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  1. #1
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    Depression or dementia?

    If it is a fact that the symptoms of major depression can perfectly mimic those of dementia, I wondered whether anyone had any comments to make on the possibility that there are people being treated with dementia who have been misdiagnosed?
    "The best of life is further on, hidden from our eye beyond the hills of time" - Sir William Mulock.
     

  2. #2
    What an interesting debate you open and one close to my heart. In fact I could write reams. My own dear Mum appeared to suffer the most major depression in her last year, which certainly seemed to coincide with a number of symptoms akin to dementia ( memory loss, unaware of day, time, agitation, unable to cope with money etc, etc, etc). Her increasing sight loss due to age related macular degeneration left her living in a very dark world, one in which serotonin levels no doubt impacted on mood. I have always felt the two were linked in some way. You have only to think how this long dark winter affected most of our moods and how the sunshine uplifts moods. Is the depressive person more prone to cognitive decline?? Or is it just that depression can mimic dementia in some ways?
     

  3. #3
    Hmm - I'm not so sure it is a fact, or at least not as clear cut as all that. I have suffered from major depression, but while agitation, withdrawal from life, sleeping too much or too little, inability to cope with complex (or even not so complex) tasks are all symptoms I have had when I was not medicated effectively, I don't believe that anyone ever considered dementia in my case. That's just one case, of course, and I'm not in the what is considered the "right" age group for dementia.

    What I do think is that often doctors will misdiagnose dementia as depression because they don't often understand either depression OR dementia, and depression might possibly be fixed.

    I've talked to my psychiatrist about this, and he tells me that few regular doctors get any kind of training when it comes illness relating to the brain. Much of what they do have is anecdotal or based on literature provided to them by suppliers of drugs.

    So I would say it was the other way around: I think a lot of people are diagnosed with depression when in fact they have dementia.
    Jennifer

    Volunteer moderator and former long distance carer.

    ďA test of a people is how it behaves toward the old. It is easy to love children. Even tyrants and dictators make a point of being fond of children. But the affection and care for the old, the incurable, the helpless are the true gold mines of a culture.Ē

    Abraham J. Heschel
     

  4. #4
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    My husband was treated for depression for nigh on 5 years before being diagnosed with Alzheimers and VD. The only test our GP did when I suggested it might be something else (his aunt had early onset dementia) was to ask him silly questions e.g who has recently been in the news. Sadly by the time he was given relevant drugs it was by then a bit too late.
    I have friends who have recently trained as doctors and their training in dementia is very minimal.
    After a recent visit to A&E when the Sister gave my hubby a bottle, asked him to supply a urine specimen and left him to it, I know the medical profession need some/ANY training in how to deal with dementia patients. The amount of people they meet with dementia, if reports are to be believed, must warrant much more training.
     

  5. #5
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    The diagnosis of dementia is very difficult and misdiagnosis of dementia is a big issue which has been highlighted a lot on TP but I would like to focus on the possibility that some people who have been diagnosed with dementia may actually have a serious depressive condition - for which there is treatment and even a "cure". I'm really talking about older people here.
    "The best of life is further on, hidden from our eye beyond the hills of time" - Sir William Mulock.
     

  6. #6
    There does appear to be a fair number of papers abut this subject. Unfortunately most of the ones I have seen need subscriptions etc to access them. Those I've been able to get to indicate that perhaps 30% of people who are initially thought to have dementia are in fact suffering from depression. However, I've also seen a fair amount of documentation indicating that it is now quite common practice to assume that what a doctor is seeing IS depression first, and then only move on to dementia if treatment for depression is ineffective. So a bit 6 of one, 1/2 dozen of another: many doctors will look at you and think dementia but actually treat for depression.
    Jennifer

    Volunteer moderator and former long distance carer.

    ďA test of a people is how it behaves toward the old. It is easy to love children. Even tyrants and dictators make a point of being fond of children. But the affection and care for the old, the incurable, the helpless are the true gold mines of a culture.Ē

    Abraham J. Heschel
     

  7. #7
     

  8. #8
    Dhiren was treated for depression for more than a year, with defferent antidepressant drugs.

