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Is it dementia or depression?

By Dr. Dara Schwartz | November 5, 2015
Is it depression or dementia?

As a geriatric psychologist, I have responded to a range of concerns affecting older adults. Over the years, I saw a steady increase in patients and family members asking one specific question: “Is it dementia?”

Unfortunately, truly answering that question takes a complete medical assessment. Before sending worried families on that difficult path, I often pose this question: “Could it be depression?”

Depression is not a normal part of aging, but older adults do have an increased risk. Depression is more common in people who have other illnesses; 80 percent of older adults have at least one chronic health condition.

A keen clinical interviewer will ask about feelings of loneliness and hopelessness; fears of being a burden on their loved ones; and diminished activity level. However, many older adults under-report their symptoms or do not think of themselves as “depressed.” Most doctors today use proven measures of geriatric depression, but even the most reliable of measures can let some depressed older adults slip by. One reason for this is the way that depression affects the older adult brain.

Our brains and bodies are intrinsically connected. We know this for many reasons, but most simply — because one sits so nicely on top of the other. When we are depressed, regardless of age, we often isolate — we stop doing what we used to do and pull back from life. As our bodies slow from the depression, so too do our brains. We don’t think as fast or as sharply. We can’t remember information or focus as well.

Unfortunately, because of the apathy associated with depression, people are sometimes unmotivated to seek help. They may even lose the ability to recognize that they need help. I describe this to my patients as the downward spiral of depression. This spiral can be misdiagnosed for older adults because when they can’t remember or focus as they used to, aren’t as sharp or on point as they used to be, what does that often look like? You’ve got it: dementia. Since a person accurately diagnosed and treated for depression can restore their cognitive function, this would be a very unfortunate misdiagnosis.

So, how can you tell if it’s dementia or depression? In order to obtain the most accurate diagnosis you need to talk with a professional, but there are three telltale signs that set the two conditions apart.

  1. In the case of depression, problems with concentration and focus often develop over weeks.  With dementia, problems with cognition develop gradually, and concentration is usually normal in the early stage.

  2. In depression, the individual is often aware and concerned about their cognitive deficits. It frustrates them that they can’t remember. Dementia patients, however, will often show less concern for their cognitive problems and minimize their deficits.

  3. For a depressed patient, loss of interest and the desire to isolate usually happens quickly. You may even be able to pinpoint a specific trigger. With a dementia patient, loss of interest or activity happens slowly — often taking years.

Recognizing that depression may be at play can prevent costly diagnostic testing for dementia and more importantly, spare the family and patient the emotional distress of a premature label of dementia.

Dementia and depression can exist together, with patients meeting the criteria for depression while also exhibiting early-stage dementia or mild cognitive impairment. It is imperative to identify and treat the depression in these individuals.

Research shows that doing so can improve their quality of life and slow the dementia process. Treating their depression early enough could potentially prevent or slow the dementia process altogether.

The important thing to know is that depression, at any age and any stage, deserves treatment. Living a meaningful life knows no age limit.

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