Dementia and Depression Connection, Top Signs & Symptoms

Depression is very common among people with Alzheimer’s, especially during the early and middle stages. Mental health treatment is available and can significantly impact the quality of life. Continue to read more about dementia and depression.


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What’s The Connection Between Dementia and Depression?

Dementia affects people in different ways, and changes in the behavior or emotional state of a person living with dementia are common.

People with dementia of any type have a high incidence of major depression. The occurrence of a first major depressive episode in an older adult is a risk factor for developing dementia.

Management of depression in a person with dementia should be enthusiastic about optimizing the quality of life. Non-pharmacological and pharmacological strategies are essential in depression treatment in dementia, and managing these patients requires a collaborative approach.

Selective serotonin reuptake inhibitors are the first-line pharmacotherapy for depression in dementia, although they are less likely to be effective in older people. [1]

Various disorders and factors contribute to the development of dementia. Neurodegenerative disorders result in a progressive and irreversible loss of neurons and brain functioning. Currently, there are no cures for these diseases.

Types of dementia include:

  • Alzheimer’s Disease – The most common dementia diagnosis among older adults. It is caused by changes in the brain, including abnormal buildups of proteins, known as amyloid plaques and tau tangles.
  • Frontotemporal Dementia – A rare form of dementia that tends to occur in people younger than 60. It is associated with abnormal amounts or structures of the proteins tau and TDP-43.
  • Lewy Body Dementia – A form of dementia caused by abnormal deposits of the protein alpha-synuclein, called Lewy bodies.
  • Vascular Dementia – A form of dementia caused by conditions that damage blood vessels or interrupt blood flow and oxygen flow to the brain.
  • Mixed Dementia – A combination of two or more types of dementia. For example, through autopsy studies involving older adults with dementia, researchers have identified that many people had various brain changes associated with different forms of dementia.

Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend entirely on others for basic living activities.

Furthermore, medical conditions such as stress, anxiety, depression, and delirium can cause serious memory problems that resemble dementia, as can alcohol use disorder and side effects of certain medicines. [2]

Psychiatric evaluations will help determine if depression or another mental health condition is causing or contributing to a person's dementia and depression symptoms.
Psychiatric evaluations will help determine if depression or another mental health condition is causing or contributing to a person’s dementia and depression symptoms.

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Depression and Dementia Statistics

An estimated 20 to 30% of people living with dementia experience depressive symptoms. People in long-term residential care are particularly at risk. Other factors that may contribute to someone’s depression include physical illness. [3]

68%

The prevalence of depression in dementias has been reported to be between 9 and 68%. 

Source: NCBI

40%

Experts estimate that up to 40% of people with Alzheimer’s disease suffer from significant depression.

Source: NCBI

1 in 6

One recent analysis estimated that one in six people with dementia suffers from major depressive disorder.

Source: NCBI

Dementia Depression Facts Sheet

Practitioners caring for people with dementia should be alert to “major depression” as this will require specific management strategies.

Depressive symptoms are pretty common in older people. However, sustained and disabling major depressive episodes are more common in those with dementia than in age-matched controls without dementia. The incidence of depression is 30% in vascular dementia and Alzheimer’s disease and over 40% in dementia associated with Parkinson’s and Huntington’s diseases.

Some signs of dementia may strongly resemble those of major depressive disorder, such as social withdrawal, lack of interest in self or others, low initiative, and poor motivation.

The symptoms and signs of “major depression” in dementia are often no different from depression in any other group. The mood is most commonly low but can be irritable, angry, or anxious. Disturbed biological rhythms in sleep, appetite, and energy are typical, and patients may be pessimistic, hopeless, or even nihilistic. Ideas of worthlessness, guilt, and self-harm also occur. Overall cognitive ability may decline significantly due to depression alone. Attributing cognitive impairment to dementia or depressive disorder may be difficult until an adequate treatment trial for depression has occurred.

