There should be no sugaring of the pill. The fact is that dementia and depression go hand in hand – it is depressing to get dementia. However, though there have been occasional headlines suggesting that those who suffer from clinical depression are more likely to develop dementia than others, the evidence is certainly not clear – there have been some studies that have claimed that there is a strong correlation, but others that directly contradict that.
That being said, perhaps unsurprisingly, what is clear is that the slowing of information processing ability and fear of further degeneration means that almost 80% of those who do develop dementia will suffer some depressive symptoms at some stage of their journey. However, as dementia takes its course, the depressive symptoms do tend to recede: studies show it tends to remit within a year of onset. The current view is that clinical depression in severe dementia may actually be less common than previously thought. So symptoms of general sadness, mood variation, insomnia, irritability and weight loss are common but these depressive symptoms can be present without developing into major depression.
The diagnosis and treatment of mood symptoms in later stage dementia sufferers is a huge challenge. Depression often goes unrecognised by the professionals involved and family members tend to report much greater levels of depression in their relatives than do clinicians and other carers. There are suitable tests that can be given to those with quite severe dementia to judge whether they are depressed and if you fear that a relative is suffering from unrecognised depression, you should seek input from a specialist old age psychiatrist.
Major depressive disorder can be more easily diagnosed in patients with mild-to-moderate levels of cognitive impairment. Major depression is more common and severe in patients with Vascular Dementia than in patients with Alzheimer’s Disease but even significant depression in dementia seldom persists over a 12-month follow-up.
Potential treatments for depression for those with dementia are the same as for other sufferers: medication, therapy, and exercise. However, none of these are likely to be as effective for those with dementia. Medication tends to be the main route as cognitive impairment, almost by definition, makes much therapy unproductive.
Of course, both the opportunity and ability to exercise is often severely curtailed as well. However, if possible, gentle stimulation from movement does seem effective, though perhaps one might suspect that the attention and care involved in giving such support might well be the the key rather than just the exercise itself.
Dr Owais Sharif is a psychiatrist with Psychiatry UK and has specialist accreditation in old age psychiatry. You can view his profile here.