Research describing wide prevalence variation of Alzheimer's disease (AD) and comorbid depression is explained in light of subsyndromal depressions, the use of standardized diagnostic instruments and procedures, and the subcortical and cortical components of mood. There appear to be several "depressions" of AD. Against this backdrop, double-blind, placebo-controlled studies of antidepressant use in AD are reviewed and methodologic problems identified. Evidence for efficacy in controlled trials is weak, but open-label trials are, as expected, more encouraging. The potential efficacy of new agents for the depressions of AD receive comment. A heuristic model makes use of the conclusions developed, the stage of illness, and a preliminary classification scheme for the depressions of AD; this model provides a rational basis for thinking about medication selection for AD depressions. Clinical decisions are illustrated. (J Geriatr Psychiatry Neurol 1995; 8(suppl 1):S40-S51).
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References
1.
Knesevich J. , Martin R., Berg L., et al. Preliminary report on affective symptoms in the early stages of senile dementia of the Alzheimer's type. Am J Psychiatry1983; 140:233-235.
2.
Merriam A., Aronnson N., Gaston P., et al. The psychiatric symptoms of Alzheimer's disease. J Am Geriatr Soc1988; 36:7-12.
3.
Tariot Pn, Blazina L.The psychopathology of dementia. In: Morris JC, ed. Handbook of dementing illnesses. New York: Marcel Dekker, 1994.
4.
Wragg Re , Jeste DVOverview of depression and psychosis in Alzheimer's disease. Am J Psychiatry1989 ; 146:577-787.
5.
Regier Da , Boyd Jh , Burke Jd Jr., et al. One-month prevalence of mental disorders in the United States. Based on five epidemiologic catchment area sites. Arch Gen Psychiatry1988; 45:977-986.
6.
Somervell Pd , Leaf Pj , Weissman Mm, et al. The prevalence of major depression in black and white adults in five United States communities . Am J Epidemiol1989 ; 130:725-735.
7.
Simon Ge , VonKorff M.Reevaluation of secular trends in depression rates. Am J Epidemiol1992; 135:1411-1422.
8.
Knauper B., Wittchen HUDiagnosing major depression in the elderly: evidence for response bias in standardized diagnostic interviews? J Psychiatr Res1994; 28:147-164.
9.
Blumer D., Benson DFPersonality changes with frontal and temporal lobe lesions. In: Benson DF, Blumer D, eds. Psychiatric aspects of neurological disease . New York: Grune & Stratton , 1975:151-170.
10.
Frisoni Gb , Pizzolato G., Geroldi C., et al. Dementia of the frontal type: neuropsychological and [ 99Tc]-HM-PAO SPECT features. J Geriatr Psychiatry Neurol1995 ; 8:42-48.
11.
Sungaila P. , Crockett DJDementia and the frontal lobes. In: Parks RW, Zec RF, Wilson RS, eds. Neuropsychology of Alzheimer's disease and other dementias. New York: Oxford University Press, 1993:235-264.
12.
Neary D., Snowden Js, Shields RASingle photon emission tomography using 99mTc-HMPAO in the investigation of dementia. JNeurol Neurosurg Psychiatry1987; 50:1101-1109.
13.
Gustafson L. , Brun A., Risberg J.Frontal lobe dementia of non-Alzheimer type . In: Wurtman RJ, Corkin S, Growdon J, et al, eds. Advances in neurology: Alzheimer's disease, Vol. 51. New York: Raven Press, 1990.
14.
Migliorelli R., Teson A., Sabe L., et al. Prevalence and correlates of dysthymia and major depression among patients with Alzheimer's disease. Am J Psychiatry1995; 152:37-44.
15.
Burns A., Jacoby R., Levy R.Psychiatric phenomena in Alzheimer's disease. III: Disorders of mood. Br J Psychiatry1990; 157:81-86.
16.
Rovner Bw , Broadhead J., Spencer M., et al. Depression and Alzheimer's disease . Am J Psychiatry1989 ; 146:350-353.
17.
Cummings J. , Ross W., Absher J., et al. Depressive symptoms in Alzheimer disease: assessment and determinants. Alzheimer Dis Assoc Disord1995; 9:87-93.
18.
Cummings Jl , Mega M., Gray K., et al. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology1994; 44:2308-2314.
19.
Newman JPAging and depression. Psychol Aging1989; 4:150-165.
20.
Vida S., DesRosiers P, Carrier L., et al.Prevalence of depression in Alzheimer's disease and validity of research diagnostic criteria. J Geriatr Psychiatry Neurol1994; 7:238-244.
