Dementia and depression: accurately diagnosing between
disorders is crucial for the wellbeing of elderly patients
Dementia and depression are clearly two separate disorders. In this article, we explore the difficulties of diagnosing between them in elderly patients, and speak to two experts, about what clinicians can do to get it right.
Diagnosing between two serious, debilitating, life-threatening and often comorbid disorders, that share a lot of similarities, can be daunting and difficult. This is the reality for health professionals in the aged care sector, who are regularly tasked with distinguishing between dementia (most commonly: Alzheimer’s) and depression in elderly patients.
This is often fraught with complications and uncertainty, due to the lack of research, information and diagnostic tools available, to help clinicians obtain the clarity necessary to act with confidence.
However, all that might be changing. The development of screening and assessment tools are empowering health professionals by allowing them to navigate these complex medical situations.
Australian neuropsychologist, Dr Fiona Lamb, currently works in a memory clinic, on a dementia research team and in an aged psychiatry unit. As a neuropsychologist, she said she’s always conscious of trying to distinguish between dementia and depression, and to make sure nothing is missed during the screening process.
“In the older population, often both [illnesses] can present with memory loss or trouble,” she said.
“When they come into the clinic, often they've got a complaint about their memory and that would be regardless of whether they've got depression or dementia. Everyone who comes to us complains about their memory.”
That’s why, Dr Lamb continued, within the services she works with, particularly within the memory clinic, every patient who presents is administered a self-reported mood questionnaire to screen for the first signs of depression.
“That's probably the first line of investigation, to make sure that it’s not being missed,” she said.
“Within our services, often if there is that flag, they'll be sent to the psychiatrist before they come to me. So, clinicians would be recommended to utilise a mood screening tool to screen and flag people who would need follow up or an assessment by a mental health clinician.”
Dr Sunil Bhar PhD, Chair of the Department of Psychological Sciences in the Faculty of Health, Arts and Design at Swinburne University of Technology in Melbourne, has been working in the area of mental health for 15 years. He has spent most of that time working with older people living in residential aged care settings.
Dr Bhar said that if we had better measures of detecting depression amongst people with dementia, it would be easier for those individuals to receive better treatment.
“We need better tools on how to measure depression, particularly for people with a diagnosis of dementia,” he said.
“The common symptoms of depression such as sleeping problems and appetite problems are not only shared by people with dementia but with people who are old as well.”
He said that it’s so common for symptoms of depression to be missed.
“In most cases that we've come across, it has been undiagnosed,” he said.
“Depression has been undetected primarily because of the lack of training, and the lack of knowledge on how to go about detecting depression from dementia. Everything gets enveloped within the diagnosis of dementia, and the logical outcome of that is underdetection and undertreatment.”
Dr Bhar said that we also need more sophisticated ideas about what is different between the two diagnoses.
“The two diagnoses share, perhaps more in common than they don't, particularly when you add the ageing sector into that”, he said.
“In fact, when you read a lot of articles about depression and dementia, it's almost obligatory for there to be a lot of similarities between the two diagnoses but we haven't yet clarified what is different.”
“It might be important for more to be said about the different things.”
Until then, however, it will be on the onus of the health professionals working with our elderly population, to ensure that every precaution is taken and every proactive effort is made, to correctly diagnose both dementia and depression.