Depression vs. Dementia

So why talk about these two different topics in the same sentence?  They are actually very similar, yet have subtle differences and sometimes get misdiagnosed.

For a long time doctors dismissed forgetfulness and mental confusion as a normal part of aging. But scientists now know that memory loss as you age is by no means inevitable. Indeed, the brain can grow new brain cells and reshape their connections throughout life.

Most people are familiar with at least some of the things that can impair memory, including alcohol and drug abuse, heavy cigarette smoking, head injuries, stroke, sleep deprivation, severe stress, vitamin B12 deficiency and illnesses such as Alzheimer’s disease and depression.

Depression is not a normal part of aging as many people believe, if it were, everyone would be depressed. Everyone is impacted by daily life and things that happen can be very depressing such as loss of our partner, loss of health, loss of our home of many years, children and grandchildren disappointing us to name a few. But, if ignored, symptoms of depression can cycle into a much more serious problem.

Why does depression often get misdiagnosed in older adults, because the symptoms are similar to dementia or we complain about physical symptoms that doctors are forced to evaluate and can also be one of the contributing factors to higher healthcare costs.

Dementia warning signs include: short term memory loss, difficulty performing familiar tasks, problems with language, disorientation to time and place, poor judgment, problems with abstract thinking, misplacing things, changes in mood or behavior, changes in personality and loss of initiative. Some of these symptoms are often present in depression but not reversible when associated with dementia. There are also diagnostic tools to evaluate for dementia beginning with the Mini-Mental Status Exam, and AD8 = Eight-item Informant Interview to Differentiate Aging and Dementia; AWV = Annual Wellness Visit; GPCOG = General Practitioner Assessment of Cognition; HRA = Health Risk Assessment; MIS = Memory Impairment Screen; MoCA = Montreal Cognitive Assessment; SLUMS = St. Louis University Mental Status Exam; Short IQCODE = Short Informant Questionnaire on Cognitive Decline in the Elderly.

Subtle differences between the two diagnoses:

DEPRESSION                                                                     DEMENTIA

Mainly a mood disorder                                                              Progressive brain damage

Others are aware of problem                                                     Others may not be aware

Short duration, rapid progression                                             Long duration, slow progression

Patient is aware of memory loss                                               Unaware of loss or denies

Little energy to perform simple tasks                                      Struggles with tasks

Forgetfulness varies day to day                                                Forgetfulness is progressive

Highlights failures                                                                        Grandiose

Reports distress                                                                           Doesn’t recognize distress

Sad and grieving                                                                          Mood swings

Withdrawn, loss of interest in food, activity or sex                Often uninhibited

Usually worse in the morning                                                    Usually worse in the evening

Memory loss equal for short and long term memory             More recent memory loss

Wants to be left alone                                                                  Affection seeking, uninhibited

Usually not incontinent                                                               Often incontinent

If you have questions or concerns about a loved one’s mood, behavior, motivation or activity level, please contact us for an assessment or resources for obtaining a diagnostic evaluation.

 

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