Source: Depression in dementia – National Center for Biotechnology Information

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Cornell Scale for Depression in Dementia

The Cornell Scale for Depression in Dementia is a 19-item clinician-administered instrument that uses information from interviews with both the patient and a nursing staff member, a method suitable for demented patients. The scale has high interrater reliability (KW = 0.67), internal consistency (coefficient alpha: 0.84), and sensitivity. Total Cornell Scale scores correlate (0.83) with depressive subtypes of various intensities classified according to Research Diagnostic Criteria. [4]

The Cornell Scale of Depression in Dementia (CSDD) is a screening measure since it incorporates information from interviews with patients and caregiver-informants. If there are discrepancies, the interviewer meets with the patient and informant a second time and makes a final rating based on his or her best clinical judgment. This way, the interviewer can evaluate depressive signs and symptoms even when patients cannot reliably self-report. Although the original administration guidelines recommend this tripartite approach, some studies only use the CSDD as an informant-based scale, usually relying on nurses as raters. [5]

An example of the Cornell Dementia Depression Scale is presented below. Available from the National Library of Medicine.

Cornell-Scale-for-Depression-in-DementiaDownload

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Depression Dementia Symptoms

The effects of dementia can have a significant impact on a person’s mood and emotions as they try to cope with their cognitive changes. This means that depression can also appear as a symptom of dementia.

In many cases regarding dementia and depression, older individuals with depressive symptoms, particularly those with Alzheimer’s disease, don’t always meet the classic diagnostic criteria for major depression.
In many cases regarding dementia and depression, older individuals with depressive symptoms, particularly those with Alzheimer’s disease, don’t always meet the classic diagnostic criteria for major depression.

When doctors prescribe antidepressants to people with dementia, they must monitor them closely. This is because it can be challenging to observe the effects of psychiatric medications in people with dementia.

Due to the significant overlap in symptoms, depression can be hard to diagnose in people with dementia. Many dementia symptoms also overlap with depression symptoms, including:

  • Having difficulty with memory and concentration
  • Feeling depressed, down, or helpless
  • Losing interest in previously enjoyable activities
  • Isolating yourself from others

Depression in Dementia Patients Risk Factors

Depression is high in the early stages of dementia because the risk of developing dementia rises with age, life difficulties, and loss. About 5 to 8% of people over age 60 have a form of dementia, says the World Health Organization. [6] Conditions that can increase the risk of dementia include:

  • Atherosclerosis – A common condition develops when a sticky substance called plaque builds up inside your arteries.
  • Depression – Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest and can interfere with your daily life.
  • Diabetes – Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to severe damage to the heart, blood vessels, eyes, kidneys, and nerves.
  • Down Syndrome – A condition in which a person has an extra chromosome. Chromosomes are small “packages” of genes in the body. They determine how a baby’s body forms and functions as it grows during pregnancy and after birth. 
  • Hearing Loss – Sensorineural hearing loss occurs when there is damage to the inner ear or the auditory nerve. 
  • HIV – The human immunodeficiency viruses are two species of Lentivirus that infect humans. Over time, they cause acquired immunodeficiency syndrome, a condition in which progressive immune system failure allows life-threatening opportunistic infections and cancers to thrive.
  • Huntington’s Disease – A condition that stops parts of the brain from working correctly over time.
  • Hydrocephalus – Hydrocephalus is the buildup of fluid in the cavities (ventricles) deep within the brain. 
  • Parkinson’s Disease – A brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination
  • Mini-Strokes, vascular disorders – When a small clot from an artery or the heart passes to the brain or eye, they cause “mini-strokes” or temporary loss of vision. 