21.
Moye J., Robiner Wn, Mackenzie TBDepression in Alzheimer patients; discrepancies between patient and caregiver reports. Alzheimer Dis Assoc Disord1993; 7:187-201.
22.
American Psychiatric Association.Diagnostic and statistical manual of mental disorders. 4th Ed. Washington, DC: American Psychiatric Association, 1994.
23.
Judd Lj , Rapaport Mh , Paulus Mp , et al.Subsyndromal depression: a new mood disorder?J Clin Psychiatry1994; 55(suppl):18-28.
24.
Greenwald Bs , Kramer-Ginsberg E., Marin Db, et al.Dementia with coexistent major depression . Am J Psychiatry1989; 146:1472-1478.
25.
Blazer DGDysthymia in community and clinical samples of older adults. Am J Psychiatry1994; 151:1567-1569. Editorial.
26.
Wells Kb , Burnam Ma , Rogers W., et al. The course of depression in adult outpatients: results from the Medical Outcomes Study. Arch Gen Psychiatry1992; 49:788-794.
27.
Broadhead We , Blazer Dg, George Lk, et al. Depression, disability days and days lost from work in a prospective epidemiologic survey . JAMA1990; 264:2524-2528.
Dunner DLTherapeutic considerations in treating depression in the elderly . J Clin Psychiatry1994; 55(suppl):48-60.
30.
Reifler Bv , Teri L., Raskind M., et al. Double-blind trial of imipramine in Alzheimer's disease patients with and without depression. Am J Psychiatry1989; 146:45-49.
31.
Folstein M. , Folstein Se, McHugh PR. "Mini-Mental State": a practical method of grading the cognitive state of patients for the clinician . J Psychiatr Res1975; 12:189-198.
32.
Merello M., Sabe L., Teson A., et al. Extrapyramidalism in Alzheimer's disease: prevalence, psychiatric, and neuropsychological correlates. J Neurol Neurosurg Psychiatry1994; 57:1503-1509.
33.
Starkstein Se , Migliorelli R., Teson A., et al. Specificity of changes in cerebral blood flow in patients with frontal lobe dementia . J Neurol Neurosurg Psychiatry1994; 57:790-796.
34.
Girling Dm , Berrios GEExtrapyramidal signs, primitive reflexes and frontal lobe function in senile dementia of the Alzheimer type . Br J Psychiatry1990; 157:888-893.
35.
Molsa Pk , Martilla Rj , Rinne UKExtrapyramidal signs in Alzheimer's disease . Neurology1984; 34:1114-1116.
36.
Starkstein Se , Migliorelle R., Sabe L., et al.Prevalence and correlates of extrapyramidalism in Alzheimer's disease. Biol Psychiatry1995 ; 37:596.
37.
Tyrrell Pj , Swale Gv , Ibanez V., et al. Clinical positron emission tomographic studies in the extrapyramidal syndrome of dementia of the Alzheimer's type . Arch Neurol1990; 47:1318-1323.
38.
Bakchine S. , Lacomblez L., Palisson E., et al. Relationship between primitive reflexes, extra-pyramidal signs, reflective apraxia and severity of cognitive impairment in dementia of the Alzheimer Type. Acta Neurol Scand1989; 79:38-46.
39.
Cummings Jl .Frontal-subcortical circuits and human behavior . Arch Neurol1993; 50:873-880.
40.
Taylor AEFrontal lobe dysfunction in Parkinson's disease. Brain1986; 109:845-883.
41.
Albert Ml , Feldman Rg , Willis ALThe 'subcortical dementia' of progressive supranuclear palsy. JNeurol Neurosurg Psychiatry1974; 37:121-130.
42.
Blazer DGDepression in the elderly. N Engl J Med1989 ; 320:164-166.
43.
Blazer D., Woodbury M., Hughes Dc, et al. A statistical analysis of the classification of depression in a mixed community and clinical sample. JAffect Disord1989; 16:11-20.
44.
Sunderland T.Depressive syndromes in the elderly: special concerns. Psychopharmacol Bull1988; 24:567-576.
45.
Pearlson Gd , Ross Ca , Lohr Wd , et al. Association between family history of affective disorder and the depressive syndrome of Alzheimer's disease. Am J Psychiatry1990 ; 147:452-456.
46.
Loreck Dj , Folstein MFDepression in Alzheimer's disease . In: Starkstein SE, Robinson RG, eds. Depression in neurologic disease. Baltimore, MD: Johns Hopkins University Press, 1993:50-62.
