Knowing the difference between dementia and depression in older adults

Signs of depression for seniors can be somewhat different than they are for younger adults

Many seniors experience some level of sadness. It can be triggered by a lot of different events as they get older: losing loved ones and spouses, experiencing an unwanted move, coping with serious illnesses.

Often, the depression that a senior experiences may be only temporary. In other cases, it can continue for months or years. Depression also can be a symptom of early dementia.

Older adults are at high risk for depression and cognitive disorders, the latter of which can be chronic (as in dementia) or acute (as in delirium). Some patients have both affective (mood) and cognitive disorders.

“Older adults come from a generation that didn’t talk about their feelings, and I think growing up in that culture has created an additional layer that we have to be able to consider,” said Rachel N. Hart, D.O., a geriatric medicine specialist with Norton Neuroscience Institute Memory Center.

Signs of geriatric depression

Signs of geriatric depression can be somewhat different than depression in younger adults. Beyond just feelings of sadness or anxiety that persist for weeks, older adults have greatly decreased levels of energy and fatigue.

Common symptoms include:

  • Sadness
  • Irritability
  • Fatigue
  • Apathy
  • Physical pain
  • Restlessness
  • Feelings of worthlessness
  • Difficulty sleeping
  • Loss of appetite

While many of these symptoms are the same across age groups, physical pain in older adults that is not explained by other medical conditions also can be brought on by depression.

Signs of dementia

Dementia includes not only memory loss, but also difficulties with cognition and the ability to carry on one’s daily activities.

“Often patients who have geriatric depression are going to be more likely to have some changes that they’re going to refer to as ‘my memory’s bad,’” Dr. Hart said.

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Common signs of dementia include:

  • Issues with language skills
  • Asking the same questions repeatedly
  • Difficulty paying attention or completing a task
  • Irritability or changes in personality
  • Disorientation as to the date; getting lost in a familiar place
  • Continually misplacing items

Ongoing memory loss and forgetfulness require medical attention. Asking the patient a simple set of questions in order to assess the severity of the impairment is key to an early diagnosis.

Cognitive behavioral therapy or talk therapy works well for patients who do have normal cognition; but for a lot of patients with dementia, they can’t do those therapies if they can’t remember the first therapy session. So, supportive care, like socializing, group therapy and structured relaxation and meditation can be helpful.

Treatment for depression

A combination of medication, therapy and lifestyle changes can help a patient find the right treatment over time. It’s important to remember that no single treatment works for everyone.

Counseling is a treatment option, but individual therapy is not for everyone. Real friends and family members, and connections at a church or with community groups can have equally effective results as meeting individually with a therapist. Socialization and connection with other people are key.


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