Ask the Expert: Depression with Dementia

Ask the Expert: Depression and dementia

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Featuring Anna Burke, MD

Question: My father has Alzheimer’s and always seems sad, disengaged and even angry. Can someone with dementia have depression too?

Answer: Individuals with Alzheimer’s disease and related dementias can suffer from depression. Unfortunately, since many common symptoms of depression, including insomnia, memory problems, anxiety, fatigue, irritability and difficulty concentrating, overlap with symptoms of dementia and make it harder to diagnose.

Apathy, which is a disorder of motivation characterized by a general reduction or withdrawal from things and activities that were once pleasurable, is often seen in Alzheimer’s disease sufferers. However, family caregivers and loved ones often misinterpret these symptoms as signs of depression. It is important to understand the difference between apathy and depression to ensure the patient receives proper care and support.

Depression within the confines of Alzheimer’s/dementia presents a bit differently than depression among those who are not cognitively impaired. Rather than exhibit typical symptoms such as crying, difficulty concentrating, suicidal thoughts and challenges expressing emotion, those with dementia may become increasingly irritable and/or have difficulty managing their frustration.

Known as the “buck up” generation, many of those currently living with Alzheimer’s have lived through difficult times, such as the Great Depression and World War II. Generally not ones to acknowledge much less discuss emotional pain, they may be more apt to complain about physical pain as a means of expressing their emotional distress. In such cases, the source of physical pain cannot be identified or confirmed by their care provider.

Based on the level of one’s depression diagnosis, there may be a multi-pronged approach to treatment that includes anti-depressant medications and environmental modifications such as engaging the individual in organized activities, intellectual and physical stimulation, and encouraging social interaction to remove or reduce triggers that foster symptoms of depression.

A diagnosis of depression in dementia is usually based largely on caregiver observations since patients may not be able to express their feelings and thoughts. Due to the intricacies of dementia, a diagnosis of depression should only be made by a mental health professional, preferably one who specializes in dementia.

Anna Burke, MD, is a geriatric psychiatrist and dementia specialist at Banner Alzheimer’s Institute. Her office can be reached at (602) 839-6900.

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