Posted on November 6, 2017 by David Troxel
Atria partners with renowned Alzheimer’s expert and author David Troxel, to provide innovative memory care that can help people with dementia continue to live meaningful, joyful lives.
The Alzheimer’s Association estimates that up to 40 percent of persons with Alzheimer’s disease or other dementia also experience significant depression. Left untreated, particularly in early dementia, depression can add to confusion and cognitive loss, reduce the person’s ability for self-care and discourage involvement in activities and relationships that support quality of life.
Here are two examples.
• Ruth: living with early Alzheimer’s disease - is receiving excellent medical care and support from her friends and family. She enjoys going to the weekly farmer’s market with her grandchildren, painting water colors to give to friends and family, walking with a supportive neighbor and going to a local early-stage support group sponsored by the Alzheimer’s Association. She is living life to her fullest and her symptoms of dementia remain mild.
• Ruth: living with early Alzheimer’s and depression - acknowledges visits from friends and family but has stopped going out. Her neighbor invites her to walk but Ruth declines. She is still working on the same water color day after day and can’t find the energy or focus to do something she has always enjoyed in the past. Ruth’s untreated depression is impacting her quality of life and her cognition is declining.
My colleague and prominent geriatrician, Michael McCloud, Professor Emeritus, University of California Davis School of Medicine says, “Alzheimer’s disease doesn’t travel alone.” Treatable conditions like depression need to be identified and addressed to help the person be at his or her best.
How can you tell if a person with dementia also has depression?
It’s not always easy; your family member can lose the ability to express his or her needs in words. Mom might not be able to say, “I’m feeling sad or hopeless.”
Instead, behavior communicates a message. Caregivers in Atria Senior Living’s Life Guidance memory care neighborhoods are trained to look for clues and cues and note changes in behavior to assess the situation.
• Fatigue, sleeping much of the time.
• Tearfulness or words expressing hopelessness or despair.
• Loss of appetite
• Withdrawal from activities he or she has once enjoyed like music, spending time in the garden or being with friendly pets.
• Loss of humor or joy. Perhaps your mother always laughed when reminded of old stories of growing up on a farm or smiled when given a warm compliment and now her expression is flat.
What should you do if you suspect depression?
Involve your family physician.
The physician can rule out treatable causes (for example, pain, urinary tract infections and medication problems) and speak with the patient while observing their body language. He or she will also want to hear your family’s story; has Mom’s mood and behavior changed significantly? Bring in a short diary or your notes about the person’s behavior that suggests depression. The physician will also consider whether the person is truly clinically depressed or is instead apathetic, a symptom that can come with certain types of dementia and one that doesn’t respond to depression medications.
If it seems that clinical depression is the diagnosis, there are a number of approaches to consider:
Activity and engagement.
With no miracle medicine to arrest or truly slow the progression of dementia symptoms, the best approach is to encourage the person to stay active. Senior living community residents living with dementia are surrounded by neighbors, conversation, music, time outdoors and meaningful activities filled with purpose. Also, they often attend cultural events and volunteer for local organizations. Loneliness, isolation and boredom are all enemies of the brain.
In my experience, many physicians will try a round of these medications when they suspect depression and usually with good results. Anti-depressants can help turn the tide, particularly when paired with a supportive approach from care partners.
My good friend and colleague, Dr. G. Allen Power, Geriatrician, Author, and Educator agrees that outdoor time, purpose and relationships are good first steps and may relieve mild depression. But, he adds, “many cases of clinical depression may need drug treatment. Unlike psychotropic drugs, there is better evidence for the safety and efficacy of anti-depressant medications and people living with dementia are no exception.”
Studies have shown that traditional talk therapy and group therapy can help reduce depression and anxiety in persons with dementia. I saw this first hand when I had the privilege of speaking this year in Chicago for the Rush Alzheimer’s Disease Center’s younger-onset Alzheimer’s group, “Without Warning.” The group offers education and support to persons facing dementia at a younger age. Many persons in the group expressed feelings of loss. Being able to talk about their situation was making a world of difference. Check with your local Alzheimer’s Association for resources including early-stage and younger-onset support groups.
In fact, I like the name of Atria’s memory care program, “Life Guidance,” since it suggests that staff provide encouragement and direction to maximize independence – doing “with” versus doing “for.” Encouraging the Life Guidance resident to experience success and have friends builds self-esteem and fights depression.
We don’t have a cure for Alzheimer’s yet, but we know how to make a difference. The brain loves company and socialization whether practiced at Atria, a local day center or in your own home with a lively set of friends and family.