Can Severe Depression Lead To Dementia

The First Diagnosis Initially Remains Without Consequences: For R Gs Wife Falls Ill With Cancer

But R. G. does not take this diagnosis seriously, or rather he cannot take it seriously and deal with it, because at the same time his wife falls ill with cancer. 15 chemotherapies and 36 radiotherapy sessions in 9 months have to be endured and overcome, there is no time for his head. He doesnt tell his wife about the diagnosis either, of course.

Understanding Depression May Help Us Better Understand Dementia

There is even overlap in clinical trials, where researchers are looking at the effectiveness of depression treatments for some symptoms of dementia. A recent analysis found that the antidepressant drug fluoxetine may show promise in improving cognitive symptoms in Alzheimers.

Together, depression and dementia may be two of the most challenging medical issues that we face in the coming decades. However, learning what depression and dementia have in common could help us treat depression and reduce the risk of some forms of dementia.

How Can Depression Affect Memory

When asked to explain the mechanisms behind the depression-dementia link, experts cite a variety of theories. According to Kenneth Freundlich, Ph.D., clinical neuropsychologist and head of the neuropsychology and consulting divisions of the Morris Psychological Group, there are currently several different biological factors that may help explain the relationship between depression and dementia. However, he cautions that no one model has been identified as the explanation for the depression-dementia connection.

Despite a variety of theories, the depression-dementia link is one that is not fully understood, Freundlich admits. People who are experiencing the early stages of dementia frequently become depressed and people who are depressed have an increased risk of developing dementia.

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What Are The Different Types Of Depression

• Depressive reaction. A less-severe and often temporary depression that arises from a specific life situation. In modern diagnostic language, a depressive reaction to a specific life stress is technically called a “stress response syndrome” . The symptoms can be severe, but unless they involve additional symptoms such as changes in sleep and appetite or thoughts of suicide, they usually do not need medication treatment and will abate over time — anywhere from two weeks to six months. Psychotherapy is sometimes recommended if symptoms start to interfere with normal everyday functioning.
• Major depression. A serious condition that can lead to an inability to function or suicide. Sufferers experience not only a depressed mood, but also have difficulty performing simple daily tasks, lose interest in their usual activities, extreme fatigue, sleep problems, or feelings of guilt and helplessness. They can sometimes also lose touch with reality, having delusions or hallucinations , in severe cases. It can be a cyclical illness, so while most patients recover from their first depressive episode, the recurrence rate is high — perhaps as high as 60% within two years and 75% within 10 years. After 15 years, 90% of individuals will have suffered a recurrence or relapse of depression.

As A Care Worker How Can You Help

There are many conditions and circumstances where you may see signs and symptoms that may be confused with dementia. As a care worker, it is not your responsibility to try to diagnose the condition. However, as you may be the one person who sees the individual on a regular basis, you are well placed to notice any changes. Encouraging an older person to visit their GP on a regular basis can help them to maintain their general health and wellbeing.

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Depression And Dementia: Similarities And Differences

Diseases often times mimic one another yet have distinct differences as well. This is no different with depression and dementia. Both can display the same symptoms, from lethargy to confusion, yet they have notable differences that define them. One can even mask the other. Add the hospice component to the equation and your loved ones symptoms may be compounded. The good news is that quality of life can be improved with proper treatment. If you are facing the need for hospice in San Francisco for your aging parent of other loved one who suffers from one or both of the above, Pathways Home Health and Hospice is here to help. Here we will discuss the similarities and differences between depression and dementia.

Is It Dementia Or Depression

In older adults who experience intellectual decline, its sometimes difficult to tell whether the cause is dementia or depression. Both disorders are common in later years, and each can lead to the other.

Depression in the elderly can also lead to a phenomenon called pseudodementiaan apparent intellectual decline that stems from a lack of energy or effort. People with this problem are often forgetful, move slowly, and have low motivation as well as mental slowing. They may or may not appear depressed. This syndrome responds well to treatments for depression. As mood improves, a persons energy, ability to concentrate, and intellectual functioning usually return to previous levels.

Although depression and dementia share certain traits, there are some differences that help distinguish one from the other:

• Unlike people with Alzheimers, people with depression are usually not disoriented.
• People with depression have difficulty concentrating, whereas those affected by Alzheimers have problems with short-term memory.
• Writing, speaking, and motor skills arent usually impaired in depression.
• Depressed people are more likely to notice and comment on their memory problems, while those with Alzheimers may seem indifferent to such changes.

Since there is no simple test that can reveal whether someone has depression or dementia, treatment is often worth trying. If depression is at the root, treatment can produce dramatic improvement.

Image: Marina113/Getty Images

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Antidepressants And Amyloid In Human Studies

Data from human studies suggest that serotonin signaling is associated with less A accumulation. In a retrospective study antidepressant-treated cognitively normal elderly participants had significantly less amyloid load as quantified by PET imaging with PIB compared to participants who were not exposed to antidepressants within the past 5 years. Cumulative time of antidepressant use within the 5-year period preceding the scan correlated with less plaque load. In a prospective study in healthy human volunteers, the effects of citalopram on A production and A concentrations in CSF were measured with CSF sampling during acute dosing of citalopram. A production in CSF was slowed in the citalopram group compared to placebo and the change was associated with an almost 40% decrease in total CSF A concentrations in the antidepressant-treated group.

