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Journal of Geriatric Psychiatry and Neurology, Vol. 15, No. 1, 38-43 (2002)
DOI: 10.1177/089198870201500108

"Life Is Not Worth Living": Hopelessness in Alzheimer's Disease

Dylan G. Harwood, PhD

Mental Health Services, VA Greater Los Angeles Healthcare System, and the Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute and Hospital, University of California at Los Angeles School of Medicine, Los Angeles, Califorma

David L. Sultzer, MD

Mental Health Services, VA Greater Los Angeles Healthcare System, and the Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute and Hospital, University of California at Los Angeles School of Medicine, Los Angeles, Califorma

This study investigated the prevalence and clinical correlates of hopelessness among 91 patients diagnosed with probable Alzheimer's disease (AD) according to National Institute of Neurological Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria. Hopeless ideation was measured with Item 3 on the Hamilton Depression Rating Scale (Suicide), which inquires specifically whether the patient thinks "life is not worth living." The results showed that hopelessness was present in 10% (n = 9) of the sample. Patients with these cognitions evidenced greater psychological symptoms of mood disturbance and more insight into their cognitive and functional impairments. Unrelated factors included age, education, Mini-Mental State Examination score, neurovegetative signs of depression, affective expressions of depression, agitation/disinhibition, and psychosis. Although indifference is frequent in AD, these results indicate that thoughts of hopelessness are also a common phenomenon, occurring in approximately 10% of our probable AD cohort. These thoughts appear to be related to the subjective expressions of depression and anxiety rather than the neurovegetative or affective signs and are more prominent among patients with greater deficit awareness. (J Geriatr Psychiatry Neurol 2002; 15:38-43).


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