Tuesday, October 22, 2019

How do you know if it is dementia, depression or both?

Have you ever had trouble recalling certain words? Do you remember your first grade teacher? Could it just be a “senior moment” or is it something more serious? We all have trouble recalling particular things like these on occasion. We may not remember where we left the car keys, or even why we went into a room; we get there but scratch our heads trying to bring to mind why we went there in the first place. Sound familiar?

These incidences are not normally caused by a mental deterioration but are most likely part of the typical aging process, but what about not knowing your spouse or child? What about changes in your mood, personality or abilities to perform normal living activities, such as cooking, shopping, handling of money, gardening or getting to your weekly bridge or golf game?

Many of us may not recall the answer to the first few questions, but sadly for someone with Alzheimer’s disease, when the loss of memory affects your ability to recall recent events, or you cannot function without assistance and begin to forget your family, it becomes complex. Although Alzheimer’s disease is the most severe form of dementia, there are several other forms of the disease and many of the symptoms can be related.

Dementia is medically defined as the progressive loss of intellectual functions, such as thinking, remembering and reasoning. This brain dysfunction is of sufficient severity that it results in a restriction of a person’s ability to perform daily activities, both of social and occupational functioning.

Although the signs and symptoms may vary from person to person, in general they tend to worsen over time. Often, eventually our loved ones will need assistance with everything that they were capable of doing in the past. The memory cannot recall things in the present or recent past, but does retain information and events that occurred many years ago.

Dementia is not a disease itself but rather a group of symptoms that may manifest diseases or conditions, much like a fever is associated with many illnesses. The disease usually occurs after the age of sixty-five and becomes more prevalent as we grow older. Approximately two percent of adults aged sixty-five to sixty-nine have the disease. Alzheimer’s disease is a form of dementia. Approximately half of all dementia patients have Alzheimer’s disease.

Researchers believe that, most commonly, dementia occurs when nerve cells, or neurons, start to break down or degenerate, and the normal connections in the brain between the nerve cells are interrupted. Except in cases of specific diseases, these disruptions can have many causes, and usually cannot be reversed unless caused by alcohol, drugs, hormone, or vitamin imbalance, or depression.

According to a recent edition of the medical journal, “Neurology,” there are various diseases that can cause dementia. These include Parkinson’s disease, Huntington’s, AIDS, Alzheimer’s (which accounts for approximately forty to forty-five percent of all dementias), vascular disease or stroke, (which accounts for twenty percent); and other conditions, including traumatic head injury, alcohol abuse, Pick’s disease, brain abscess, Multiple Sclerosis, vitamin B1 and B12 deficiencies, hypothyroidism, and more than fifty other rare degenerative conditions.

The many symptoms of this is horrific and complicated disease of dementia can mimic depression. Similarly, symptoms of depression can mimic dementia. According to the National Mental Health Association, thirty to fifty percent of older adults with memory loss, or dementia, also suffer from depression and “unfortunately, symptoms of depression are often overlooked and untreated when they coincide with other medical illnesses” or life events that commonly occur as people age.

In the case of dementia, depression can last over a period of months and it can occur anywhere in the disease process. An important aspect to consider is that depression can cause additional stress in the early stages of dementia and later it can trigger behavioral problems, which can be severe.

Some of the symptoms of depression alone can cause dementia-like symptoms such as social withdrawal, lack of interest in previously enjoyed activities, low spirits, feelings of hopelessness, sadness, tearfulness, sleep disturbances, changes in appetite, confusion, forgetfulness, inability to concentrate, irritability, aggression and distrust.

Additional depression symptoms such as apathy, loss of interest in previously enjoyed activities and hobbies, worry, weight loss and isolations can be compounded with dementia. In persons with Alzheimer’s, the depression can lead to wandering, delusions, hallucinations, verbal agitation and aggression towards caregivers during the performance of activities of daily living. For persons with Alzheimer’s, depressive symptoms may come and go, be less severe, not last long or reoccur as often as someone without Alzheimer’s.

It is important to get the right diagnosis. Of considerable interest is a recent report from the Alzheimer’s Association: the US National Institute of Mental Health has proposed a new diagnostic criteria for a specific disorder called “depression of Alzheimer’s disease,” to be used to identify those with the dual diagnoses of Alzheimer’s and depression. Although the criteria are similar to general standards for major depression, they reduce the verbal emphasis and include irritability and social isolation.
To meet these criteria, someone must have, in addition to an Alzheimer’s diagnosis, other changes in functioning characterized by three or more symptom during the same two-week period. These must include at least one of the first two on the list – depressed mood or decreased pleasure in usual activities.

Early recognition and treatment is the key as every seventy-two seconds someone in America develops Alzheimer’s disease according to the National Association.

Paula Camposano Robinson, RN, is co-founder and owner of Sanitasole Senior Health Services. This is an information-only column and is not intended to replace medical advice from a physician. Email meat probinson@sanitasole.net or visit www.sanitasole.net for more information. Phone: 239.394.9931.

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