47.
Lazarus Lw , Newton N., Cohler B., et al. Frequency and presentation of depressive symptoms in patients with primary degenerative dementia. Am J Psychiatry1987; 144:41-45.
48.
Reifler BVMixed cognitive-affective disturbances in the elderly; a new classification . J Clin Psychiatry1986; 47:354-356.
49.
Galynker I. , Roane D., Miner C., et al. Negative symptoms in patients with Alzheimer's disease. Am J Geriatr Psychiatry1995; 3:52-59.
50.
Royall Dr , Mahurin Rk , Cornell J.Bedside assessment of frontal degeneration: distinguishing Alzheimer's disease from non-Alzheimer's cortical dementia . Exp Aging Res1994; 20:95-103.
51.
Rothland Jc , Brandt J.A brief assessment of frontal and subcortical functions in dementia. J Neuropsychiatry Clin Neurosci1993; 5:73-77.
52.
Ditter Sm , Mirra SSNeuropathologic and clinical features of Parkinson's disease in Alzheimer's disease patients. Neurology1987; 37:754-760.
53.
Funkenstein Hh , Albert Ms, Cook Nr, et al. Extrapyramidal signs and other neurological findings in clinically diagnosed Alzheimer's disease. Arch Neurol1993; 50:51-56.
54.
Minchon A., Deweer B., Agid Y., et al. Relation of anosognosia to frontal lobe dysfunction in Alzheimer's disease. J Neurol Neurosurg Psychiatry1994 ; 57:805-809.
55.
Reed Br , Jagust Wj , Coulter L., et al. Anosognosia in Alzheimer's disease: relationships to depression, cognitive function, and cerebral prefusion . J Exp Clin Neuropsychol1993; 15:231-244.
56.
Forstl H., Burns A., Jacoby R., et al. Neuroanatomical correlates of clinical misidentification and misperception in senile dementia of the Alzheimer type. J Clin Psychiatry1991; 52:268-271.
57.
American Psychiatric Association.Diagnostic and statistical manual of mental disorders. 3rd Ed. Washington, DC: American Psychiatric Association, 1980.
58.
Hamilton M.Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol1976; 6:278-296.
59.
Fuchs A., Hehnke U., Erhart C., et al. Video rating analysis of effect of maprotiline in patients with dementia and depression. Pharmacopsychiatry1993; 26:37-41.
60.
American Psychiatric Association.Diagnostic and statistical manual of mental disorders. 3rd Ed., Revised. Washington, DC: American Psychiatric Association, 1987.
61.
Nyth Al , Gottfries CGThe clinical efficacy of citalopram in treatment of emotional disturbances in dementia disorders. A Nordic multicentre study. Br J Psychiatry1990;157:894-901.
62.
Montgomery S., Åsberg M.A new depression scale designed to be sensitive to change. Br J Psychiatry1979; 134:381-382.
63.
Nyth A., Gottfries C., Lyby K., et al. A controlled multicenter clinical study of citalopram and placebo in elderly depressed patients with and without concomitant dementia. Acta Psychiatr Scand1992; 86:138-145.
64.
Leblhuber F.Citalopram in treatment of behavioral disorders in demented patients. Acta Med Austriaca1994; 21:104-106.
65.
McKhann G., Drachman D., Folstein M., et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology1984; 34:939-944.
66.
Olafsson K. , Jorgensen S., Jenson Hv, et al. Fluvoxamime m the treatment of demented elderly patients: a double-blind, placebo-controlled study. Acta Psychiatr Scand1992; 85:453-456.
67.
Rampello L. , Nicoletti G., Raffaele R.Dopaminergic hypothesis for retarded depression: a symptom profile for predicting therapeutic responses . Acta Psychiatr Scand1991; 84:552-554.
68.
Brown As , Gershon S.Dopamine and depression. J Neural Transm1993; 91:75-109.
69.
Passeri M., Cucmotta D., DeMello M., et al. Comparison of minaprine and placebo in the treatment of Alzheimer's disease and multi-infarct dementia. Int J Geriatr Psychiatry1987; 2:97-104.
70.
Marin Rs , Fogel Bs , Hawkins J., et al. Apathy: a treatable syndrome . J Neuropsychiatry Clin Neurosci1995; 7:23-30.
71.
Bouckoms A. , Mangini L.Pergolide: an antidepressant adjuvant for mood disorders? Psychopharmacol Bull1993 ; 29:207-211.
72.
