Living with dementia magazine May 2011

Luke Bishop looks at the links between depression and dementia and finds out how Bill Wilson, who has Alzheimer's disease, stops himself from getting down

Depression and dementia share many of the same symptoms. This can make it difficult to identify depression in people with dementia. Because of the close relationship between the two, many people with dementia are mistakenly diagnosed with depression first.

Research is being carried out to try to understand the relationship between the two conditions better. This will help determine whether depression is a cause or a contributor to the symptoms of dementia.

We do know that depression is common among people with dementia. It affects one-fifth of people with Alzheimer's disease and almost a third of those with vascular dementia and dementia with Lewy Bodies.

Causes of depression

People with dementia may become depressed as a result of lifestyle factors such as isolation, worries about the future or frustration with their diminishing abilities. Their own biological make up can also be a contributing factor.

People with vascular dementia carry a greater risk of developing dementia, particularly if the strokes affect the left frontal side of the brain. In people with Alzheimer's disease, depression can be associated with the loss of cells in areas of the brain stem.

Professor Clive Ballard, Director of Research at Alzheimer's Society, says,

'Depression can present with memory problems or with difficulty concentrating and can often make existing memory problems worse. Because there is some overlap in symptoms, disentangling whether someone has depression, early dementia or both together can be very difficult.'

What to look out for

It can be difficult to know when a person with dementia is depressed, particularly as the dementia progresses. Signs that a person with dementia may have mild depression include moodiness, feelings of worthlessness, increased anxiety and lack of interest in their surroundings.

Physical symptoms include changes in appetite and waking up early, while in more severe cases people may refuse food and drink and talk about suicide. Many of the symptoms of dementia, for example, confusion and memory loss, can also be seen in the more severe forms of depression.

Dealing with depression

There are, however, simple and practical ways for people with dementia and their carers to reduce the chance of getting depressed and feel better if they are feeling down. Studies have shown that treatment of milder forms of depression can include simple, practical solutions such as encouraging people with dementia to do things they enjoy.  

Professor Ballard says,

'The idea is to make sure the person takes part in activities they see as pleasurable and valuable. Their wife, husband, partner or carer can play an active role in these. There is also evidence to support the benefits of exercise in helping to relieve depression, for example aerobic training, balance and strength training. Two-and-a-half hours of exercise a week is sufficient.'

In people with severe depression these activities can be supplemented with antidepressants. Research shows the effects of antidepressants on mild depression are inconclusive.

Making a bad day good

Bill Wilson, 61, has early-onset Alzheimer's but was initially diagnosed with depression. Five years after his diagnosis Bill still gets bad days where he feels down, but he combats these by sticking to a routine of activities he enjoys.

These include taking his dog Max for a walk, going to his local newsagent, visiting Alzheimer's Society's Coventry office or strolling on Coundon Wedge, a nearby beauty spot. It is also important for Bill to have a busy diary of work and he values his role as a media volunteer for the Society.

Bill says,

'It's all about taking away the feeling that I'm having a bad day and that is where my routines come into it. I live by my routines and they have to happen, whether it is walking Max or going to the corner shop, these things make me feel better. One thing I particularly love doing is walking on Coundon Wedge. When I'm there I have no fears or worries whatsoever.'

Keeping to these routines helps Bill fight feelings of hopelessness, frustration and negativity that go along with his bad days.

Bill's wife Pat believes that carers also need to play an active part in supporting people to have these positive experiences. She says,

'Bill gets down when he's not doing anything. He just sits and you can see him sinking. Keeping him occupied makes a big difference.'

You can find out more about depression in the A-Z section of our website at alzheimers.org.uk/depression

You can read our factsheet, Depression (444)