Some people living with dementia become low in mood, slower in behaviour and thought, appear fatigued or lose their usual energy and motivation to do things they used to be enthusiastic about. People with dementia are at risk of developing depressive episodes, but it is often more difficult to detect for caregivers – but trained healthcare professionals can help with this.
One study of 97 patients identified that people with vascular dementia (VaD) were more likely to experience depression than those with Alzheimer’s-type dementia (AD). Another larger study of 241 people with AD showed that the more severe the disease, the more likely the person is to experience depression. In AD, depression can develop at all stages of the disease (i.e. mild, moderate and severe cognitive impairment) but for VaD depression appears more common in those with moderate or severe disease.
Many people ask if it’s the dementia causing depression, or are the signs and symptoms (of depression) part of having dementia anyway – this question is difficult to answer and more importantly, is less important than obtaining the practical help that is available and can improve the person’s quality of life.
What to look for
For caregivers, the most important thing is to look for changes in the person with dementia. It can help to keep a diary of these changes, paying attention to the following features:
People with depression often appear sad or report feeling sad – importantly, this depressed mood lasts for weeks or months, rather than occasional ‘bad days’.
Depression causes people to lose interest in things they normally enjoy (hobbies, daily activities) and find it difficult to enjoy events or activities (for example, seeing friends and family)
Depression worsens concentration and people may become indecisive – this feature seems to be more common in people with dementia than in people with depression but not dementia
Many people with depression become slower in thought and behaviour, but some people become more agitated, for example, pacing or being unable to sit still
Depression often makes people feel tired, fatigued or drained of energy and they can reduce or increase their food intake
Insomnia (difficulty sleeping) or excessive sleep is common in depression – however, this appears to affect people without dementia more than those who have AD.
When depressed, the content of people’s thoughts changes – often, they describe feeling worthless or guilty and again, this appears to be more common in people without dementia
Some people with dementia and depression show emotional lability where they appear to rapidly and uncontrollably shift between moods and this appears to others as very exaggerated emotional responses such as uncontrollable laughing/crying and being more prone to irritability or bad temper.
What to Do
Most people with dementia will be cared for by their GP and many will also have a specialist hospital and community team. You should ask any of these for help if someone with dementia appears to be depressed.
Strategies for helping people with depression can also be used for people with dementia and depression.
making sure other problems such as pain, incontinence and vision/hearing problems are well-managed
staying active, having structure in their days and weeks and maintaining social contact
talking therapies (counselling or formal psychotherapies)
in some cases, with appropriate specialist input, medication can be helpful
Further Information and Getting Help
The Alzheimer’s Association has a similar resource available here: https://www.alz.org/help-support/caregiving/stages-behaviors/depression
DementiaUK has resources on depression for people with dementia and their carers available here https://www.dementiauk.org/get-support/maintaining-health-in-dementia/managing-anxiety-and-depression-in-a-person-living-with-dementia/
The Alzheimer’s Society has produced a comprehensive discussion and guide to depression and anxiety, available here https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/apathy-depression-anxiety
This post draws from research contained in:
Zubenko, G. S., Zubenko, W. N., McPherson, S., Spoor, E., Marin, D. B., Farlow, M. R., ... & Sunderland, T. (2003). A collaborative study of the emergence and clinical features of the major depressive syndrome of Alzheimer’s disease. American Journal of Psychiatry, 160(5), 857-866.
Ballard, C., Neill, D., O’brien, J., McKeith, I. G., Ince, P., & Perry, R. (2000). Anxiety, depression and psychosis in vascular dementia: prevalence and associations. Journal of affective disorders, 59(2), 97-106.
National Institute for Health and Care Excellence (NICE) (2018) Dementia: assessment, management and support for people living with dementia and their carers. NICE Guideline [NG97].
Orgeta, V., Qazi, A., Spector, A. E., & Orrell, M. (2014). Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database of Systematic Reviews, (1).