I once heard a family member complain at the nursing station about a parent being on antidepressants.
“She can’t remember a thing. How can she be depressed?”
The nurse replied, “I know.”
|Marc E. Agronin, MD
We tend to associate Alzheimer’s disease (AD) and other forms of dementia primarily with memory problems, but as a geriatric psychiatrist who specializes in dementia, most of my consults are for mood and behavioral problems. In fact, rates of depression approach 40% in AD sufferers over the course of their illness. Depression may look differently, however, in the context of dementia. Irritability, agitation, and resistance to care might be seen as prominently as a sad mood. Loss of appetite and poor sleep are common manifestations of both dementia and depression, and can make it difficult to tease them apart. In clinical practice, we look primarily for a rapid decline from one’s baseline when depression strikes.
The cause of depression in AD likely has less to do with a psychological reaction to cognitive and functional loss and more to the damage the disease causes to brain nuclei that regulate moods and produce key neurotransmitters. As a result, antidepressants that we use to treat depression in younger and nondemented individuals can be used with similar efficacy and safety. In early stages of illness, talk therapy can also play a key role, and in all stages there may be benefit to therapeutic programming involving music, pets, and exercise.
As I make clear in my book “How We Age: A Doctor’s Journey into the Heart of Growing Old,” we cannot adopt a fatalistic attitude or even give up when depression or other mental illnesses afflict AD patients. Not only is there much we can do to treat these symptoms, but there are always underlying strengths that can be tapped, including humor, creativity, sensory enjoyment, and the ability to interact in socially meaningful ways.