Charlene has a problem. She feels sad and has trouble remembering to book an event on her calendar let alone show up for it . She is anxious, has trouble sleeping yet sometimes sleeps too much, experiences increased aches and pains, and has little or no appetite. Richard experiences the same symptoms. It turns out that Charlene is depressed and Richard suffers from progressive dementia. Then there’s Greta who has all those symptoms and i s diagnosed with both dementia and depression. Now, consider Henry who has non e of those symptoms but over a period of several weeks goes from having perfect cognition to mild confusion to full – blown delirium with hallucinations, which is an acute form of reversible dementia. Henry’s problem is a urinary tract infection. This article explores the reasons why, a s a friend or family member of someone who you think is afflicted with dementia or depression or both, your first mandate is to see to it that your loved one gets a critically needed medical diagnosis before any other action is taken.

While there is good information on the Internet, depression and dementia are two separate and complicated illnesses with very similar symptoms, and we can not learn enough about either to tell the difference by ourselves. In this case, arm chair diagnosis is dangerous. Only a physician specialist can make a diagnosis of depression, dementia, or a combination of both. Start by engaging the person’s primary care physician to obtain a preliminary diagnosis. Emphasis here is on preliminary because unless a treatable physical problem (like Henry’s) is causing dementia-like behavior, the primary physician will need to make a referral to the appropriate healthcare specialist(s).

A primary care doctor does what is called a “rule out” to determine if a patient’s dementia or depressive symptoms are caused by a physical problem. The “rule out” is important because m any physiological problems can mimic both dementia and depression . Behavior related to a physical cause must be eliminated before the patient is sent to a specialist. Heart, lung, thyroid, kidney problems, strokes, and chest or urinary infections are famous for masquerading as dementia . If a person experiences depression for the first time as an older adult, the problem may be a result of restricted blood flow to the brain, called “vascular depression” that could indicate a risk for high blood pressure, Peripheral Artery Disease, heart attack, stroke, or other vascular illness . Dementia – like side effects can also be brought on by medications, vitamin deficiencies, dehydration, or substance abuse. The good news is that usually once the underlying physical problem is treat ed, the dementia-like behavior stops. Of course, if a stroke , for example, is severe enough to cause permanent brain damage, the dementia may be permanent.

If a physical problem is either identified and treated or ruled out , and dementia rather than depression is suspected , the primary care physician should immediately refer the person to a memory clinic, neurologist or psychiatrist where the specific type of organic brain disease is identified and a treatment protocol is established and monitored . As eager as we are to discover our loved one’s problem, we must resist the urge to ask the primary care doctor to make any diagnosis beyond a physical one. A specialist’s diagnosis is absolutely necessary because if dementia is misdiagnosed as depression and the patient goes without medical intervention targeted t o memory loss, the person’s quality of life suffers. If the primary care physician believes dementia and depression overlap as in the case of Greta, appropriate specialists make the diagnosis(s) and prescribe and monitor medication and therapy.

If the primary physician suspects that depression alone is the problem, the person is placed under the care of the appropriate specialist; a combination of psychological therapy and medication is generally regarded as the best way to manage the disease . Depression c an creep up gradually or swoop in like a flash flood, and it is not unusual that depressed behavior like Charlene’s can imitate dementia. Depression is a common side effect of experiencing loss, loneliness or difficulty dealing with physical problems cause d by a chronic disease. Fortunately, appropriate medication and/or talk therapy can help to improve the quality of life. While l ate – life depression is common , note that it is not normal. Sadly, it affects million s of Americans age 65 and older , yet only around 10% receive treatment for it. That number represents a lot of distressed people who need help. Again, correct diagnosis by the appropriate professional is key because if depression is misdiagnosed as dementia, the person may not only continue to experience emotional damage but also could suffer physical harm from taking the wrong medicine.

The takeaway here is as friend s or family member s who watch a loved one struggle with irritability and panic at times, or with forgetfulness, poor concentration, social withdrawal, and many other symptoms of both depression and dementia, rather than make an armchair diagnosis, we need to familiarize ourselves with a few general facts about both diseases and get our loved one medical help, starting with the primary physician who will make any necessary referrals.

As a general rule:

  • People who are suffering from dementia have difficulty with both processing and retaining new information because of organic brain disease rather than a deficit in attention or motivation.
  • People who are depressed may have difficulty in learning new information or tasks that require sustained attention or effort, but once learned they tend to remember it. The difficulty likely stems from a deficit in attention or motivation rather than in memory.
  • Dementia patients are not likely to be aware of the extent of their cognitive impairment as they typically are progressively unable to be self-aware.
  • Depressed patients are typically aware that they are forgetful and complain about the fact that they have a poor memory.

The information presented here is only a drop in a gigantic bucket of data about dementia and depression. We owe it to our older loved ones to find out if their symptoms arise from an undiagnosed physical problem.

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Too many seniors suffer prolonged and debilitating dementia symptoms their family thinks are permanent when a change in medication , a round or two of antibiotics to treat a urinary infection , or even simple rehydration can cure a reversible form of dementia . When dementia or depression is diagnosed, each must be treated accordingly . If problems are the result of progressive dementia, medications and non – medical interventions can give our loved ones more pleasant days . If depression cause s unhealthy or inappropriate behavior, with proper help there are interventions and coping techniques that can lead to a better quality of life. Getting the right diagnosis is critical for the one afflicted and also for the mental well – being of all who love and care for the person.

Kathy Faenzi - Head ShotKathy C. Faenzi MA is a Clinical Gerontologist and Senior Care Consultant based in San Mateo, CA.

JC Spicer, M.Ed. is a Freelance Social Science Writer and Developmental Editor based in the U.K.