Dementia, Depression, and Stress. Interview with Prof. Giuseppe Bersani.

The correlation between stress, depression, and cognitive symptoms, which sometimes overlap, shows how early intervention in case of psycho-emotional distress is crucial for a correct diagnosis and to ensure these problems do not exacerbate one another.

We discussed it with Professor Giuseppe Bersani, a specialist in Psychiatry, Clinical Criminology, and Forensic Psychiatry, and the head of the Center for Depressive Disorders at UPMC Salvator Mundi International Hospital.

Professor Bersani, how do the cognitive symptoms of depression present clinically?

Depression is a condition that manifests through somatic symptoms of cerebral origin, and through cognitive symptoms. In more severe cases, cognitive symptoms include issues of concentration, attention, memory, and verbal fluidity, and also emotional symptoms such as sadness, anxiety, and inhibition. These cognitive symptoms tend to anticipate specific emotional manifestations, they intensify as depression worsens, and often persist even after an apparent clinical remission. The persistence of the cognitive symptoms after a clinical improvement is an indicator of incomplete remission and a risk factor for a possible relapse.

Cognitive deficits, objective and subjective, are a serious factor of the disease and can increase the level of discomfort. However, in the vast majority of cases they don't lead to an irreversible development of the disease, although this may be perceived as such.

What can be done in similar cases?

In case of cognitive symptoms of depression it is important to consult a psychiatrist for an accurate assessment and correct diagnosis. Treatment of depression often includes a combination of antidepressants and psychotherapy.

However, if dementia is present, the neuronal damage is irreversible and cannot be fully treated. In this case, treatment is aimed at slowing the progression of the disease and improving the patient’s quality of life using drugs and non-pharmacological therapies such as occupational therapy and behavioral therapy.

In both cases, it's important to work with an interdisciplinary team of doctors, nurses, therapists and social workers, to provide comprehensive and personalized care to patients and their families.

What are the brain mechanisms behind the cognitive symptoms of depression and how does stress affect them?

The brain mechanisms underlying cognitive symptoms of depression are complex and still not fully understood. However, we know chronic stress can lead to neuroendocrine alterations, such as an increase in blood cortisol levels, inhibiting neuronal proliferation and connectivity in some brain regions, including the hippocampus. This neuronal dysfunction can lead to cognitive deficits, such as issues of concentration, learning, and memory.

This neuronal alteration is thought to have a pathogenetic role in the cognitive symptoms of depression. However, antidepressants can alleviate both depressive and cognitive symptoms, as they seem to reduce neuronal distress and restore brain connectivity. In summary, chronic stress can affect the brain mechanisms underlying the cognitive symptoms of depression, and appropriate therapies can help improve cognitive symptoms.

How can we differentiate between cognitive impairments caused by depression and those caused by dementia?

First of all, the course of the two conditions is different: depression has a more unstable and phasic course, while dementia has a more degenerative course. Brain neuroimaging studies can be very helpful to identify structural differences between the two conditions. However, in the initial or less full-blown stages of disease, the neuropsychological investigation can be very useful in highlighting the different profiles of cognitive impairment, which may be more present in depression or in the different forms of dementia.

What is the social impact of cognitive impairments in patients with depression and dementia, and how can it be limited?

Dementia has huge social consequences due to their dysfunctional aspects, mainly cognitive, and the need for care. However, clinically significant forms of depression, which are prevalent in the general population (about 20% for life), also have significant social consequences due to the associated cognitive deficits. These deficits can affect a person's condition, job performance and therapeutic needs. Early diagnosis is therefore essential to start a more effective disease management or therapy. In the case of depression, which in most cases can be cured, early diagnosis and timely start of adequate care, particularly pharmacological care, can play a key role treating the disorder and the prodromal, state or residual pictures of cognitive impairment.

Learn more about Psychiatry and Psychology service and about Center for Treatment of Major Depressive Disorders of UPMC Salvator Mundi International Hospital.