (2014). Depressive, functional status, and neuropsychiatric symptom trajectories before an Alzheimer's disease diagnosis. Aging & Mental Health, 18, 110116.
Giebel, C. M. et al. (2014). Deterioration of basic activities of daily living and their impact on quality of life across different cognitive stages of dementia: a European study. International Psychogeriatrics, 26, 12831293.
Giebel, C. M., Sutcliffe, C. and Challis, D. (2015). Activities of daily living and quality of life across different stages of dementia: a UK study. Aging & Mental Health, 19(1), 6371.
Graeske, J., Fischer, T., Kuhlmey, A. and Wolf-Ostermann, K. (2012). Quality of life in dementia care – differences in quality of life measurements performed by residents with dementia and by nursing staff. Aging & Mental Health, 16, 819827.
Hawes, C., Morris, J. N., Phillips, C. D., Fries, B. E., Murphy, K. and Mor, V. (1997). Development of the nursing home resident assessment instrument in the USA. Age & Ageing, 26 (Suppl. 2), 1925.
Hoe, J., Katona, C., Roch, B. and Livingston, G. (2005). Use of the QoL-AD for measuring quality of life in people with severe dementia – the LASER-AD study. Age & Ageing, 34, 130135.
Iden, K. R., Engedal, K., Hjorleifsson, S. and Ruths, S. (2014). Prevalence of depression among recently admitted long-term care patients in norwegian nursing homes: associations with diagnostic workup and use of antidepressants. Dementia and Geriatric Cognitive Disorders, 37, 154162.
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A. and Jaffe, M. W. (1963). Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. Journal of the American Medical Association, 85, 914919.
Kaufer, D. I. et al. (2000). Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. Journal of Neuropsychiatry and Clinical Neuroscience, 12, 233239.
Knapskog, A.-B., Barca, M. L. and Engedal, K. (2011). The cornell study group: a comparison of the validity of the cornell scale and the MADRS in detecting depression among memory clinic patients. Dementia and Geriatric Cognitive Disorders, 32, 287294.
Knapskog, A.-B., Barca, M. L. and Engedal, K. (2013). Prevalence of depression among memory clinic patients as measured by the cornell scale of depression in Dementia. Aging & Mental Health, 18, 579587.
Kruger, T. M., Abner, E. L., Mendiondo, M., Schmitt, F. A., Smith, C. D. and Jicha, G.A. (2012). Differential reports of pain and depression differentiate mild cognitive impairment from cognitively intact elderly participants. Journal of Geriatric Psychiatry and Neurology, 25, 107112.
Logsdon, R. G., Gibbons, L. E., McCurry, S. M. and Terri, L. (1999). Quality of life in Alzheimer's disease: patient and caregiver reports. Journal of Mental Health & Aging, 5, 2132.
Maas, C. J. M. and Hox, J. J. (2005). Sufficient sample sizes for multilevel modeling. Methodology: European Journal of Research Methods for the Behavioral and Social Sciences, 1, 8692.
Miller, L. A., Mioshi, E., Savage, S., Lah, S., Hodges, J. R. and Piguet, O. (2013). Identifying cognitive and demographic variables that contribute to carer burden in dementia. Dementia and Geriatric Cognitive Disorders, 36, 4349.
Molloy, D. W., Alemayehu, E. and Roberts, R. (1991). Reliability of a standardized Mini-Mental State Examination compared with the traditional Mini-Mental State Examination. American Journal of Psychiatry, 148, 102105.
Molloy, D. W. and Standish, T. I. M. (1997). A guide to the standardized mini-mental state examination. International Psychogeriatrics, 9 (Suppl. 1), 8794.
National Institute for Health and Clinical Excellence (NICE) (2006). Final Appraisal Determination: Donepezil, Galantamine, Rivastagmine (Review) and Memantine for the Treatment of Alzheimer's Disease. London: Department of Health.
Nikmat, A. W., Hawthorne, G. and Al-Mashoor, S. H. (2013). The comparison of quality of life among people with mild dementia in nursing home and home care—a preliminary report. Dementia, doi: 10.1177/1471301213494509.
Onder, G., Liperoti, R., Soldato, M., Cipriani, M. C., Bernabei, R. and Landi, F. (2007). Depression and risk of nursing home admission among older adults in home care in europe: results from the aged in home care (AdHOC) study. Journal of Clinical Psychiatry, 68, 13921398.
Payne, J. L. et al. (1998). Relationship of cognitive and functional impairment to depressive features in Alzheimer's disease and other dementias. Journal of Neuropsychiatry and Clinical Neuroscience, 10, 440447.
Prina, A. M. et al. (2013). Association between depression and hospital outcomes among older men. Canadian Medical Association Journal, 185, 117123.
Reppermund, S. et al. (2011). The relationship of current depressive symptoms and past depression with cognitive impairment and instrumental activities of daily living in an elderly population: the Sydney memory and ageing study. Journal of Psychiatric Research, 45, 16001607.
Rosness, T. A., Barca, M. L. and Engedal, K. (2010). Occurrence of depression and its correlates in early onset dementia patients. International Journal of Geriatric Psychiatry, 25, 704711.
Soto-Martin, M. et al. (2014). Associated factors with antipsychotic use in long-term institutional care in eight European countries: results from the RightTimePlaceCare study. Journal of the American Medical Directors Association, in press.
Thorgrimsen, L. et al. (2003). Whose quality of life is it anyway?: the validity and reliability of the quality of life-Alzheimer's disease (QoL-AD) scale. Alzheimer Disease and Associated Disorders, 17, 201208.
Tombaugh, T. N. and Mclntyre, N. J. (1992). The mini-mental state examination: a comprehensive review. Journal of the American Geriatric Society, 40, 922935.
van Asch, I. F. M., Nuyen, J., Verbeek, M. A., Frijters, D. H. M., Achterberg, W. P. and Pot, A. M. (2013). The diagnosis of depression and use of antidepressants in nursing home residents with and without dementia. International Journal of Geriatric Psychiatry, 28, 312318.
van der Linde, R. M., Dening, T., Matthews, F. E. and Brayne, C. (2014). Grouping of behavioural and psychological symptoms of dementia. International Journal of Geriatric Psychiatry, 29, 562568.
Van der Museele, S. et al. (2013). Prevalence and associated behavioural symptoms of depression in mild cognitive impairment and dementia due to Alzheimer's disease. International Journal of Geriatric Psychiatry, 28, 947958.
Verbeek, H. et al. (2012). A European study investigating patterns of transition from home care towards institutional dementia care: the protocol of a RightTimePlaceCare study. BMC Public Health, 12, 68.
Vilalta-Franch, J. et al. (2010). Syndromic association of behavioral and psychological symptoms of dementia in Alzheimer disease and patient classification. American Journal of Geriatric Psychiatry, 18, 421432.
Wetzels, R. B., Zuidema, S. U., De Jonghe, J. F. M., Verhey, F. R. J. and Koopmans, R. T. C. M. (2010). Determinants of quality of life in nursing home residents with dementia. Dementia and Geriatric Cognitive Disorders, 29, 189197.
WHO Collaborating Centre for Drug Statistics Methodology (2012). Guidelines for ATC classification and DDD assignment 2013. Oslo.
Woods, R. T. et al. (2014). What contributes to a good quality of life in early dementia? awareness and the QoL-AD: a cross-sectional study. Health Quality of Life Outcomes, 12, 94104.
Wright, S. L. and Persad, C. (2007). Distinguishing between depression and dementia in older persons: neuropsychological and neuropathological correlates. Journal of Geriatric Psychiatry and Neurology, 20, 189198.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed