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Dementia or Depression?
Dementia and depression – two illnesses that affect many people in old age and about which much ignorance prevails. These are taboo subjects that society is reluctant to discuss, out of fear, shame, or ignorance. Yet it is important. "If people notice cognitive impairments over a longer period, they should have it checked," advises Sabine Tschainer-Zangl, head of the institute aufschwungalt ( https://www.demenzerisch-lernen.de/ ). The theologian and psycho-gerontologist has been training caregivers and family members on the topic of dementia for 30 years, including for famPlus.
In reality, however, the opposite often happens, according to the expert. "People withdraw, try to hide their difficulties, and avoid talking about it. Behind this, many also believe that nothing can be done," says Sabine Tschainer-Zangl. "But there is something that can be done. Depression is well treatable. Primary causes of dementia are not curable, but various strategies can improve the quality of life and slow down the course of the disease." For this to be possible, a diagnosis is first needed.
What symptoms do people with dementia and people with depression exhibit?
The changes associated with dementia or depression often occur gradually. This is precisely what makes it so difficult to recognize them, both for the individuals affected and their relatives. Many people wait a long time before seeing a doctor, and only when the level of distress is high do they feel "sick enough" and seek medical advice or are registered for a doctor's appointment by their relatives.
Many cases of dementia show similar symptoms to depression: cognitive performance declines, people have difficulties with concentration and orientation, they withdraw and have trouble coping with daily life. The day-night rhythm can also be altered.
What is the difference between dementia and depression?
It is not easy for relatives to distinguish whether dementia or depression is behind the abnormalities. "Only a specialist can make an accurate diagnosis," says Sabine Tschainer-Zangl. However, there are a few clues that can help relatives distinguish whether it could be dementia or depression.
An indication is the different drive or lack of drive throughout the day. "Many people with depression have great difficulty getting going in the morning," explains the expert. "Getting up before 1 PM is a big achievement for many." Activity often increases over the course of the day. It is different for people with Alzheimer's or other dementias: "They are more energetic in the morning, but as the day progresses, their ability to concentrate—and often their activity and drive—decrease," says Tschainer-Zangl.
A second typical point: "People with depression are indeed aware of their symptoms. They often tend to self-reproach because they feel like they are burdening others," explains Sabine Tschainer-Zangl. People with dementia, on the other hand, do exhibit symptoms, but they often do not perceive them themselves or initially try to cover them up. For example, they deny mistakes or repeatedly ask the same questions because they have forgotten that they have already asked.
What happens in the body with dementia and depression?
Even though dementia and depression can indeed have similar symptoms, their causes differ. Dementias like Alzheimer's or vascular dementia are considered primary dementias. During these conditions, processes occur in the body that destroy the nerve cells and the connections between them. While the process may potentially be slowed down, it cannot be stopped.
Depression is referred to as a so-called secondary dementia. "This means that cognitive impairments are triggered by other diseases," explains the expert. In depression, the cause lies in a metabolic disorder in the brain. The balance of certain neurotransmitters is disturbed, so that information can no longer be passed from nerve cell to nerve cell as effectively. "The difference from primary dementia, however, is that the nerve cells themselves are not destroyed. With therapy, the depression is treated, and the cognitive impairments disappear," says Sabine Tschainer-Zangl.
What to do if you suspect dementia or depression?
If there is suspicion of dementia or depression, a quick medical evaluation is important. For both illnesses, the rule is: the earlier, the better. "Primary dementia can potentially be delayed in the early stages with the existing medications," says Tschainer-Zangl. An early diagnosis gives the affected person self-determination, as they can participate in decisions about what kind of care and support they wish for and can document this in appropriate powers of attorney and directives.
Even in the case of depression, an early diagnosis is helpful. Any illness that lasts longer becomes more difficult to treat," explains the expert. The earlier a corresponding treatment - often a combination of psychotherapy and medication - begins, the shorter the course of the illness usually is, and the better the quality of life.
A variety of tests for diagnosing various diseases are circulating on the internet. These include online tests for depression as well as questionnaires from various neuropsychological dementia tests. Sabine Tschainer-Zangl advises against doing these at home with your relatives. She explains: "On the one hand, a professional environment and expertise are required to conduct these examinations correctly. On the other hand, laypeople often struggle to interpret the results accurately.
The first point of contact is usually the general practitioner, who can refer patients to other specialists or facilities if necessary. Sometimes the general practitioner can already help and initiate appropriate treatment, such as prescribing antidepressants.
When dementia and depression occur together
It can also happen that dementia and depression occur together. "People with early-stage dementia are particularly affected," says Sabine Tschainer-Zangl. They notice the cognitive changes, the memory gaps, and lapses in speech – and this causes fear and worry. This can facilitate the onset of depression.
When people with dementia show depressive symptoms, it should definitely be treated to improve their quality of life," says Tschainer-Zangl. Medication is usually the best choice as it has a mood-lifting effect. "Psychotherapies, on the other hand, often overwhelm people with primary dementia. Here, you should consult closely with a doctor," advises the expert. She also recommends relying on other methods, such as facilitating a social and active daily life. "Depending on the cognitive stage, people with primary dementia can perform tasks appropriate to their illness and should do so, as it strengthens their remaining abilities and self-esteem." Studies show that poor self-esteem and loneliness increase the risk of depression. Studies also show: Dementia progresses more slowly and is associated with a higher quality of life when affected individuals are socially integrated.
When caregiving leads to depression
Basically, anyone can develop depression. However, challenging life situations increase the likelihood of developing depression. These include the death of a loved one, a chronic illness, as well as persistent stress and overwhelming situations. For instance, studies show that caregivers are particularly at risk of developing depression.
Breaks for caregivers are therefore essential," says Sabine Tschainer-Zangl. In her lectures, she gives a lot of space to the topic of self-care. "Many family members think they can handle the care and support of a person with dementia on their own. But taking care of a person is like a marathon. You need support to avoid getting sick yourself," says the expert. She advises organizing help and support early, using care consultations, and building a care network. She always tells caregivers: "You can only take good care of another person if you are doing well.
Here you will find advice:
famPLUS care consultation. info@famplus.de or 089-809902700
German Depression Aid and Suicide Prevention Foundation www.deutsche-depressionshilfe.de and Info-Telephone for Depression at Tel 0800/ 3344533
German Depression League www.depressionsliga.de
German Alzheimer Society www.deutsche-alzheimer.de and Alzheimer hotline at Tel. 030/ 259 37 95 14
Sources:
https://www.demenzerisch-lernen.de/
https://www.wegweiser-demenz.de/wwd/medizinisches/behandlung/demenz-und-depression
https://www.deutsche-depressionshilfe.de/depression-infos-und-hilfe/wo-finde-ich-hilfe/info-telefon
Depression: Understanding and Mindfully Supporting," Peggy Elfmann, Pharmacy Journal