These results suggest that inhibition of A oligomer-mediated aggregation significantly contributes to the overall neuroprotective activity of antidepressants. The ability to decrease A concentrations by antidepressant treatment is an important potential strategy for AD and might be a key target for future AD prevention.

Depression As An Early Sign Or Prodrome Of Dementia

Additional studies have shown that depressive symptoms before the onset of AD are significantly associated with the development of AD dementia, even when the onset of depressive symptoms occurred more than 25 years before the onset of cognitive symptoms. Because the neurodegenerative changes in AD precede the clinical diagnosis by several years, depressive symptoms may therefore also be one of the earliest non-cognitive manifestations of this neurodegenerative disease, suggesting a reverse causality hypothesis,.

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Biological Mechanisms Linking Depression To Dementia

The most prominent biological mechanisms linking depression to dementia include a hypothalamic-pituitary-adrenal axis dysregulation with alterations in glucocorticoid steroid levels, hippocampal atrophy, inflammatory changes, deficits of nerve growth factors, increased deposition of Amyloid- plaques and cerebrovascular disease.

Animal Studies On Antidepressants And Neurogenesis

Table 1 Summary of antidepressant actions with neuroprotective effects.

The focus of the neurotrophic hypothesis has been on BDNF, although there is also evidence that antidepressants increase VEGF , FGF2 and IGF-1 ,. Chronic stress results in decreased transcription of BDNF, whereas chronic treatment with monoamine modulators results in increased BDNF transcription. BDNF-TrkB signaling, involved in birth and survival of neurons in the hippocampus, stimulates several signaling cascades including mitogen-activated protein kinase and phosphatidyl inositol 3-kinase-Akt pathways . A decreased MAPK function is involved in the pathophysiology of depression and antidepressants produce an enhanced MAPK signaling. Studies indicate that BDNF is a key factor for antidepressant effects, which are partly mediated by induction of neuronal and glial cell birth and possibly also by effects on dendrite complexity. There is evidence for Wnt-GSK-3 in the actions of antidepressants. It is important for the growth and guidance of neurons during development and dendritic arborization in adult brain and might contribute to the reversal of neural atrophy by antidepressants.

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Depression Is A Risk Factor For Dementia

Many studies have found that people who are diagnosed with depression are more likely to develop dementia and experience earlier onset. Treating depression may also have a protective effect, reducing the risk of developing dementia later in life.

But since dementia and depression occur so often, figuring out whether theyre caused by similar processes in the brain is difficult. There may be common factors that contribute to the onset of both depression and dementia. Both depression and dementia are more likely to affect women. Both also involve dysfunction in the brains immune system.

Depression As An Accelerating Factor Of Cognitive Decline Before And Within Dementia

Dementia and mild cognitive impairment have been related to an increased risk of depressive symptoms. The prevalence of depression in MCI patients is high and depression is the predominant neuropsychiatric symptom of amnestic MCI. In a recent meta-analysis, the overall pooled prevalence of depression in MCI patients was 32%. The overall prevalence of depressive disorders among dementia patients is estimated to be 2530% with a significantly higher prevalence of depressive disorders in VaD and unspecified dementia compared with AD ,,,. Moreover, numerous studies have shown the potential role of depression in the conversion from normal cognition to MCI and from MCI to dementia. The majority of studies found, depression is an important accelerating factor contributing to the progression and conversion from a cognitively normal state to MCI and dementia,,,,. Older adults with a combination of MCI and recently active depression are a particularly high-risk subgroup.

Fig. 1: The relationship between depression and cognitive decline throughout the development and clinical course of Alzheimers disease .

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Seniors And Depression: The Difference Between Depression And Dementia

Depression is a mood disorder dementias like Alzheimers disease, can have similar symptoms but they are different illnesses and have different treatment plans.

Its important to know what to look for to help determine what illness you might be dealing with. Only a doctor can make a diagnosis however so if you experience any of the symptoms of either illness see your doctor right away.

Depression Mixed With Dementia

Regarding depression as a prodromal state of dementia, Ownby et al. conducted a meta-analysis of 9 case-control and 11 cohort studies and reported odds ratios of 2.03 and 1.90 for the development of AD in patients with a history of depression compared with those without a history of depression, respectively . Other meta-analyses have reported odds ratios of 1.65 and 2.52 for the development of AD and VaD, respectively, in older patients with a history of depression compared with patients without a history of depression . In addition, a systematic review of longitudinal studies of pseudodementia reported that 33% of patients with depressive pseudodementia had progressed to irreversible dementia at follow-up . Recently, depression has received special attention as one of the precursors of DLB, and a retrospective study of 90 patients with DLB reported that depressive symptoms preceded memory impairment by an average of 4.8 years .