    His depression didn`t lift but his repetitive behaviour [constantly referring to the calendar to see what were plans for the day] , loss of spatial awareness [ parking problems , overtaking problems, driving in the middle of the road problems ] increased, as did his loss of memory.

    It was then decided a brain scan was the most logical step forwards.

    During this period and even after diagnosis, my sister was constantly on my back telling me there was nothing wrong with Dhiren that a `project` hobby, new interest and more understanding from me would cure.

    Sylvia

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  9. #9
    Quote Originally Posted by jenniferpa View Post
    What I do think is that often doctors will misdiagnose dementia as depression because they don't often understand either depression OR dementia, and depression might possibly be fixed.
    I agree. My 90 year old FIL has been displaying classic dementia signs, but at first the GP refused to do any tests and treated him for depression. After weeks of arguing he was referred for testing (not scan) where the results were inconclusive in that he scored quite well but the doctor felt that something was very wrong. After more "prompting" from us a scan was done, but again it was inconclusive. For the past 18 months he has continued to be treated for depression (not very effectively), but with the suggestion that he may also have age-related dementia. His decline has been very rapid which is so sad.
     

  10. #10
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    Pseudodementia

    Hi
    My motherís experience has taught me to always question a diagnosis. She was diagnosed with dementia. She did have all the symptoms. When she was put in a care home, I was told that she would never get any better. My mother had a Doppler scan and a SPEC scan. I was told that these scans showed signs of VAD. She had lost the ability to do anything herself.

    She was only in the care home for two months when I started to see an improvement. She was no longer doubly incontinent, could hold a conversation, knew what day of the week it was etc. When I questioned the fact that she was getting better I was told because she felt safe and no longer had any worries with regards looking after herself or her house. This did not sit well with me.

    I researched and researched, contacted loads of medical organisation and the bottom line was that everyone told me that if my mother had the rapid VAD that she was diagnosed with then it was impossible for her to get better from it.

    When I spoke with her dementia specialist he did not really have any answers either. I pointed out to him that my motherís history was one of deep clinical depression. He dismissed my motherís history and still said that she had rapid VAD and that she would have good days and bad days.

    Well my mother did get better, but unfortunately for her the depression kicked in again and she stopped getting out of bed, washing herself or eating. When the dementia specialist visited her in the care home he said that she was declining again due to VAD. My mother was perfectly coherent and told everyone that she did not want to be in the care home. Her wishes where dismissed due to her diagnosis of dementia.

    I had my mother staying with me for a month at a time and I could see that she was ok but had lost her life skills and confidence. I started to really question her diagnosis as I really felt that she had been misdiagnosed.

    When my mother came to live with me permanently I got copies of all her medical records. I was really appalled to see that the results of her SPEC scan indicated no dementia. I could not believe what I was reading.

    Luckily my motherís story has a kind of happy ending. The Drs where wrong but it took a long battle to prove this. She is living a full independent life now. She has deep clinical depression and will probably suffer from this for the rest of her life. But currently no dementia. When the specialist finally put in writing that she did not have dementia he added insult to injury when he wrote "she is not suffering from dementia at this time but this is not to say that she will not develop it in the future". Well it could happen as it could happen to me. But currently she is loving life and so values her independence.

    I know how I felt when my mother was first diagnosed with VAD, I was shocked, felt bereft with grief, read every single fact sheet, medical information I could get. If I had not fought my motherís corner, she would not be where she is now mentally. She wanted to die in the care home as she could not see a way out for herself. She is so very grateful that she is living with me know and is able to lead a relatively normal life. It was a very hard battle and took for her to actually leave her birth place and move to London with me for her to get her independence back.

    I know that my motherís case is very unusual, and I am the first to admit that she did have all the VAD symptoms in the beginning. But the Drs did misdiagnose her!!

    The bottom line is the Drs did not fully look into my motherís history, they saw a woman who was over 65, had been a heavy smoker, suffered TIAís whilst in the Psyche unit. I do believe that Pseudodementia exists and that my mother case proves it.