Contributing factors may include:

  • Long-term alcohol or drug use
  • Obesity
  • Poor diet
  • Repeated blows to the head
  • Sedentary lifestyle
  • Smoking

Researchers say depression can increase your risk for dementia. According to the National Institute of Mental Health, about 16 million adults in the United States (almost 7% of all American adults) have experienced at least one major depressive episode in the past year. Moreover, depression is the leading cause of disability in the United States for people ages 15 to 44. [7]

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Diagnosing Delirium VS Dementia VS Depression

Depression, dementia, and delirium have some features in common. Depression and delirium, particularly hypoactive delirium, may present with apathy, withdrawal, and tearfulness. Delirium occurs suddenly (over a matter of hours or days), and the symptoms tend to fluctuate throughout the day; depression describes an adverse change in mood that has persisted for at least two weeks, and the onset of dementia is generally slow and insidious. The section below briefly explains how depression vs dementia and delirium differ.

Feature

Onset and duration

Dementia

Slow and insidious onset; deterioration is progressive over time.

Delirium

Slow and insidious onset; deterioration is progressive over time.

Depression

The recent change in mood persisting for at least two weeks – may coincide with life changes – can last for months or years.

Course

Symptoms are progressive over a long period; not reversible.

Short and fluctuating; often worse at night and on waking. Usually reversible with treatment of the underlying condition.

Typically worse in the morning. Usually reversible with treatment.

Psychomotor activity

Wandering/exit seeking

Agitated

Withdrawn (may be related to coexisting depression)

Hyperactive delirium: agitation, restlessness, hallucinations

Hypoactive delirium: sleepy, slow-moving

Mixed: alternating features of the above.

Usually withdrawn

Apathy

May include agitation

Alertness

Generally normal

Fluctuating or may be hyper-vigilant through to very passive.

Normal

Attention

Generally normal

Impaired or fluctuating, difficulty following a conversation.

May appear impaired

Mood

Depression may be present in early dementia.

Fluctuating emotions – for example, anger, tearful outbursts, fear.

Depressed mood

Lack of interest or pleasure in usual activities

Change in appetite (increase or decrease)

Thinking

Difficulty with word-finding and abstraction

Disorganized, distorted, fragmented

Intact; themes of helplessness and hopelessness present

Perception

Misperceptions are usually absent (can be present in Lewy body dementia)

Distorted – illusions, hallucinations, delusions; difficulty distinguishing between reality and misperceptions

Usually intact (hallucinations and delusions only present
in severe cases)

Delays in investigating and treating underlying reasons for cognitive impairment, or initiating inappropriate treatment, can have severe consequences for an older person’s health and well-being while in the hospital, treatment facility, and on discharge.

Knowing the signs of depression or dementia and seeking treatment is very important. Do get an evaluation if you’re wondering. Exercising regularly will help with both anxiety and mood. Avoid recreational drugs or drinking excessively, which can make the problem worse. Make time to reflect on what you appreciate in your life. Get enough sleep because sleep deprivation significantly affects mood. Finally, staying social and maintaining close relationships with others can help considerably.

Mental health professionals generally agree that there are things we can do to maintain or improve our mood to stave off cognitive decline. If you're looking for dementia and depression treatment resources, connect with the We Level Up FL mental health treatment center.
Mental health professionals generally agree that there are things we can do to maintain or improve our mood to stave off cognitive decline. If you’re looking for dementia and depression treatment resources, connect with the We Level Up FL mental health treatment center.

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Treating Depression With Dementia

Dementia itself is not a disease but a constellation of symptoms caused by diseases and disorders that affect the brain, including Alzheimer’s disease (AD), Parkinson’s disease (PD), diffuse Lewy body disease (DLBD), strokes, and others. Dementia involves progressive memory loss and other cognitive functions such as problem-solving and emotional control. The earliest diagnosable stage of dementia is referred to as mild cognitive impairment (MCI). For those who develop dementia or depression, abilities to independently perform instrumental and essential activities of daily living are generally impaired as the condition progresses.