Passeri M., Cucinotta D., Abate G., et al.Oral 5'-methyltetrahydrofolic acid in senile organic mental disorders with depression: results of a double-blind multicenter study. Aging (Milano)1993; 5:63-71.
73.
Heuser I., Heuser-Link M., Gotthardt U., et al.Behavioral effects of a synthetic corticotropin 4-9 analog in patients with depression and patients with Alzheimer's disease . J Clin Psychopharmacol1993 ; 13:171-174.
74.
Bottiglieri T., Godfrey P., Flynn T., et al. Cerebrospinal fluid S-adenosylmethionine in depression and dementia: effects of treatment with parenteral and oral S-adenosylmethionine. J Neurol Neurosurg Psychiatry1990; 53:1096-1098.
75.
Levinson B. , Wright P., Barklem S.Effect of buflomedil on behaviour, memory, and intellectual capacity in patients with dementia. A placebo-controlled study. S Afr Med J1985 ; 68:302-307.
76.
Teri L., Reifler Bv, Veith Rc, et al. Imipramine in the treatment of depression in Alzheimer's patients: impact on cognition. J Gerontol1991; 46:372-377.
77.
Sunderland T., Tariot P., Cohen R., et al. Anticholinergic sensitivity in patients with dementia of the Alzheimer type and age-matched controls. Arch Gen Psychiatry1987; 44:418-426.
78.
Branconnier R., De Vitt D., Cole J., et al.Amitriptyline selectively disrupts verbal recall from secondary memory of the normal aged . Neurobiol Aging1982; 3:55-59.
79.
Meyers B., Mattis S., Gabriele M., et al. Effects of nortriptyline on memory self-assessment and performance in recovered elderly depressives. Psychopharmacol Bull1991; 27:295-299.
80.
Young R., Mattis S., Alexopoulos G., et al. Verbal memory and plasma drug concentrations in elderly depressives treated with nortriptyline. Psychopharmacol Bull1991; 27:291-294.
81.
Marcopulos Ba , Graves REAntidepressant effect on memory in depressed older persons. J Clin Exp Neuropsychol1990 ; 12:655-663.
82.
Katz I., Simpson G., Curlick S., et al. Pharmacologic treatment of major depression for elderly patients in residential care settings. J Clin Psychiatry1990; 51:41-47.
83.
Reynolds Cf III, Perel Jm, Kupfer Dj, et al.Open-trial response to antidepressant treatment in elderly patients with mixed depression and cognitive impairment . Psychiatr Res1987; 21:111-122.
84.
Greden JFAntidepressant maintenance medications: when to discontinue and how to stop . J Clin Psychiatry1993; 54(suppl):39-45.
85.
Roose S., Glassman A., Attia E., et al. Comparative efficacy of selective serotonin reuptake inhibitors and tricyclics in the treatment of melancholia. Am J Psychiatry1994; 151: 1735-1739.
86.
Hindmarch I. , Shillingford J., Shillingford C.The effects of sertraline on psychomotor performance in elderly volunteers. J Clin Psychiatry1990; 51:34-36.
87.
Mattila Mj , Saarialho-Kere U., Mattila M.Acute effects of sertraline, amitriptyline, and placebo on the psychomotor performance of healthy subjects over 50 years of age. J Clin Psychiatry1988 ; 49:52-58.
88.
Tueth M.How to manage depression and psychosis in Alzheimer's disease. Geriatrics1995; 50:43-49.
89.
Dewan Vk, Burke Wj, Roccaforte WHSelective serotonin reuptake inhibitors for treatment of depression and psychosis in dementia. In: New research and program abstracts: 1995 annual meeting. Washington, DC: American Psychiatric Association, 1995: 57.
90.
Burke W., Folks D., Roccaforte W., et al. Serotonin reuptake inhibitors for the treatment of coexisting depression and psychosis in dementia of the Alzheimer type. Am J Geriatr Psychiatry1994; 2:352-354.
91.
Volicer L., Rheaume Y., Cyr D.Treatment of depression in advanced Alzheimer's disease using sertraline . J Geriatr Psychiatry Neurol1994; 7:227-229.
92.
Preskorn S. , Burke M.Somatic therapy for major depressive disorder: selection of an antidepressant. J Clin Psychiatry1992; 53(suppl):S1-S14.
93.
Baldwin D., Fineberg N., Montgomery S.Fluoxetine, fluvoxamine and extrapyramidal tract disorders. Int Clin Psychopharmacol1991; 6:51-58.
94.