    Please note that I am only writing about my motherís experience, I know each and every case is different, the brain is such a complex thing and I do not believe that the Drs fully appreciate what deep depression can do to someone.
     

  11. #11
    there are so many illnesses which can cause dementia like symptoms - it's really hard to know what to think. in my mother's case she had a brain scan which confirmed alzheimer's.

    but it is a really interesting point you raise about depression. My mother is being treated for depression as well as dementia - but I have often wondered if the dementia could have been caused by a life of emotional distress & turmoil.

    my mother has had what i would describe as a fairly unhappy life - she never handled the cards which life dealt her very well. the cards were not the best hand - but her personality, (or was it depression causing her to react this way), meant that she could never move on and overcome all the disappointments in her life. this seems to have intensified over the years so that now, in her eighties, she traumatised by the past (which she is still living in due to the dementia). it is like this sadness & pain is just taking over and eroding her away.

    at the moment her depression is coming out as aggression. she is angry - for a frail old lady, she can become unbelievably scary.

    i don't think we will ever know which came first - the depression or the dementia? or understand when these illnesses first started.
     

  12. #12
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    Quote Originally Posted by alams View Post
    i don't think we will ever know which came first - the depression or the dementia? or understand when these illnesses first started.
    In general people who have depressive episodes suffer more brain damage and are more likely to go on to develop AD.
    It's one of the reasons why we should do much more to support those who are suffering the stress and responsibility for looking after people with dementia.
    Alzheimer's Caregivers May Be at Risk for Dementia
    Stress and Shared Lifestyle May Raise Risk of Mental Decline for Spouses Who Are Also Caregivers


    The current cuts that are taking place in the UK are going to be counter-productive. I'd better not start on that topic though.
     

  13. #13
    On the one hand we are being told dementia is one condition unrelated to life style , and then are expcted to see the credibility in reports such as those in the above links.

    I wonder if any research has been undertaken to see how many carers come through the ordeal determined not to be beaten by it.

    What price positive thinking versus doom and gloom?

    Sylvia

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  14. #14
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    I've been thinking a lot about the effect of depression (not so much the cause as this could be due to so many different things) on a person who has reached a certain age. Before Altzheimers there was senile dementia - people who appeared to have "lost it" at a certain age were simply accepted to have senile dementia. Not so many years ago children were told by their parents to keep away from the old man or woman who was "eccentric". In my town we had "Mad Mary" who used to swear and wave her stick around and wore funny clothing. We just accepted she was old and had gone funny. I think she was locked up in the asylum in the end. It was accepted that events in her life had "driven her mad".This was not considered to be uncommon.

    I have not suffered from depression so perhaps I'm not the right person to raise this discussion but I have read a lot about conditions such as melancholy and accidie and the effect of isolation and sensory deprivation and this makes me wonder whether the lack of knowledge and understanding we have (of depression in whatever form) is responsible for the apparent increase in "dementia type illnesses" which are accepted as irreversible. Most people tell me I am "in denial" whenever I talk about this (denial that my relative has dementia).
    "The best of life is further on, hidden from our eye beyond the hills of time" - Sir William Mulock.
     

  15. #15
    Such an interesting thread. The GP, who finally diagnosed Dementia in my Mums case, said it had been very difficult to diagnose.

    I recall him saying it had been difficult to differentiate between her depression and Dementia.

    At the time of diagnosis Mum was grieving the loss of my father, to this day, she still is.

    Her current GP, (the chocolate fire guard) .....sorry for that comment but it seems to be true, simply says that she is on all the correct medication for all of her problems, ie.,Depression, Dementia, heart problems, diabetes, he leaves it to me to deal with her being miserably affected by all her mental health related problems.

    I often think that if Mum was a younger person she may well be admitted to hospital for treatment which could possibly help her depression and therefore help with her Dementia.

    Who knows? I certainly don't but I do feel the lack of positive input from the medical profession is not helping. Maybe that is due to their lack of insight, maybe not. I just don't know that either.

    Hazel

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