Nonpharmacologic interventions, including emotion-oriented therapies, behavioral and cognitive-behavioral modification programs, and structured activity programs, demonstrate initial support for treating dementia and depression.
Does depression cause dementia? Yes. But help is available. Nonpharmacologic interventions, including emotion-oriented therapies, behavioral and cognitive-behavioral modification programs, and structured activity programs, demonstrate initial support for treating dementia and depression.

Behavioral and psychological symptoms of dementia (BPSD) affect up to 95% of those with dementia during the illness. Fortunately, many pharmacological and nonpharmacological treatments have been used to relieve depression in persons with cognitive impairment and dementia. [8]

The good news is, among mental health issues, depression is one of the most treatable. Medications like antidepressants, cognitive behavioral therapy, and electroconvulsive therapy have been proven to improve depression symptoms positively.

The We Level Up FL mental health treatment center can help you understand your symptoms and how to manage them appropriately. With many years of expertise and a compassionate commitment to helping people facing the challenges of depression, our goal is to help you achieve physical and mental well-being. Contact us today to learn more about how we can help you!

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Call us now for a free mental health assessment! In addition, for the substance abuse or dual diagnosis approach, our inpatient treatment, inpatient medical detox, and residential primary addiction treatment may be available at our affiliated facility. For more endogenous depression treatment resources, call us about your symptoms, and we can help you determine the cause and develop a treatment plan.

We Level Up FL treatment center provides world-class care with round-the-clock medical professionals available to help you cope. Make this your opportunity to reclaim your life. Call today to speak with one of our treatment specialists. Your call is private and confidential, and there is never any obligation.

Top 5 Most Depression in Dementia Frequently Asked Questions

  1. Can depression mimic dementia?

    Yes. The symptoms of depression are often mistaken for dementia.

  2. Does dementia cause depression?

    Depression is ubiquitous in people living with dementia. An estimated 20 to 30% of people living with dementia experience depressive symptoms. People in long-term residential care are particularly at risk.

  3. Can depression cause dementia?

    Yes. The prolonged depressive symptoms in later life (in the decade before dementia onset, not earlier) are good predictors of increased dementia risk. 

  4. Is it true that pseudo dementia can be caused by depression and mimics dementia?

    Yes. The term pseudodementia refers generically to treatable disorders that mimic dementia. The most common is depression. Vascular dementia and depression can lead to reduced motivation, impaired concentration, and mental slowing. Consequently, both diseases can lead to widespread cognitive and memory dysfunctions.

  5. Can dementia delirium depression be cured?

    Other than dementia, delirium and depression could be treated and reversible.

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Sources

[1,3] Kitching D. Depression in dementia. Aust Prescr. 2015 Dec;38(6):209-2011. DOI: 10.18773/austprescr.2015.071. Epub 2015 Dec 1. PMID: 26843714; PMCID: PMC4674029.

[2] What Is Dementia? Symptoms, Types, and Diagnosis – National Institute on Aging

[4] Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry. 1988 Feb 1;23(3):271-84. DOI: 10.1016/0006-3223(88)90038-8. PMID: 3337862.

[5] Towsley G, Neradilek MB, Snow AL, Ersek M. Evaluating the Cornell Scale for Depression in Dementia as a proxy measure in nursing home residents with and without dementia. Aging Ment Health. 2012;16(7):892-901. DOI: 10.1080/13607863.2012.667785. Epub 2012 Apr 10. PMID: 22486638; PMCID: PMC3416948.

[6] Dementia – WHO/World Health Organization

[7] Major Depression – NIMH/National Institute of Mental Health

[8] Gellis ZD, McClive-Reed KP, Brown E. Treatments for Depression in Older Persons with Dementia. Ann Longterm Care. 2009 Feb 2;17(2):29-36. PMID: 21814486; PMCID: PMC3147175.

[9] Ramírez Echeverría MdL, Schoo C, Paul M. Delirium. [Updated 2022 Nov 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470399/

[10] Emmady PD, Schoo C, Tadi P. Major Neurocognitive Disorder (Dementia) [Updated 2022 Nov 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557444/