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How Do I Know If Someone With Dementia Is Depressed?

4 answers | Last updated: Aug 28, 2014
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Caring.com User - Leslie Kernisan, M.D.
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Dr. Leslie Kernisan is a senior medical editor at Caring.com and a clinical instructor in the University of California, San Francisco, Division of Geriatrics....
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Unfortunately, you can't always know if someone who has dementia is depressed. Dementia can make depression much trickier to diagnose, since the symptoms of depression and of dementia can overlap. See also:
How do I go about diagnosing Alzheimer's for my mom?

See all 929 questions about Alzheimer's and Other Dementias
For example, anxiety, agitation, apathy, and/or irritability can be seen in either dementia or depression, or in both. It's very common for people with dementia to have depression as well.

For anyone with dementia

To be diagnosed with depression, a person should show, over at least a two-week period, evidence of at least one of these two key symptoms:

  • Feeling down/depressed/hopeless
  • Being unable to find enjoyment in any activities

Note that changes in routine can increase confusion and emotional responses in people with dementia. So it's best to have the person evaluated for depression when his or her routine has stabilized (not immediately after a move, for example).

For a person with mild-to-moderate dementia

Try asking these five questions, known as the short version of the Geriatric Depression Scale:

  • Are you basically satisfied with your life?
  • Do you often get bored?
  • Do you often feel helpless?
  • Do you prefer to stay at home rather than going out and doing new things?
  • Do you feel pretty worthless the way you are now?

A "no" to question 1 or "yes" to questions 2 through 5 are considered depressive responses. Two out of five such responses in total suggests the diagnosis of depression.

For a person with more significant dementia

Because the person with late-stage disease is apt to have lost a lot of conversational ability, the caregiver and healthcare provider may have to rely on observing behavior and apparent mood. For example, frequent crying would signal a sad mood. No longer enjoying the company of even familiar friends and family would also be a concerning sign. The Cornell Scale for Depression in Dementia is a special questionnaire that can give added insight.

Sometimes after careful evaluation, healthcare providers may still not be sure if depression is present. This is especially common if there are other health problems that could be causing pain or tiredness. In this case, it's usually reasonable to try treatment for depression for at least several months. Lack of improvement can suggest that the concerning symptoms were not in fact due to depression.

 

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An anonymous caregiver answered...

How do you deal with a mother who REFUSED to go to a doctor after my Dad died and had deep depression that I feel led to her dementia and then does guilt trips with crying to make you feel sorry for her when she refuses to do anything to help herself. The Phys. told me to ignore her when she does these and most times when she realizes that I am ignoring her; she gets up like nothing ever happened. Lately, she has been doing these more often and longer times. Knowing her past history of making everyone feel guilty; How do you know if it is real one time? Nothing leads up to these to make her sad.

 

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English Girl answered...

Dementia can be linked to hearing loss and loss of eyesight, lack of brain stimulation and lack of physical and mental exercise. It is not caused by depression necessarily. Remember, no matter how horrible it is, none of it was caused by you or is your fault. Things you'll need to know... She will stop bathing (sense of smell diminishes). Get her in the habit of weekly baths while she can still be reasoned with. It will make things easier later. If you can convince her to let you help now it will make it easier when she forgets hot/cold faucets and reduce burn incidents. Lay out clean clothes nightly and remove dirty clothes WHEN she is not looking! (If she sees it, it will distress her. Change is her enemy. Get her to the beauty parlor for pedicures (but warn them of dementia). She will not clip her nails or file them. If you get staff at beauty parlor trained they will be helpful as she gets worse. Remember dementia is a progressive disease, it will not get better. There will come a time when she will claim people are watching her (she will no longer recognize her reflection). You will need to cover mirrors and close drapes. She will see shadows as train tracks and cars... When she can no longer chew well, you will need a blender to puree food. Baby food and strainers are another option. Remember HYDRATION is important. Make sure she's drinking enough. Sippy cups and straws are useful to prevent spills.

 

 
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