Clinical understanding of the relationship between dementia and depression continues to evolve. Ten years ago, researchers affirmed that depression earlier in life was associated with a twofold increase in risk of dementia later in life (NIH). Today, with dementia diagnoses on the rise, researchers are still examining the connection with depression for its value in predicting dementia. Medically directed home care, meanwhile, continues to play an important role in nonpharmacologic care of both conditions.

Depression and dementia: Which precedes which?

Before a person has the problems with memory and cognition that point to dementia, there may be non-cognitive signs that warn of its onset.

That’s what the architects of a longitudinal Washington University in St Louis study set out to investigate. The study, which involved nearly 2500 people age 50+ over a period of seven years, found that “depression and behavioral changes may occur before memory declines in people who will go on to develop Alzheimer’s disease.”

Yet neurology professor Catherine Roe, PhD, acknowledged that “We still don’t know whether some of these symptoms, such as irritability and sadness, are due to people realizing on some level that they are having problems with memory and thinking, or whether these symptoms are caused directly by Alzheimer’s.”

A definitive description of how dementia and depression are related does not exist, so research continues – and professional caregivers must seek a pragmatic approach to coping with related mental and behavioral health issues.

90 percentage

Dementia patients with behavioral and psychological (non-cognitive) symptoms of dementia.

A 2021 Dovepress study reported the overwhelming overlap between dementia and behavioral and psychological states including anxiety, depression, aggression, disinhibition, and others.

Impact of behavioral and psychological symptoms of dementia (BPSD)

As any caregiver will attest, dementia patients can present a range of difficult behaviors.

“More than 50% of {Alzheimer’s} patients show more than four neuropsychiatric symptoms at the same time,” reported a 2021 Dovepress study. These include sleep disturbances, anxiety, aggression, depression, wandering, delusion, hallucinations, and disinhibition. “The presence of such symptoms,” the study continued, “affects normal functioning, as well as further cognitive decline, and represents one of the main reasons for the institutionalization of {Alzheimer’s} patients.” It’s also worth mentioning that these symptoms have a significant impact on family caregivers, who experience a high rate of burnout.

“For people with dementia, there’s a consistent connection with depression, and the isolation and loneliness have made it harder. Some of our most important work is just sitting with clients, listening to music and being engaged with their reality.”

Renee Gutierrez, SeniorBridge Care Manger

5 action steps for dealing with depression in dementia patients

The Dovepress study states that while medications may be prescribed for behavioral and psychological symptoms, side effects can make this approach less than optimal. But non-pharmacologic avenues of care for people with dementia are readily available. Here’s an overview of the several known to be effective.

  1. Physical activity. Exercise and general activity can improve cognition, fitness, and behavior.
  2. Education. The majority of studies (80%+) on training for family caregivers and dementia patients have shown that educational measures are effective. “This especially applies to helping family members be present,” said SeniorBridge Care Manager Renee Gutierrez. “The simple act of being there can make things better.”
  3. Music. Multiple studies have shown that music can reduce anxiety, depression, and irritability and support memory and physical orientation..
  4. Sensory stimulation. Cooking, crafting, gardening, and other practices that engage the sense of touch are thought to reduce agitation and behavioral disturbances. And, in a related area, what has been called “reminiscence therapy” (looking at photos, for example) can produce similar effects.
  5. Light therapy. Bright Light Therapy (BLT) is known to have a positive effect on dementia patients, including reduced aggression and better cognition and motor skills.

If you’re interested in nonpharmacologic care for people with dementia, read this short article.

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide.

SeniorBridge offers an integrated care management practice model that involves two components:

  1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
  2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on medically directed home care, contact SeniorBridge.

Sources consulted:
US National Library of Medicine/NIH (2011)
Washington University in St Louis (2015)
Dovepress (2021)

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