Introduction:
Dementia and depression are two different neuropsychiatric disorders with similar symptoms. Dementia is an impairment in cognitive function caused by various underlying diseases or conditions like Alzheimer's disease.
Depression is a constant sadness that affects a person's day-to-day activities. Both are commonly noted in the older age group of 60 years and above. However, studies show that people with preexisting psychiatric disorders have an alleviated degree of symptoms as the brain ages.
Dementia and depression have similar clinical symptoms, but utterly different treatment approaches; hence it is essential to diagnose them carefully. Some patients might have both. Treatment for depression is more promising than treatment for dementia. The physiological functions of all the vital organs in the body, including the brain, peak in their thirties and then start to decrease in their sixties to about 60 % to 80 %. A decrease in the brain's weight is also noted at 60 years of age and above. Old age is the most common period for developing disorders like dementia and depression.
How to Differentiate Between Dementia and Depression?
Elderly patients are at a greater risk of developing disorders and other medical comorbidities that add to cognitive and mood-related changes. It is challenging to differentiate and diagnose these two disorders. The following are the different ways used to distinguish between the two.
-
Determining a patient’s baseline ability to function and perform, activities of daily living (ADLs) (bathing, walking, using a chair, dressing up, eating, using a toilet), and instrumental activities of daily living_IADLs (managing finances, grocery shopping, cooking food, using a telephone). This baseline will help the physician notice any changes and act upon them.
-
Observing the patient very carefully and enquiring about the patient from his friend, family, or staff from assisted facilities where the patient resides will help in telling us about their cognitive and functional behavior, which might otherwise be missed.
-
Patients suffering from depression are more likely to bring their problems to their doctor's attention, whereas patients with dementia might be unaware of them. In addition, certain patients should be screened for pseudodementia, where patients suffer cognitive impairment along with depression.
-
Early stages of dementia can easily be neglected as they correspond to the signs of aging. Still, clinical signs to diagnose dementia a doctor would be missed appointments, inability to follow given instructions, poor hygiene, and grooming.
-
Depression can be diagnosed as a more chronic low-mood state with or without cognitive impairment.
-
The onset duration for depression is weeks to months, whereas, for dementia, it is months to years.
-
The mood is always low in depression and fluctuates in dementia.
-
Depression is chronic and responds to treatment, but dementia is chronic and deteriorates over time.
How to Treat Depression and Dementia?
1. Treating Depression in Patients With Dementia: Depression can worsen the problem of dementia, whereas treating depression can improve functional levels in dementia.
-
Non-pharmacological Approach: Interventions targeting the patients and caregivers are essential. Arranging a daycare for the patients and engaging them in different social and interactive activities. Educating the caregivers about the various caregiving skills.
-
Pharmacological Approach: After starting the non-pharmacological approach, it is essential to start pharmacological treatment. This involves starting the patient on antidepressant medications like Fluoxetine, Sertraline, Paroxetine, Citalopram, Escitalopram, Venlafaxine, Bupropion, Mirtazapine, Nortriptyline, Methylphenidate, Duloxetine. Initially, they are started on a low dose and titrated slowly. Treatment response can be seen in eight to 12 weeks.
2. Treating Depression in Patients With Dementia: Dementia is a slowly progressing disorder that has no complete cure. Still, we can slow the disease's progress and reduce the severity of symptoms by medications and starting specific therapies. The medications for dementia are Cholinesterase inhibitors (Donepezil, Rivastigmine, Galantamine). The brain has a chemical called acetylcholine which helps send signals to certain types of nerve cells. In patients with dementia, these chemical-acetylcholine levels are decreasing, and the loss of nerve cells is increasing. Cholinesterase inhibitors prevent the enzyme cholinesterase from breaking down this important messenger chemical of the brain (acetylcholine). These medications have proven to improve symptoms of dementia-like improvement in the patient's memory and daily activities like bathing, eating, and hygiene.
3. Psychological Therapies for Dementia: This offers additional support to the patient and their families apart from medications.
4. Cognitive Stimulation Therapy: This therapy aims at organizing daily and weekly group activities for the patients. It also plans an exercise routine for the patient. This helps patients with mild to moderate dementia and helps improve the patient’s problem-solving skills, memory, communication, etc. They often have unique themes for their activities and are conducted twice weekly or as recommended. The activities can include crosswords, puzzles, drawing, and music.
5. Behavioral Therapy for Dementia: In this therapy, it is crucial to understand the source of the behavior and suggest alternatives to eliminate the source. For example, the standard behavior of the patient can be, wandering outside the house due to restlessness; this can be addressed by resolving the patient’s restlessness by keeping him engaged in other activities like gardening, exercising, or anything of the patient’s interest. Family members should always inform the medical team about their parent’s behavioral changes.
6. Treating for Depression: Depression alone can be treated with the antidepressants mentioned above; patients can join social help groups for the elderly fighting depression. They can take one on one counseling sessions regularly with a psychologist. There is always an underlying cause leading to depression in older people as they would have gone through or will be going through a lot in life. The underlying cause should be dealt with, and support from friends and family will help such patients to recover sooner.
Conclusion:
Various studies show that depression is more commonly seen in patients with dementia than in those who do not have this condition. In addition, studies reveal that men are more prone to developing these disorders than women. Depression and dementia are widely seen in low-income and middle-income older adults. In such situations, accurate diagnosis and immediate treatment are crucial.
