Pilot study results suggest that older adults with both depression and cognitive impairment (DEP-CI) show cognitive decline and often convert to dementia, primarily Alzheimer's disease. In this pilot clinical trial, older adults with DEP-CI will be treated with the antidepressant citalopram for 8 weeks. Those who respond to treatment will then take add-on donepezil or a placebo. Non-responders to citalopram will be treated with the antidepressant venlafaxine for 8 weeks, then add-on donepezil or a placebo. Investigators seek to clarify how donepezil works in older adults with DEP-CI. The ultimate goal is to kmprove cognition and delay conversion to dementia in this high-risk group.
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Depression (DEP) and cognitive impairment (CI) are common neuropsychiatric disorders in older adults. Since DEP in patients with CI increases the risk of conversion to dementia, treatment strategies for DEP-CI have implications beyond acute treatment with antidepressants. The long-term prognosis of individuals with DEP-CI remains unclear, as there is a lack of data on response of mood symptoms to antidepressant treatment and of cognitive deficits to cognitive enhancer treatment.
The primary aim of the study is to assess changes in cognitive status over 18 months in antidepressant-treated older adults with DEP-CI, comparing donepezil to a placebo. We hypothesize that antidepressant-treated participants on donepezil will show a lower rate of conversion to dementia, compared with participants treated with a placebo. The study population consists of 80 older adults with DEP-CI who have been treated with antidepressants. Participants who respond to treatment with the antidepressant citalopram will then receive add-on donepezil or a placebo. Non-responders to citalopram will receive treatment with the antidepressant venlafaxine, then add-on donepezil or a placebo. if a participant does not respond to either citalopram or venlafaxine, the study physician may choose to treat him or her with an alternative antidepressant.
In addition, the investigators will explore apolipoprotein E ε4 genotype, MRI hippocampal and entorhinal cortex atrophy, and odor identification deficits as biomarkers that moderate response to treatment.
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Geolocation is 40.8409822, -73.9447994
Geolocation is 36.0038131, -78.9387241
New York State Psychiatric Institute
National Institute on Aging
Davangere Devanand, MD
Gregory Pelton, MD
Steven Roose, MD
Murali Doraiswamy, MD
Kristina M. D'Antonio