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Risk of conversion from mild cognitive impairment to Alzheimer’s dementia

Author: C. Bartels, M. Wagner, S. Wolfsgruber et al. Am J Psychiatry 2018; 175: 232–241
Depression in old age is associated with an increased risk of AD. The underlying reasons are still up for debate, but the possibilities include depression as a prodrome of the disease, an early symptom, a bona fide risk factor, or a confounding factor associated with comorbidities, such as vascular disease, which a in turn predispose to AD.
Experiments in animal models have suggested that selective serotonin reuptake inhibitors (SSRIs) may reduce amyloid plaque burden and cognitive impairment, presumably by stimulating non-amyloidogenic processing of amyloid precursor protein (APP).
In cognitively normal humans, long-term medication with the SSRI citalopram has been found to be associated with a lower amyloid plaque burden, and acute treatment with citalopram was found to reduce the rate of newly generated β-amyloid.
Several randomized, placebo-controlled studies have evaluated the effect of SSRIs on cognition in Alzheimer’s dementia, finding favorable effects, no effects, or even disadvantageous effects of SSRI treatment. With one exception, these studies covered only short periods of time, ranging from 8 to 24 weeks.


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