Depression and anxiety are two of the most common mental health struggles among people of any age. Although older adults — people over the age of 65 — are generally considered to have a somewhat lower risk of falling victim to (or at least being diagnosed with) depression or anxiety, both these disorders remain quite prevalent in older people.
Research shows, for instance, that:
- An estimated 30 percent of people who have vascular dementia and Alzheimer’s disease will develop major depressive disorder.
- That rate is even higher for dementia linked with Parkinson's and Huntington’s disease, at 40 percent.
- Somewhere between 5 and 21 percent of older adults with dementia are believed to suffer from anxiety disorders, and this risk seems to be higher in those people who were diagnosed with vascular dementia than in those who have Alzheimer's disease.
When someone has dementia, that diagnosis often becomes the focus. It would be quite easy to attribute any changes in personality, behavior, and even energy levels to dementia rather than looking for possible anxiety and depression — but that would be a mistake, because anxiety and depression need to be treated to help the person enjoy a higher quality of life.
How do the symptoms of depression and anxiety differ from those of dementia?
While the (externally observable) signs and symptoms (the experiences of patients themselves) of anxiety and depression aren't really any different in people who also have dementia than in anyone else, there are some challenges in recognizing them because they can overlap with the clinical picture seen in dementia patients. In fact, some researchers also see anxiety and depression, which often go hand in hand, as connected parts of a wider entity.
Depression, for instance, commonly causes:
- A depressed, low, hopeless, pessimistic, mood — which can also manifest as irritability and grumpiness, especially in younger children and older adults.
- Changes in sleep patterns, such as oversleeping or being unable to go to sleep.
- Losing interest in activities and things that were previously important to the person.
- Appetite changes, either loss or gain.
- Being unmotivated.
- Withdrawing from social contacts.
Anxiety, meanwhile, leads to:
- Restlessness, being fidgety, seeming nervous.
- Trouble concentrating.
- Chronic fatigue.
- Expressing worries about (everyday) situations.
All of these symptoms are also common and even expected in people with dementia. Making it even more complicated is the fact that major depressive episodes are often the first sign of dementia, and because of the symptom overlap, dementia often can't be diagnosed until the depression is treated.
When should you seek help for possible anxiety or depression?
If you have been diagnosed with dementia, or a loved one has, and you notice increased anxiety, loss of interest in daily life, hopelessness, and lack of motivation, it is incredibly important to have these symptoms checked out by a doctor to rule anxiety and depression in or out. This is especially true if the symptoms of depression or anxiety are new and have made your, or your loved one's, life significantly worse in a short period of time.
Any older adult (and sometimes, younger people, too, as early-onset dementia is a possibility) who has persistent symptoms of depression and anxiety but also struggles with memory loss, losing things, getting lost, repeatedly asking the same questions, and cognitive decline in general should also be assessed for possible dementia.
How are anxiety and depression treated in people with dementia?
Selective serotonin reuptake inhibitors (SSRIs), a very popular class of antidepressants, are recommended as the first class of antidepressant to prescribe to depressed people living with dementia, although they, like other antidepressants, have been found to be less effective in elderly people. Other kinds of antidepressants, like tricyclic antidepressants, can worsen cognitive difficulties and should therefore be prescribed with caution.
Regardless of the antidepressant of choice, the initial dose will be as low as possible and the medical team will reevaluate after a few weeks. The person's physical health should also be monitored carefully during this time.
There's fairly limited evidence that talk therapy, like cognitive behavioral therapy, helps alleviate depression in people who suffer from dementia — but this is another treatment option to consider. Apart from that, the main way to manage depression in someone with dementia would be offering increased practical and social support. When depression sets in because the person is scared of all the changes their brain is going through, frustrated with their lost abilities and independence, and lonely, this increased social interaction and support can often make a very big difference.
In addition, cognitive behavioral therapy can be explored, alongside anti-anxiety medications, and benzodiazepines in particular. Where there are signs of hallucinations and delusions, which can greatly contribute to anxiety in people with dementia, antipsychotics are another treatment option.
A final word
Whether you have yourself recently been diagnosed with dementia, and are now feeling depressed, anxious, or both, or you are concerned about a loved one, don't simply dismiss these symptoms as an inherent part of dementia. Tell your doctor how you're feeling, or tell your loved one's caregivers what you have noticed.
Diagnosing depression or anxiety in someone with dementia is much harder than arriving at these diagnoses in someone who doesn't have dementia — not all medical experts even agree about the criteria. However, there is a consensus that treating anxiety and depression in people living with dementia greatly improves their quality of life; unsurprising, of course.
Alleviating depression or anxiety can help increase cognitive function, quality of sleep, and energy levels, but also the person's subjective quality of life and motivation. Don't continue to suffer in silence, and communicate what you feel or observe to health care providers.