As if the changes brought about by dementia weren’t devastating enough, many of the more than 5 million people living with the disease in the U.S. also face depression. In fact, it's common for people with dementia to experience not only depression but also anxiety and paranoia, according to the American Psychological Association.
Those with Alzheimer’s disease – the most common form of dementia affecting about 1 in 10 U.S. adults over 65 – often experience depression in the early and middle stages of the illness. Since dementia and depression share similar symptoms, it can be difficult for doctors to know whether someone has dementia, depression, or both.
If your loved one has symptoms of either condition, they’ll need a full physical and mental health examination to get an accurate diagnosis. As with dementia by itself, it’s best to see a doctor about depression in dementia sooner than later, since treatment can make a big difference in the patient’s quality of life, and give family caregivers important tools to help their loved one cope.
Signs of co-existing depression and dementia
Sometimes it can be hard to know whether a loved one with dementia is depressed or is only showing dementia-related symptoms that don’t necessarily indicate depression. However, research shows that people with Alzheimer’s disease tend to experience depression differently from those without Alzheimer’s.
Depression symptoms in people with Alzheimer’s tend to be less severe than in those who are depressed but don’t have dementia, according to research by Ellen Walker, MD and David Steffens, MD of Duke University Medical Center. Individuals with both Alzheimer’s and depression may have noticeable irritability and social withdrawal, but they may not show many of the other symptoms typically associated with depression, according to the research.
Some signs that a person with dementia may also be depressed include:
- Social withdrawal
- Apathy or lack of interest in previously enjoyed activities
- Not eating
“Many times, the isolation is one of the big signs that you have some dementia going on, and isolating yourself in your room and not being interested in life is a sign of depression,” says Joyce Simard, MSW, a social worker and dementia care specialist who has worked in senior living communities for nearly 40 years.
Brenda Avadian, a caregiver advocate and author of numerous books about caring for a loved one with Alzheimer’s, notes that while social withdrawal is a key symptom of depression in dementia, this behavior can also occur because the person with dementia is hearing impaired.
Diagnosing depression in dementia patients
Even doctors have difficulty determining whether an older adult has depression or dementia, since the two conditions share so many overlapping symptoms. In older adults experiencing depression for the first time, signs of cognitive decline are also common, according to Walker and Steffens.
Still, if your loved one is experiencing any of the above symptoms, it’s important to see a doctor as soon as possible to decide the best course of treatment. Doctors rely on a few different tests to help detect whether an older patient has co-existing depression and dementia, says Ladislav Volicer, M.D., a professor at the University of South Florida’s School of Aging. One is the Cornell Scale for Depression in Dementia, which relies on interviews with patients and nursing staff to evaluate symptoms.
Another is the Geriatric Depression Scale -- a 15-item “Yes or No” questionnaire designed to help seniors assess how many depressive symptoms they’re experiencing, which can be a useful diagnostic tool in the earlier stages of dementia. And the Minimum Data Set 3.0 Cognitive Function Scale is a performance-based screening test for incoming patients at skilled nursing facilities.
For many people with dementia and depression, a combination of treatments is recommended, including non-drug approaches such as support groups and working with the person to establish a routine, plus taking antidepressants, if needed.
While non-drug approaches can be very successful in treating depression in dementia patients, there are those who benefit from prescription medications, too, Volicer notes.
“Families should know that there are some very effective pharmacological treatments for [depression in dementia],” he says.
There are a number of medications designed to alleviate depressive symptoms in dementia patients, and a doctor can help determine which, if any, to try. Doctors often prescribe a type of antidepressant known as Selective Serotonin Reuptake Inhibitors (SSRIs) to Alzheimer’s patients with depression, since these tend to be less likely to cause interactions with other medicines, according to the Alzheimer’s Association.
Simard and Avadian are among the many dementia care experts who point to inactivity as a major problem for people with dementia and depression. Both say that keeping the person with dementia engaged in the world around them is crucial to protecting their well being. And a big part of keeping the person with dementia engaged is making sure he or she is socially stimulated, they contend.
“Engage the person in purposeful activities,” Avadian advises. “When we lose our sense of purpose, we withdraw and decline. When we’re actively engaged and allowed to reach beyond our potential, we have little time to wallow in the murky waters of self-pity.”
Simard shares that view, and has created two programs meant to keep people at different stages of dementia involved and engaged in activities, however simple, throughout the day.
“My answer has always been keeping people busy and giving them meaningful activities and a reason to get up every day,” Simard says. Even simple undertakings and interpersonal interactions can go a long way toward preventing or easing depression in someone with dementia, she notes.
“The Club” is one of the dementia care programs Simard designed for skilled nursing facilities and assisted living communities. Participants keep busy with activities like sorting items like buttons or cards. A day’s schedule for The Club members might include both right-brain and left-brain activities, physical exercises, trivia, gentle shoulder massages and activities that help participants feel like they are part of a family, says Simard.
Throughout these activities, staff members interact with participants to help them stay engaged and to give them a sense that what they’re doing is valuable. Regular meals and a naptime punctuate the roster of activities, and participants usually cap off the day with a “pajama party” gathering before a staff member helps them settle in for bedtime.
The key, Simard says, is to occupy people with dementia with a continuous stream of activities. “When you have an activity that stops – that’s when you have the depression signs - that’s when you have apathy, that’s when they fall asleep and when they start to wander,” she says.
Love, support and patience go a long way, too
The love and support of family, friends and paid caregivers are among the most important components of preventing or reducing depression in a person with dementia, experts say.
“It’s important to have family and friends who understand the progression of dementia and enable the diagnosed loved one plenty of opportunities to function as independently as possible,” Avadian says. “It takes patience to sit and listen to a loved one with dementia try to communicate. When well-meaning caregivers step in and take control, a person with dementia may resist or lose their incentive to live a healthy life with dignity.”
Simard says being part of a group where meaningful activities are designed especially for them helps to keep residents with advanced dementia engaged, and that when they’re engaged with others, they're rarely depressed. The second dementia care program she created, called Namaste Care, ensures that the nursing facility or assisted livin residents with advanced dementia get regular doses of personal attention and a "loving touch" approach to activities, such as having their face gently washed and moisturized with the familiar scent of a product they already know, like Pond’s Cold Cream.
Namaste Care staff make a point of engaging with participants throughout the activities, looking them in the eye, lightly touching their hair or cheek, talking to them about what they’re doing and giving compliments, all of which can help keep the person engaged and feeling valued. Staff members also bring in elements from the outdoors, like a basin of snow, fall leaves or in-season flowers – to help residents feel connected with the outside world.
The results have been incredible, she says. Even non-verbal residents have started talking during Namaste sessions, and smiles and giggles happen regularly. Residents who take part in the program either reduce or stop using antipsychotic or hypnotic medications, and family and staff satisfaction increases when everyone feels as if they can be part of the program, Simard says.
“Simply saying 'Thank you for holding the brush' can help people feel that they have a reason for living, that there is something special about them and that they are loved,” she says.