Patient description: An 89-year-old man was brought to the emergency department by his wife and son after six months of progressive changes in cognition and personality. He began to have poor memory, difficulty expressing himself, and exhibited unusual behaviors, such as pouring milk onto the table and undressing immediately after getting dressed. He is unable to dress, bathe, use the toilet, or walk independently. On examination the patient's temperature was 36.5C (97.7F), the heart rate 61 bpm in an irregular rhythm, the blood pressure 144/78 mm Hg, and the respiratory rate 18 bpm. The patient was alert and oriented to self and city but not year. He frequently interrupted the examiner. He repeatedly reached out to grab things in front of him, including the examiner's tie and face. He could not spell the word "world" backward, could not follow commands involving multiple steps and was unable to perform simple calculations. His speech was fluent, but he often used similar-sounding word substitutions. He could immediately recall three out of three words but recalled none of them after 5 minutes. Examination of the cranial nerves revealed clinically significant paratonic rigidity. Myoclonic jerks were seen in the arms, with symmetrically brisk reflexes. The reflexes in

Clinical trial eligibility criteria: eligible ages (years): 65.0-999.0,  Depression Dementia Geriatrics Age: >64 (65 years and older) Diagnosis: Major depression, unipolar as determined by the Structured Clinical Interview for the Diagnostic and Statistical Manual for Mental Disorders (SCID), using Diagnostic and Statistical Manual for Mental Disorders (DSM)IV criteria Severity of depression: Montgomery Asberg Depression Rating Scale (MADRS) >=18 Disability, i.e. impairment in at least 1 Instrumental Activity of Daily Living as measured by Philadelphia Multilevel Assessment Instrument Instrumental Activities of Daily Living subscale (MAI-IADL) Evidence of at least mild cognitive impairment but not severe impairment (Dementia Rating Scale (DRS) total score between 90 and 133 inclusive) Caregiver (family member or professional) able and willing to participate in treatment Off antidepressants, cholinesterase inhibitors, or memantine or on a stable dosage for 12 weeks and no medical recommendation for change of these agents in the near future Command of English sufficient to participate in therapy and research assessments  High suicide risk, i.e. intent or plan to attempt suicide in near future Axis I psychiatric disorder or substance abuse other than unipolar major depression, non-psychotic depression Axis II diagnosis of antisocial personality as determined by the SCID personality disorder section (using DSM-IV criteria) Moderate to Severe Dementia: We will participants with DRS Total Score corresponding to moderate or more severe dementia (DRS Total <=90) Acute or severe medical illness (i.e., delirium, metastatic cancer, decompensated cardiac, liver or kidney failure, major surgery, stroke or myocardial infarction during the three months prior to entry); drugs known to cause depression (e.g., reserpine, alpha-methyl-dopa, steroids); or chronic addictive drug use Current involvement in psychotherapy Aphasia