How can you tell whether an elderly person is suffering from depression or dementia? Is it possible for someone to have both conditions? Why is it so difficult to differentiate between the two ailments?
Depression mirrors a range of biological and social features, which may be difficult to diagnose in older people as its presentation may differ from that of younger people.
Older people tend to under-report depressive symptoms and may not acknowledge being sad or depressed. Instead they report symptoms such as a loss of interest in life, lack of enjoyment in normal activities, apprehension and poor sleep. Other symptoms are persistent thoughts of death, chronic unexplained pain, and poor concentration.
Depression in old age is often accompanied by memory changes which is usually the main focus for medical intervention rather than the depressive illness.
Family, friends and doctors frequently attribute those symptoms to old age or dementia. The result is that the depression may go undiagnosed and untreated for a long time.
Symptoms of depression often become apparent on close questioning. However, the older person may deny that depression could be the problem. In extreme cases, the older person may believe they have an incurable disease which can put them at risk of suicide.
Treatment of the underlying depression usually improves memory if there is no corresponding dementing process going on as well.
Dementia on the other hand, describes a set of symptoms that may include memory loss and difficulties with thinking, problem-solving or language.
A person diagnosed with Alzheimer’s disease, which is the most common form of dementia, may also experience changes in their mood or behavior.
Early Alzheimer's disease and depression share many symptoms, so it can be difficult even for doctors to distinguish between the disorders. Plus, many people with Alzheimer's disease are also depressed.
The discrepancy between the two conditions can be found in cognitive abilities, behavior, language and motor skills. In depression, mental decline is relatively rapid, while in dementia it happens slowly.
The individual suffering from depression is usually orientated to time, day, date, and knows where he or she is, while the person with dementia is usually confused and disoriented, prone to becoming lost in familiar locations.
The depressed person is aware of memory problems and has difficulty concentrating, while the person living with dementia experiences difficulty with short-term memory, and is not aware of the problem. They are unable to remember recent events such as what they had for breakfast or whether they did have breakfast.
Language and motor skills are slow but normal in the depressed elder, while writing, speaking, and motor skills are impaired in the person with dementia.
Due to the overlap in symptoms, separating whether someone has depression, early dementia or both can be very difficult.
How can you tell if someone who has Alzheimer’s disease or dementia is also depressed?
Common signs include anxiety, sadness, lack of appetite, spending more time sleeping, weight loss and agitation. Sometimes the person will express painful, upsetting thoughts or make negative comments like “I want to die,” or “I’m so alone.” These are words that are signs of depression.
Many people living with dementia may not be able to tell you they are depressed, but their actions will communicate a message.
For example, if a person suffering only from dementia has always loved gardening, they will continue to respond positively to activities involving flowers or taking a walk outside to see roses in bloom.
However, a person with dementia who is depressed will develop apathy, refusing to do the things they have often enjoyed in the past, even things they have enjoyed fairly recently.
Just as treatment is important for people with depression alone, it's equally crucial for people with Alzheimer's disease and depression to get treatment for their depression.
Establishing a diagnosis of depression versus dementia is critical before treatment can begin.
Once a diagnosis has been made, depression is usually treated with antidepressant medicines, therapy or a combination of the two. People are generally responsive to such treatments, though it will depend on the severity of the case.
Dementia treatments usually depend on the underlying cause of the dementia.
If the primary cause is infection or a vitamin deficiency, appropriate treatment can reverse the dementia. On the other hand, if the dementia is a progressive condition like Alzheimer's disease, it may be possible to manage many of the symptoms, but not cure it.
Reviewed July 14, 2016
by Michele Blacksberg RN
Edited by Jody Smith