Lauterbach ECReversible intermittent rhythmic myoclonus with fluoxetine in presumed Pick's disease. Mov Disord1994; 9:343-346.
95.
Beasley C., Potvin J.Fluoxetine: activating and sedating effects. Int Clin Psychopharmacol1993; 8:271-275.
96.
Hoehn-Saric R., Lipsey J., McLeod D.Apathy and indifference in patients on fluvoxamine and fluoxetine. J Clin Psychopharmacol1990 ; 10:343-345.
97.
Lantz Ms , Louis A., Lowenstein G., et al. A longitudinal study of psychotropic prescriptions in a teaching nursing home. Am J Psychiatry1990; 147:1637-1639.
98.
Saura J., Luque Jm, Cesura Am, et al. Increased monoamine oxidase B activity in plaque-associated astrocytes of Alzheimer brains revealed by quantitative enzyme radioautography . Neuroscience1994; 62:15-30.
99.
Fischer P., Gotz Me, Ellinger B., et al. Platelet monoamine oxidase B activity and vitamin B12 in dementia. Biol Psychiatry1994; 35:772-774.
100.
Schneider L., Tariot P., Goldstein B.Therapy with 1-deprenyl (selegiline) and relation to abuse liability. Clin Pharmacol Ther1994; 56:750-756.
101.
Wesnes K., Anand R., Lorscheid T.Potential of moclobemide to improve cerebral insufficiency identified using a scopolamine model of aging and dementia. Acta Psychiatr Scand1990; 82:71-72.
102.
Ashford Jw , Ford CVUse of MAO inhibitors in elderly patients . Am J Psychiatry1979; 136:1466-1467.
103.
Jenike MAMonoamine oxidase inhibitors as treatment for depressed patients with primary degenerative dementia (Alzheimer's disease . Am J Psychiatry1985; 142:763-764.
104.
Mangoni A. , Grassi Mp, Frattola L., et al. Effects of a MAO-B inhibitor in the treatment of Alzheimer disease. Eur Neurol1991; 31:100-107.
105.
Agnoli A., Martucci N., Fabbrini G., et al. Monoamine oxidase and dementia: treatment with an inhibitor of MAO-B activity. Dementia1990; 1:109-114.
106.
Piccinin Fl , Finali G., Piccirilli M.Neuropsychological effects of 1-deprenyl in Alzheimer's type dementia. Clin Neuropharmacol1990 ; 13:147-163.
107.
Tariot Pn , Sunderland T., Weingartner H., et al. L-Deprenyl in Alzheimer's disease . Arch Gen Psychiatry1987; 44: 427-433.
108.
Sunderland T., Cohen R., Molchan S., et al. High-dose selegiline in treatment-resistant older depressive patient. Arch Gen Psychiatry1994; 51:607-615.
109.
Mann J., Aarons S., Wilner P., et al. A controlled study of the antidepressant efficacy and side-effects of l-deprenyl. Arch Gen Psychiatry1989; 46:45-50.
110.
Bodner Ra , Lynch T., Lewis L., et al. Serotonin syndrome . Neurology1995; 45:219-223.
111.
CesuraAm , Pletsher A.The new generation of monoamine oxidase inhibitors . Prog Drug Res1992; 38:171-297.
Postma Ju , Vranesic D.Moclobemide in the treatment of depression in demented geriatric patients . Acta Therapeutica1985; 11:1-4.
114.
Chan-Palay V.Depression and senile dementia of the Alzheimer type: a role for moclobemide. Psychopharmacology1992; 106 (suppl):S137-S139.
115.
Fawcett J., Busch KAPsychostimulants in psychiatry. In: Shatzberg AF, Nemeroff CB, eds. Psychopharmacology. Washington, DC: American Psychiatric Press, 1995:417-435.
116.
Jeste Dv , Lohr Jb , Goodwin FKNeuroanatomical studies of major affective disorders: a review and suggestions for future research. Br J Psychiatry1988 ; 153:444-459.
117.
Branconnier Rj , Cole JOThe therapeutic role of methylphenidate in senile organic brain syndrome. Proc Annu Meet Am Psychopathol Assoc1980; 69:183-196.
118.
Kaplitz SEWithdrawn, apathetic geriatric patients responsive to methylphenidate. JAm Geriatr Soc1975; 23:271-276.
119.
Gurian B., Rosowsky E.Low-dose methylphenidate in the very old. J Geriatr Psychiatry Neurol1990; 3:152-154.
120.
Pickett P. , Masand P., Murra GSPsychostimulant treatment of geriatric depressive disorders secondary to medical illness. J Geriatr Psychiatry Neurol1990; 3:146-151.
