Dementia and depression frequently coexist and are common in later life. Depression is often unrecognised and therefore not treated properly. This can lead to decreased quality of life and functional abilities. The symptoms of depression include low mood, reduced energy, lack of interest in life, sleep and appetite disturbances, negative ideas and impaired concentration. These symptoms may be difficult to distinguish from dementia.

People with a past history of depression, cognitive impairment, chronic physical illness, substance abuse, recent major losses (for example, death of spouse), or those who have recently moved to residential care are more likely to develop depression.

Recognising depression in the presence of dementia is important. The most significant aspect of assessment for depression is change in mood or activity. Family and carers are important sources of information. An assessment scale such as the Geriatric Depression Scale may be useful for those who are able to respond to survey or interview questions. When self-reporting questionnaires are not possible, the Cornell Scale is a useful alternative.

Some clues to the diagnosis of depression include the following:

• Mood: Does the person say they feel depressed or unhappy? Do they look depressed or cry frequently? Is their mood worse in the morning? Do they no longer enjoy the things they used to (for example, spending time with grandchildren, gardening)?
• Activity: Does the person lack energy or has activity declined? Is the person overactive (for example, wringing their hands)?
• Sleep: Has the pattern of sleep changed? Is there a regular disturbance of night sleeping with early morning waking?
• Appetite: Has appetite changed or has the person lost weight?

Other changes of behaviour such as increased irritability and aggression, and negative delusions (for example, thinking people want to harm or poison them) may also indicate depression. Suicidal ideas require urgent treatment.

There are effective medications for depression, however it is important to refer to you doctor or health professional if the condition is suspected in a person with dementia. Supportive therapies such as increased activity and exercise can help. Referral to a geriatric psychiatrist may be required in situations where significant cognitive, functional and behavioural changes are evident or safety is an issue. Families and carers are also at high risk of depression.

Recommendations

• Depression in older people is common and often not diagnosed. It can cause symptoms that mimic dementia
• Depression is common in those with all forms of established dementia
• Careful history taking and information gathering from carers and family are important steps towards accurate diagnosis
• A recent change in mood, sleep habits, appetite or activity levels may indicate depression.

Summary

Depression and delirium may have symptoms similar to those of dementia and accurate diagnosis is important. Early recognition of depression and appropriate referral are important as treatment options are effective and may improve quality of life.

Source: Department of Health and Ageing