Expert Q & A


Can Seniors with Dementia Also Experience Depression?

Oct 22, 2014 10:03AM
Question: Can Seniors with Dementia Also Suffer From Depression Simultaneously?

Dementia Expert,  Martha Stettinius
Answer:
Yes, it’s quite common for elders who are living with Alzheimer’s disease or another type of dementia to also experience depression. Thirty to 50 percent of people living with dementia also have depression.

When my mother lived with the early stages of dementia and moved in with me and my family, she felt very depressed. While grateful at first for our help, she soon retreated to her room and often refused to come out for meals. She had no interest in getting to know the neighbors who invited her to join them for dinner and concerts. While my husband and I and our children were out of the house all day, Mom grew more and more unhappy.

Looking back, I realize that her feelings were quite normal for someone who could no longer live alone in her own home, had given up her car keys, and had lost all of her old friends (who stopped visiting as her dementia progressed). Her depression was also normal for someone who was self-conscious about her memory loss and perhaps feared embarrassing herself in new situations. Once Mom moved into assisted living and grew to enjoy some new friends there, she seemed happier. She also continued to take an antidepressant. But it was only in the middle stages of dementia, when she lost awareness that she had dementia and began to live solely “in the moment,” that she seemed to lose all traces of depression.

Diagnosing depression in elders with dementia

With many symptoms of dementia mimicking symptoms of depression, it’s helpful to consider some guidelines created by the National Institute of Mental Health (NIMH) to diagnose depression in people living with Alzheimer’s disease.

According to NIMH, “three (or more) of the following symptoms must be present during the same two-week period, and represent a change from previous functioning, to diagnose depression in a person with Alzheimer’s disease. At least one of the symptoms must either be 1) depressed mood or 2) decreased positive affect or pleasure:

•    Clinically significant depressed mood
•    Decreased positive affect or pleasure in response to social contacts and usual activities
•    Social isolation or withdrawal
•    Disruption in appetite
•    Disruption in sleep
•    Psychomotor changes
•    Irritability
•    Fatigue or loss of energy
•    Feelings of worthlessness, hopelessness, or excessive or inappropriate guilt
•    Recurrent thoughts of death, suicidal ideation, plan or attempt”

Symptoms should cause “significant distress or disruption in functioning,” and should not be caused by delirium (which is confusion or inattention that comes on suddenly and is caused by something specific and acute such as a urinary tract infection, a new medication, or an interaction between medications). NIMH notes that a diagnosis of depression should also rule out “other conditions such as major depressive disorder, bipolar disorder, bereavement, schizophrenia, schizoaffective disorder, psychosis of Alzheimer disease, anxiety disorders, [and] substance-related disorders.”

According to a recent study of depression in people with Alzheimer’s, depression in Alzheimer’s disease is “notable for a higher frequency of motivational disturbances, such as fatigue, psychomotor slowing, and apathy” while depression in elders without Alzheimer’s disease is more likely to show “mood symptoms such as depressed mood, anxiety, suicidality, and sleep and appetitive disturbances.”

Problems with misdiagnosis

Many people in the early stages of dementia are sometimes misdiagnosed as having only depression, rather than dementia that is causing depression. That was the case with Mom for many years. Such misdiagnosis is a problem because it can prevent the person from receiving medication that can lessen the symptoms of dementia, from participating in clinical trials, from discussing their care preferences with loved ones, and from making financial plans.

Conversely, many elders with depression will never develop dementia but need medication or talk therapy to relieve the depression.

It’s important, therefore, to seek a thorough medical screening for both dementia and depression. A neurologist can administer a neuropsychological exam for dementia, and a geriatric psychiatrist can evaluate for depression.

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Martha Stettinius was a “sandwich generation” caregiver for 8 years for her mother with dementia, and is the author of the book “Inside the Dementia Epidemic: A Daughter’s Memoir.” An editor with a master’s in English Education from Columbia University, she blogs for caregivers.com and serves as a volunteer representative for New York State for the Caregiver Action Network.  For more information, go to http://www.insidedementia.com
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