121.
Holmes Vf , Fernandez F., Levy JKPsychostimulant response in AIDS-related complex patients. J Clin Psychiatry1989; 50:5-8.
122.
Marin D., David K.Experimental therapeutics. In: Bloom FE, Kupfer DJ, eds. Psychopharmacology: the fourth generation of progress. New York: Raven Press, 1995:1417-1426.
123.
Alexopoulos GSTreatment of depression. In: Salzman C, ed. Clinical genatric psychopharmacology . 2nd Ed. Baltimore, MD: Williams & Wilkins, 1992:153.
124.
Maletta Gj , Winegarden T.Reversal of anorexia by methylphenidate in apathetic, severely demented nursing home patients. Am J Geriatr Psychiatry1993; 1:234-243.
125.
Kasper S., Moller Hj, Montgomery S., Zondag E.Antidepressant efficacy in relation to item analysis and severity of depression: a placebo-controlled trial of fluvoxamine versus imipramine . Int Clin Psychopharmacol1995; 9:3-12.
126.
Pinner E., Rich CLEffects of trazodone on aggressive behavior in seven patients with organic mental disorders. Am J Psychiatry1988; 145:1295-1296.
127.
Simpson Dm , Foster D.Improvement in organically disturbed behavior with trazodone treatment. J Clin Psychiatry1986; 47:191-193.
128.
Fontaine R.Novel serotonergic mechanisms and clinical experience with nefazodone. Clin Neuropharmacol1993; 16(suppl 3):S45-S50.
129.
Pick Cg , Paul D., Eison Ms , et al. Potentiation of opioid analgesia by the antidepressant nefazodone . Eur J Pharmacol1992; 211:375-381.
130.
Danjou P., Hackett D.Safety and tolerance profile of venlafaxine. Int Clin Psychopharmacol1995; 10:15-20.
131.
Lecrubier Y.Clinical utility ofvenlafaxine in comparison with other antidepressants. Int Clin Psychopharmacol1995; 10:29-35.
132.
Gerson S., Plotkin D., Jarvik L.Antidepressant drug studies, 1964 to 1986: empirical evidence for aging patients . J Clin Psychopharmacol1988 ; 8:311-322.
133.
Flint A.Recent developments in geriatric psychopharmacotherapy. Can J Psychiatry1994; 39(suppl.):S9-S18.
134.
Reisberg B. , Ferris Sh , de Leon Mj , Crook T.The global deterioration scale for assessment of primary degenerative dementia . Am J Psychiatry1982; 139:1136-1139.
135.
Hoehn M., Yahr M.Parkinsonism: onset, progression, and mortality. Neurology1967; 17:427-433.
136.
Huber S., Freidenberg D., Paulson G., et al. The pattern of depressive symptoms varies with progression of Parkinson's disease. J Neurol Neurosurg Psychiatry1990; 53:275-278.
137.
Martin A., Brouwers P., Lalonde F., et al. Towards a behavioral typology ofAlzheimer's patients. J Clin Exp Neuropsychol1986; 8:594-610.
138.
Mayeux R., Stern Y., Spanton S.Heterogeneity in dementia of the Alzheimer type. Neurology1985; 35:453-461.
139.
Cummings JLBehavioral complications of drug treatment of Parkinson's disease. J Am Geriatr Soc1991 ; 39:708-716.
140.
Gelenberg A.Apathy and new antidepressants. Biol Ther Psychiatry Newsletter1991; 14:9,12.
141.
McQuistian Hl , Adler La , Leong S.Carbamazepine in frontal lobe syndrome: two more cases. J Clin Psychiatry1987; 48:456.
142.
McAllister TWCarbamazepine in mixed frontal lobe and psychiatric disorders. J Clin Psychiatry1985 ; 46:393-394.
143.
Richter JEPractical approach to the diagnosis of unexplained chest pain. Med Clin North Am1991; 75:1203-1208.
144.
Kroenke K. , Mangelsdorff ADCommon symptoms in ambulatory care: incidence, evaluation, therapy and outcome. Am J Med1989; 86:262-266.
145.
Fleet Rp , Dupuis G., Marchand A., et al. Panic disorder, chest pain and coronary artery disease: literature review. Can J Car-diol1994; 10:827-834.
146.
Salloway S. , Cummings J.Subcortical disease and neuropsychiatric illness . JNeuropsychiatry Clin Neurosci1994 ; 6:93-99. Editorial.
