Older adults with depression often experience cognitive impair-ment as part of the clinical syndrome. Symptoms of depression may simulate dementia with concentration difficulties, memory loss and distractibility. Commonly, MDD and dementia cooccur. It is less frequent that findings of dementia are fully explained on the basis of depression (pseudodementia). The prevalence of MDD in older adults residing in nursing homes is estimated to be approximately 30%. MDD in the elderly often cooccurs in the presence of medical conditions which complicates the treatment for both the depression and the primary medical condition. Care-ful evaluation of medications may also reveal explanations for associated symptoms of depression. Older adults with first onset of depression must be carefully evaluated for cooccurring medi-cal conditions. Among the common disorders to be considered are silent cerebral ischemic events, undiagnosed cancer, or com-plications of metabolic conditions such as adult-onset diabetes mellitus and thyroid dysfunction.
In working with individuals of different ethnic groups, the lan-guage which expresses depressive symptomatology varies. Non-western cultural expressions emphasize somatic complaints more prominently than psychological complaints. Depending on the particular ethnic group understanding the specific “language of depression” is important, because the prevalence estimates cross-culturally do not appear to differ significantly from those reported in the USA.