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The Link Between Dementia and Depression

Stria Staff March 8, 2020
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The co-occurrence of dementia and depression can be a challenge for longevity professionals.

Differentiating between dementia and depression can be a challenge for professionals working with older people who have mild cognitive impairments. That’s especially true because research tells us that dementia and depression symptoms can appear together–with people dealing with both underlining chronic conditions.

Dementia is a chronic impairment of the mental processes by the brain. Depression is a mental illness that targets the individual’s mood, thinking and behaviors—and can be displayed throughout the early stages of dementia.

Dementia and depression among older adults are both very serious matters that should not be overlooked. Depression occurs in 20% to 30% of people diagnosed with Alzheimer’s disease, and that this percentage is even higher in people diagnosed with vascular dementia and Lewy body dementia.

This co-occurrence can make it harder to diagnosis and care for older people with dementia or depression – and that can have a significant impact on how effective services are in support clients and customers. 

Headlines & Insights: Curated excerpts from thought-provoking articles

Late-Life Depression, Mild Cognitive Impairment, and Dementia (pdf)
JAMA Neurology

Different explanations for the relationship between latelife depression and dementia have been suggested. Late-life depression could be an early symptom in the progression to dementia; depression could affect the threshold for dementia to become manifest or could be a reaction to cognitive impairment.

Depression could also be a causal risk factor for dementia through hippocampal damage mediated by the influence of depression on the hypothalamic-pituitary-adrenal axis. Finally, common risk factors contributing to an increased risk of depression and dementia, such as cerebrovascular disease, could explain the association between the two.

Pathologic Mechanisms of Depression in Alzheimer Disease
Psychiatry Advisor | Nicola Davies, PhD

Approximately 40% of individuals with Alzheimer disease (AD) have depression. In such cases, the complex interplay between the underlying neurologic pathologies and the special needs of individuals with AD gives rise to a unique set of challenges with respect to the diagnosis, treatment, and prognosis of both depression and AD…

Regardless of whether there is a pathologic association, the number of hospitalizations and mortality rates is higher for individuals with both depression and AD than for individuals with either condition alone. Furthermore, the co-occurrence of these conditions drastically reduces the quality of life for both patients and their caregivers.Therefore, it is imperative to develop effective diagnostic and treatment strategies specifically for depression comorbid with AD.

Depression May Raise Risk Of Dementia, Alzheimer’s, Study Says
CNN | Elizabeth Landau

The link between depression and dementia has always been unclear, but a new study supports the theory that depression increases dementia risk.

The findings, published in the journal Neurology, are based on nearly 1,000 people who were studied for up to 17 years. Researchers evaluated them for depression and dementia using standard clinical tests. Those who were depressed when first examined almost doubled their risk for dementia and also increased their risk for Alzheimer’s disease…

The study did not figure out if depression causes dementia, or if something else is involved.

New Therapies Help Patients With Dementia Cope With Depression
The New York Times | Andrea Petersen

The [Problem Adaptation Therapy, or PATH] therapy, developed at Weill Cornell Medicine in New York City and White Plains, N.Y., focuses on solving tangible problems that fuel feelings of sadness and hopelessness. It incorporates tools, like checklists, calendars, signs and videos, to make it accessible for people with memory issues. A caregiver is often involved.

The approach is one of several new psychotherapies to treat anxiety and depression in people with cognitive impairments, including early to moderate dementia. Another, the Peaceful Mind program, developed by researchers at Baylor College of Medicine and elsewhere for patients with anxiety and dementia, simplifies traditional cognitive behavioral therapy and focuses on scheduling pleasurable activities and skills, like deep breathing. Therapy sessions are short and take place in patients’ homes. A program designed by researchers at University College London gives cards to patients to take home to remind them of key strategies. One that says “Stop and Think” prompts them to pause when they have panicky and unhelpful thoughts to help keep those thoughts from spiraling and creating more anxiety.

Early research on the new approaches is encouraging, but longer and larger studies will be needed to fully assess the effectiveness.

What’s the Best Way to Manage Agitation Related to Dementia?
Harvard Health Publishing  |  Stephanie Collier, MD, MPH

Behavioral and psychological symptoms are very common in dementia, and affect up to 90% of people living with dementia. In addition to memory changes, people with dementia may experience agitation, psychosis, anxiety, depression, and apathy. These behavioral symptoms often lead to greater distress than memory changes….

To decrease agitation and aggression in people with dementia, nondrug options are more effective than medications. Physical activity, touch and massage, and music can all be used as tools to manage agitation related to dementia.

Most Seniors with Dementia Live at Home, Despite Pain, Anxiety, Poor Health 
UCSF News Service  |  Suzanne Leigh

Contrary to popular belief, most older Americans with advancing dementia remain in their own homes – many until they die. But a new study by researchers at UC San Francisco has revealed that this population may endure more pain and have more complex or unaddressed medical needs than their counterparts in nursing homes…

Seniors in residential facilities with moderately severe dementia differed from those at home and in nursing homes. This group, whose average age was 85, had less depression and anxiety, fewer chronic conditions and less unintentional weight loss. However, the cost of residential care facilities, which average $48,000 a year, makes them prohibitive to most seniors for multi-year stays. 


This story was created in partnership with students from the Department of Gerontology at Virginia Commonwealth University. Thanks to Larisa Hoyle for contributing research for this piece on suicide among older people.

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