Brain Health

Is it Dementia or Depression?

Or Both...

An article published last year on the Mayo Clinic website asks the question, “Alzheimer’s or depression: Could it be both?” It’s possible, because many of the early symptoms of Alzheimer’s mimic depression’s symptoms.

  • Loss of interest in once-enjoyable activities and hobbies
  • Social withdrawal
  • Memory problems
  • Sleeping too much or too little
  • Impaired concentration[1]

This highlights the importance of treating depression whether Alzheimer’s is suspected or not. However, there is a greater challenge for detecting depression when a person has dementia. Non-verbal cues and caregiver feedback become the main means of detecting issues because it’s common for someone with declining memory to not self-report symptoms accurately.

Is There a Relationship?

The egg or chicken first argument on this topic is still in contest. “The depression-to-dementia direction is supported by evidence that depressive disorder is a risk factor for developing dementia in later life.” However, “[t]he association between depression and later development of dementia is still not completely understood.”[2]

It has been proven that Alzheimer’s can be genetic. For example, an association has been seen in people with Down Syndrome between depression and the development of Alzheimer’s. There has also been a genetic correlation found in an extended family in Columbia. In this family, depression has not been quoted as a precursor.

Regardless of whether a linkage exists between depression and Alzheimer’s risk, it’s clear that “depressive syndromes are common in those with dementia, and that this comorbidity causes increased deficits in functioning, increased problematic behavior, increased nursing-home placement, increased caregiver stress, and increased mortality.”[3]

What matters most within our Highgate Senior Living communities is that we typically recognize the difference between depression and the many different kinds of dementia, and we advocate that the medications our residents take are right and necessary.

Should Treatment Be the Standard Approach?

The more advanced dementia is, the more difficult it is to separate it from depression. At the same time if we fail to diagnose the depression, it makes Alzheimer’s care problematic. Replacing depression-treating meds with behavior-modifying meds such as benzodiazepines or neuroleptics can results in serious issues. These pharma-groups have a history of increasing falls, decreasing alertness, reducing mobility, diminishing functional abilities and raising mortality rates. This isn’t the quality of life we want for residents in our Highgate assisted living or memory care communities.

At the same time, we are aware of the risks of over-diagnosis. Anti-depressants have their own set of adverse effects—confusion being a typical side-effect of tricyclic antidepressants. They have also been associated with vision problems. The newer selective serotonin reuptake inhibitors (SSRIs) may disturb sleep and increase fragility-related bone fractures.

Does this mean the situation is hopeless? No. There are natural remedies which are helpful for depression including exercise and nutrition. We have seen individuals who appeared to be suffering from senile dementia, who have recovered significant brain function through these two elements alone.

At Highgate Senior Living, we have also observed that there are depressive symptoms that are more common in clinical depression. They aren’t seen as often with dementia. These include a:

  • Burden of guilt
  • Loss of self-worth
  • Growth in hopelessness
  • Consideration of self-harm

In this case, we encourage members in our community to discuss treatment options with their healthcare providers.

Summary

Depression may be a common problem among seniors, but it should never be considered ‘normal.’ There is every reason to do all we can to improve the quality of life for both memory care residents and their families.


[1] http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers/art-20048362

[2] http://www.alzheimer.ca/~/media/Files/national/Articles-lit-review/article_Depression_vs_Dementia_2009_e.pdf

[3] http://www.alzheimer.ca/~/media/Files/national/Articles-lit-review/article_Depression_vs_Dementia_2009_e.pdf

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