When elderly parents start exhibiting signs such as forgetting appointments, repeating questions hundreds of times, or having difficulty keeping the flow of a conversation, their loved ones or other family members may start worrying if the parent has dementia. While this particular concern may sometimes be justified, in many cases, depression may be at play, which has similar manifestations but can easily be treated. It is rather complicated to differentiate between dementia and depression even for physicians, because the symptoms are similar and may even accompany each other, making it more likely to happen. Knowing the differences will enable the family members to ask relevant questions and make sure that their relative goes through the necessary examinations.
How Depression Affects Memory
It’s likely too simplistic, however, to say that depression is only a mood disorder. In addition to being a mood disorder, depression impacts brain functioning. For example, it interferes with someone’s ability to focus, think, and remember information. Various factors such as a rise in levels of this hormone and poor quality of sleep may contribute to this issue. For a better understanding of the causes of the symptoms mentioned above, this blog post can help explain.
In older adults, these cognitive changes might resemble symptoms of dementia. What used to be dubbed “pseudodementia” is currently referred to in most cases as the term “depression-related cognitive impairment”. No matter what name a condition is referred to by, the point remains that the cognitive problems mentioned above could be alleviated whenever the patient undergoes treatment.
Key Differences Between Depression and Dementia
While one indication alone doesn’t resolve the issue entirely, several markers suggest one side or the other.
How quickly symptoms appeared. Cognitive issues relating to depression usually have a specific onset point that they may develop during several days (or weeks), or may come after a serious event, like loss, moving, or falling ill. Dementia is usually subtle and develops slowly, which is why it becomes difficult for families to pinpoint the exact moment it appeared.
How the person answers the questions. In testing their memory, individuals with depression would answer “I don’t know” way more often than it was necessary. They might say “I don’t know” when they would be able to answer otherwise, while people suffering from dementia would give wrong answers but would be confident in their response.
How much the person notices and worries. Individuals suffering from memory impairments may intuitively understand and feel anxiety over their conditions. On the contrary, individuals with dementia do not realize the extent of the problem or underestimate it.
Effort and motivation. Depression can take away one’s motivation and enthusiasm, and a person can exert little effort in performing tasks and talking about failures. Conversely, people with dementia do their best and get frustrated when they can’t succeed.
Other abilities. Dementia can interfere with a person’s ability to communicate, write, and navigate familiar spaces. The impacts of dementia on these skills are generally more significant than those experienced from depression alone.
Treatment response. Treatment response gives a significant hint. When depression is treated successfully, related problems in memory and thinking usually improve. Cognitive deterioration persists in some cases even when mood improves, raising concerns about dementia.
Why It's Not Always Either/Or
The overlap between depression and dementia indicates the significance of correctly differentiating between the two conditions.
In some situations, depression may signal the onset of dementia before any memory problems are identified. Also, depression may occur in those who have already developed dementia. Depression could also increase the risk of dementia later in life. A 2013 review article published in the British Journal of Psychiatry analyzed 23 studies and found that people with late-onset depression increased their risk of developing any form of dementia by 1.85 times, their risk of developing Alzheimer’s disease by 1.65 times, and their risk of developing vascular dementia by 2.52 times.
Previous studies of elderly hospitalized patients with depression suggest that any cognitive decline, such as dementia, can accelerate the progression of dementia in the years to come. Therefore, even when families may feel their patients are recovering from depression, they should still monitor their patients’ condition.
Other Conditions That Can Look Like Dementia
Depression isn’t the only treatable condition that can mimic cognitive decline. A thorough evaluation will usually check for:
- Side effects of drugs are another cause of confusion in older adults, especially if the person is on more than one medication.
- Other factors include thyroid problems, which slow down the process of thinking, anxiety, and depression, which can be confusing.
- Deficiency of Vitamin B12 and problems with absorption as a person gets older.
- Sleep disorders may lead to confusion.
- Hearing problems come in the way of conversation. The other causes of confusion are virulent infections and other acute illnesses.
- Acute confusion also differs from the gradual process of memory loss. It may be a sign of delirium, which requires immediate medical attention.
What an Evaluation Looks Like
In the case of concerns regarding the memory of a loved one, visiting their family doctor should be the first step. Evaluation may include:
- A detailed history, ideally with input from family members who have noticed changes
- Depression screening, often using tools designed for older adults such as the Geriatric Depression Scale
- Cognitive testing to assess memory, attention, language and problem-solving
- Blood tests, commonly including thyroid function and vitamin B12 levels
- A full medication review
- Neuropsychological testing or brain imaging when the picture remains unclear
You may want to take notes to the visit, including the symptoms that appeared, any stress factors in the period of onset of the symptoms, changes in sleep, appetite, mood, and examples of memory gaps.
Treatment and Next Steps
If depression is the cause of memory issues, treatment methods usually include psychotherapy, medication, or both, alongside focusing on factors such as quality sleep, physical exercise, and social life. A psychiatrist can also adjust medications that can worsen cognitive skills and monitor memory progress along with mood changes.
When dementia is detected, treating any comorbid depression is still important.
The Factors
Problems with memory in older people need a full study of the reasons, but do not necessarily lead to dementia. Older people are sometimes depressed, but depression is curable, even though it negatively influences one’s intelligence. It might be very important to help the elderly person get a diagnosis as soon as possible.
If you or your loved one has any self-harm thoughts, contact the Suicide & Crisis Lifeline at 988, and in the case of sudden changes in consciousness, call 911.
