People do not conventionally put these two disorders together, but you may be surprised how much they link. If you have been diagnosed with Alzheimer’s disease, or know someone who has been, it is extremely important to monitor mood, we will explain why.
Quick note: Throughout this blog post we are addressing both those who have been diagnosed with Alzheimer’s Disease and those who know someone that has been diagnosed. Although we mention a diagnosis, we are aware that a diagnosis does not come easily so it can apply to those who suspect (with some clinical input) that they/or another person may be displaying symptoms of Alzheimer’s disease.
Is there is a ‘dementia time bomb’?
Research conducted in 2019 by the Alzheimer’s Society found that there were over 850,000 people in the UK with dementia. This represents 1 in every 14 of the population aged 65 years and over. If current trends continue and no action is taken, the number of people in the UK with dementia is forecasted to increase to 1,000,000 by 2025 and 1,590,000 by 2040.
You may have heard people talk about a ‘dementia time bomb’. This refers to a point of time where numbers will rise to the point the UK healthcare system cannot deal with it. We do not agree with this phrase as it is not only misleading but very scary to those who have been diagnosed. We would say that the numbers will continue to grow, but not in a particularly dramatic fashion, over the next 25 years. Although we accept that numbers are high, we must remember that we are a forever aging population and as life expectancy increases, this number will in parallel. However, bearing this all in mind, it is still a topic that needs to be addressed.
Why is everything I read about Alzheimer’s disease?
It is simply because it is the most common form of dementia, making up between 50-75% of dementia diagnoses. Other types of dementia include Vascular dementia (making up to 20% of dementia diagnoses and often co-exists with Alzheimer’s disease), Lewy body dementia (making up between 10-15% of dementia diagnoses) and frontotemporal dementia (making up just 2% of dementia diagnoses). Most diagnoses are made in people 65 years and over but in 2013 43,000 early-onset cases were recorded.
Do I have Alzheimer’s disease or depression?
This may seem like a silly question because most people would say that they are two very different disorders, but you may be surprised to know that they share some symptoms, for example:
- Loss of interest in activities and hobbies
- Social withdrawal
- Trouble concentrating
- Impaired thinking
We have told you this not to question the diagnosis given to you, but their link is crucial in understanding their co-existence.
I am more worried about forgetfulness than depression…
When you read about Alzheimer’s disease, there are a host of symptoms an individual could display. Most commonly you read about increased forgetfulness and confusion, difficulty with language and reading, difficulty with organising thoughts and attention span…and the list goes on. There may be a brief mention of ‘low mood’ but there is a real lack of attention to this matter.
Did you know that up to 40% of people with Alzheimer’s disease suffer from significant depression?
That is just under half, take a minute to absorb that!
If you meet with a Consultant Old Age Psychiatrist or your GP, they will usually ask about mood, possibly prescribe some medication, but what if you are not at that stage yet or you have not noticed that there was a change in mood?
It is important to keep mood management as much of a priority as managing other symptoms because treating the depression (if existent) can improve sense of well-being, function and quality of life.
Identifying depression in someone with Alzheimer’s can be quite difficult, for a few reasons. First is because they share similar symptoms (as described above). Second, the cognitive impairment experienced by people with Alzheimer’s often makes it difficult from them to articulate their sadness, hopeless (or other feelings associated with being depressed). Thirdly, depression in Alzheimer’s may ‘look different’ to depression without Alzheimer’s. By this, we mean depression in Alzheimer’s may be less severe, not as long-lasting and recurrent or even discussed. The point is, if you have Alzheimer’s (or someone you know) and there is an inkling that you (or they) may be depressed, you must consult your GP.
We must warn you that there is no single test or questionnaire that can detect depression. A doctor will complete a thorough evaluation to come to a conclusion. You can expect that they will review medical history, carry out a mental examination and possibly request blood tests. For those who present with more moderate symptoms, this may be quite difficult because they may not remember their entire history or may not acknowledge that they are unhappy most of the time, so often interviews with family members who know the individual well will take place. That being said, it is wise to consult an Old Age psychiatrist who specialises in recognising and treating depression in older adults, not just because they are best placed to recognise depression if it exists, but they can make the whole appointment a little bit less stressful.
Ok, but how do I know if I am depressed?
We understand that it is not entirely obvious, so we will talk you through some of the diagnostic criteria. Please note that we are not giving this information so you can self-diagnose, instead it should be used to decide/provide reassurance that a problem may exist. You must consult a professional for an actual diagnosis.
For a person to be diagnosed with depression in Alzheimer’s, he or she must have:
- Depressed mood (sad, hopeless, discouraged, tearful) or decreased pleasure in usual activities
- Along with 2 or more of the following symptoms:
- Social isolation or withdrawal
- Disruption in appetite that is not related to another medical condition
- Disruption in sleep
- Agitation or slowed behaviour
- Fatigue or loss of energy
- Feelings of worthlessness or hopelessness, or excessive guilt.
- Recurrent thoughts of death, suicide plans or a suicide attempt
How is it treated?
We do not want to get into too much detail here because different treatment options are more (or less) appropriate for different people with different symptoms and only after a full evaluation takes place can a medical professional suggest a treatment plan. However, the most common treatment involves a combination of medicine, counselling and a gradual reconnection to previously enjoyed activities.
With that being said, here are some ‘non-drug’ approaches that you can try:
- See what support groups are available for people in a similar situation. This may only work for those in the early stages of Alzheimer’s and are able to discuss their feelings. FYI – most support groups have moved to online methods due to COVID-19, but it is worth getting in touch.
- Find your ‘tiger time’, which refers to your most productive time, and use that time to do the things you find most difficult.
- Make all enjoyable activities ‘COVID-safe’. Just because COVID19 is here does not mean you cannot do the activities you once enjoyed. Get help from family and think of new ways to keep doing these activities in a safer way. It may mean buying new things, setting things up in the garden or having small gatherings at home, but there will be a way.
- Acknowledge the negative feelings and celebrate small successes.
- Exercise –E with Joe Wicks is great fun and throughout lockdown and until the end of July, he works out live most days. His previous videos are also available on his YouTube channel if you missed it.
- Additionally, if someone close to you has depression and Alzheimer’s disease, you can reassure them consistently that they will not be abandoned, they are loved and important in your life and nurture them with things they like.
If you have decided to consult a medical professional, Phoenix Mental Services work with 2 specialist Consultant Adult Old Age Psychiatrists, Dr Martine Stoffels and Dr Emma Dineen.
Due to COVID-19, we are offering nationwide remote consultations and some face-to-face appointments for those living in a closer proximity to Wooburn Green, High Wycombe.