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Treatment And Management Implications

Currently, there are 35.6 million individuals with dementia worldwide and the associated costs in 2010 were more than 600 billion dollars.100 Dementia is projected to increase to 65.7 million by 2030 with associated costs expected to rise 85%.100 Thus, delaying dementia onset could prevent millions of cases and save billions of dollars.

An alternative strategy to improving the course of cognitive decline with depression-interventions is an integrated treatment approach. A recent pilot study in this area has shown promising results, where addition of a cholinesterase inhibitor following antidepressant medication treatment in elderly depressed, cognitively impaired patients showed significant improvement in memory.112 Another approach may be to combine antidepressants with behavioral interventions that may protect against cognitive decline . A combined treatment approach of antidepressants, cholinesterase inhibitors, vitamins, and diet, lifestyle and exercise modifications has been found to protract cognitive decline over 24 months and improve memory and frontal lobe functions.113 Although testing the efficacy and effectiveness of such interventions is in its infancy, these integrated strategies hold great promise. Thus, future studies should continue to examine the implication for depression modification in clinical trials, focusing on whether simultaneous or subsequent interventions have additive or multiplicative effects on cognition.

Behavioral Effects Of Depression On The Brain

Alzheimers educator Robin Dessel believes there are also certain behavioral elements which may play a role.

Depression and dementia mirror each other in a catalogue of symptoms and triggers, she explains. There is a very real and integral connection between the health and well-being of brain and body, mind and spirit.

For example, one of the primary symptoms of depression is an unwillingness to engage in regular activities and socialization opportunities. Social withdrawal and reluctance to participate may lead to what Dessel refers to as an inactive brain and a depressed lifestyle.

Two separate studies have found that loneliness and a lack of social engagement placed individuals age 65 and older at greater risk for developing dementia. This lack of engagement can enhance an individuals susceptibility to showing signs of dementia, especially when compounded by certain genetic, physiological and environmental factors that have been shown to contribute to cognitive impairment.

Since depression seems to contribute to dementia and vice versa, it can be difficult to tell exactly what physical and mental health conditions are primarily responsible for a seniors cognitive decline and changes in mood.

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What Is Alzheimer Dementia

Alzheimer dementia is the most common type of dementia. Dementia is a group of symptoms caused by damage to brain cells. This can happen because of a tumor, head injury, stroke or disease. Alzheimer dementia makes it hard for people to remember, learn, and communicate. These changes eventually make it hard for people to care for themselves. It may also cause changes in mood and personality.

Depression is very common among people who have Alzheimer dementia. In many cases, they become depressed when they realize that their memory and ability to function are getting worse. Together, depression and Alzheimer dementia can cause other symptoms. They may not want to go places or see people anymore. Their outlook and quality of life can suffer.

Dementia And Depression Are Connected Heres What You Need To Know About The Relationship Between The Two Health Conditions

More than 60 percent of people with dementia are also diagnosed with depression. In some cases, studies indicate that depression might even cause the brain to age faster. Both conditions have similar symptoms which occasionally lead to a mixed-up diagnosis. This has led many scientists and clinicians to seek to understand this connection.

Some of the questions researchers are now asking: Does depression always occur before dementia? And if so, is it part of the disease process an early symptom of depression? Or does it have a causative relationship with the neurodegeneration that follows? We dont yet know the answers, but we do know there are some very complex interactions between these two diseases.

There are a couple things we know that depression and dementia have in common: For starters, these conditions both occur at very high rates in older populations, both are complex in their origin, and neither is easy to treat. Here are a few other things we know so far:

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Clinical Characteristics Of The Study Population And Gender Differences

The study population comprised 60 older adults over the age of 65 years , their age ranged from 65 to 93 years .

Regarding gender differences, the mean age of males was lower than that of females . Common diseases characterized a significant proportion of both older males and females, as did other physical comorbidities. Both females and males took a number of medications because of their several illnesses. In addition to medications taken for the underlying physical conditions , the use of analgesics and psychotropic medications was also significant . Males had more previous and current psychiatric treatments. However, no significant gender differences were found in the occurrence of the already diagnosed mental disorders, in the number of previous in-patient or out-patient psychiatric treatments, or in the current use of psychiatric medications . Among mental disorders in the patients history, addictions were more common among males , while depression and dementia in females.

Table 1 The main clinical characteristics and gender differences in the old age study population

Dementia And Depression Are Both Treatable But To Varying Extents

One big difference between dementia and depression is that the latter is easier to treat. While it may take one to two years of trying different medications and therapists, many people do go into remission.

On the other hand, there is currently only one disease-modifying treatment approved for Alzheimers Biogen and Eisais drug Aduhelm the efficacy of which is still controversial. Beyond the sheer question of whether it does in fact do what it was designed to do, the drug is difficult to access, not to mention expensive for people outside of clinical trials.

Speaking with a doctor and getting the right diagnosis is important for treatment. Some older adults who are diagnosed with depression could experience more cognitive impairment when treated with some, but not all, antidepressants while others have been found to lower the risk of developing dementia.

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