Philippe J. Khouri, M.D., Princeton HealthCare System
Dementia and depression are two of the most common psychiatric conditions among older adults and telling the difference can be difficult for most people. Yet coming up with the correct diagnosis is critical to managing symptoms and helping older adults maintain their quality of life.
In fact, for patients with depression, Princeton House Behavioral Health, a unit of Princeton HealthCare System offers a range of services to treat the condition and enable older adults to make a full recovery.
Dementia or depression?
It is estimated that four million Americans currently suffer from some form of dementia, including nearly 10 percent of all people over age 65 and up to half of those over age 85, according to the Geriatric Mental Health Foundation.
Some of the first signs dementia often include:
Memory loss; language difficulties; trouble performing routine activities such as driving and shopping; mood changes; personality changes; loss of initiative; poor appetite; sleep disturbances.
However, many of these symptoms are also associated with depression, making it critical to see a physician for evaluation.
Often symptoms of depression come on faster than those of dementia and are more acute. Moreover, patients with depression are more likely to complain about the changes than are patients with dementia. Typically, with dementia, family members are the first to notice the signs, while their loved one seems unaware of the differences in their behavior.
To diagnose dementia or depression, doctors will take a thorough medical history and evaluation of the symptoms. They also will perform a neurological exam along with tests to assess the patient’s cognitive functions including orientation, short-term memory, executive function, language ability, and visuospatial ability.
Patients with dementia generally have more trouble with cognitive functions than patients with depression. The ability to orient themselves in space and time is impaired as is the ability to perform tasks in sequential order.
Risk factors and causes
Age, followed by family history are the greatest risk factor for dementia. However, it is important to note that dementia is a medical condition and not a natural part of the aging process.
Dementia is most often a result of Alzheimer’s disease, which is caused by a loss of nerve cells in the areas of the brain central to memory. Less common causes of dementia are vascular conditions such as stroke or a condition called Lewy body disease.
Like dementia, depression in older adults is not a normal part of the aging process. Typically, depression that occurs later in life is caused by stressors such as illness or grief associated with the loss of a loved one.
An estimated 6 percent of people or two million ages 65 or older in a given year have a diagnosable depressive illness, according to the Geriatric Mental Health Foundation.
Treatment
Treatment for dementia generally focuses on controlling the symptoms, delaying the onset of severity of the progression and maintaining quality of life. However, dementia is a degenerative disease that typically worsens over time.
Depression, on the other hand, is a highly treatable illness and the majority of adults recover from the condition.
Treatment for depression generally includes psychotherapy and antidepressant medication. Research shows that antidepressant medication is extremely effective in relieving depression in older adults and improving their quality of life. There are many effective options and patients should speak with their doctor to identify what’s best for them.
In severe cases of depression that do no respond to medication, doctors may also recommend electroconvulsive therapy (ECT), a safe and effective treatment available at Princeton House Behavioral Health. ECT uses a small amount of electricity to initiate a minor seizure in the brain. That seizure appears to cause changes in the brain’s chemistry that improve depressive symptoms.
Princeton House Behavioral Health also offers Senior Link, a partial hospital program for seniors who are suffering from depression, anxiety and other mood disorders.
Individuals typically attend Senior Link four to five full days a week at first, and as they go through the recovery process, they can attend fewer days per week. The full-day session is from 9:30 a.m. to 3:30 p.m., while a half-day program runs from 9:30 a.m. to 12:30 p.m. Duration of treatment and full-day or half-day options vary based on clinical need. The program includes psychotherapy groups, psychoeducational groups and activity groups, as well as individual and family therapy. Transportation is available.
Senior Link is staffed by trained and licensed professionals, including psychiatrists who specialize in geriatrics and master’s level counselors and social workers.
For more information about Senior Link at Princeton House Behavioral Health, call (800) 242-2550.
Philippe J. Khouri, M.D. is board certified in adult and geriatric psychiatry and is the medical director of Psychiatric Consultation at University Medical Center at Princeton and associate medical director of electroconvulsive therapy services at Princeton House Behavioral Health.
