Table of contents
  1. How common is depression in dementia?
  2. Signs of depression in someone with dementia
  3. Depression, apathy or dementia? A symptom comparison
  4. Is it dementia or depression in an older adult?
  5. When to call the doctor, and what to tell them
  6. What treatment usually involves
  7. What helps at home, day to day
  8. Depression in the caregiver
  9. Urgent signs: when to get help now
  10. Florida help for depression and dementia
  11. Where our companion care fits
  12. Frequently asked questions
  13. Sources

Depression is common in dementia: the Alzheimer’s Association says up to 40 percent of people living with Alzheimer’s or another dementia may have significant depression, most often in the early and middle stages. The two conditions share signs such as withdrawal, poor concentration and lost interest, so depression is easy to miss and easy to mistake for the dementia getting worse. It can be treated, so if your parent seems low, withdrawn or tearful for two weeks or more, tell their doctor.

This guide covers the signs, how depression differs from apathy and from dementia, what to tell the doctor and what helps at home. It describes; it does not diagnose. Your parent’s doctor decides on any treatment.

How common is depression in dementia?

Figures vary with how depression is measured, but every source we checked agrees it is common:

  • Up to 40 percent of people living with Alzheimer’s or other dementias may have significant depression, according to the Alzheimer’s Association, which says it is especially common in the early and middle stages.
  • About 1 in 6 people with dementia has major depressive disorder, according to one recent analysis cited by BrightFocus Foundation. Milder depressive symptoms are more common still, and rates are higher among nursing home residents.
  • It varies by type. A 2021 review in Aging and Disease reported depressive episodes in 33.2 percent of people with Alzheimer’s, 43.7 percent with dementia with Lewy bodies and 60 percent with vascular dementia.

Why it happens is not fully understood. The Alzheimer’s Society says the diseases that cause dementia may damage parts of the brain involved in emotion, and lists other factors: past depression, other health problems, medicine side effects, loneliness, poor sleep, bereavement and money or family stress.

Signs of depression in someone with dementia

A person with dementia may not be able to say “I feel sad.” BrightFocus notes that depression in dementia may show up instead as agitation, withdrawal, fearful ideas or aggression. Signs to watch for, drawn from the Alzheimer’s Association, the Alzheimer’s Society and Dementia Australia:

  • A low or sad mood most days, or tearfulness
  • Losing pleasure in things they used to enjoy, such as visitors, music, church or the garden
  • Pulling away from family and friends
  • Sleeping much more or much less than usual
  • Eating less, or weight loss not explained by another illness
  • Tiredness and low energy
  • Irritability, restlessness, or moving and speaking more slowly
  • Saying they are useless, a burden, or to blame
  • Seeming more confused than usual
  • Talking about death or not wanting to live

The Alzheimer’s Association describes guidelines from the National Institute of Mental Health for diagnosing depression in Alzheimer’s: a low mood or less pleasure in usual activities, plus at least two other symptoms from a list like the one above, lasting two weeks or more. It adds that depression in dementia may be less severe, may come and go, and often comes with physical complaints such as pain or tiredness. In the later stages, the Alzheimer’s Society says, depression often shows as tearfulness and poor appetite.

Depression, apathy or dementia? A symptom comparison

This is the hardest part for families. The Alzheimer’s Association lists the signs dementia and depression share: loss of interest in hobbies, withdrawal, isolation, trouble concentrating and impaired thinking. Apathy, a loss of motivation, adds a third layer. BrightFocus says apathy is more common than depression in dementia, and the Alzheimer’s Society says even doctors can find the two hard to tell apart.

The clearest clue is feeling. A 2021 review in Aging and Disease says older people with apathy “do not feel troubled” that they no longer do chores or hobbies, while depression brings a low mood, self-blame and sometimes thoughts of death. In short: apathy is not caring to start things; depression is hurting.

What you see Depression Apathy Dementia itself
Mood Sad, tearful, hopeless or irritable most days Flat or neutral, not distressed Can swing, but not low most of the time
Loss of interest Yes, and it seems to upset them Yes, but they seem untroubled by it Hobbies dropped because they became too hard
Starting activities Can be encouraged, but finds little pleasure Sits for long periods; joins in when someone else starts Struggles with the steps, not the wish
Words about themselves “I’m a burden,” “What’s the point,” guilt Few complaints May not notice their own changes
Sleep and appetite Often changed early Not the main sign Usually change in later stages
Talk of death or guilt Possible; always take it seriously Not typical Not typical; tell the doctor if it appears

A person can have all three at once. The table is a guide for what to tell the doctor, not a way to diagnose. Our guide to apathy and withdrawal in dementia goes further on apathy and how to gently re-engage someone.

A sudden change is different again. If your parent became confused, drowsy or agitated over hours or days, think of delirium, which often has a treatable cause such as an infection. See our page on delirium in dementia.

Is it dementia or depression in an older adult?

Sometimes the question comes before any diagnosis: is Mom’s memory slipping, or is she depressed? Depression can cause real problems with thinking. Harvard Health says depression can cause a decline in mental functioning that comes from low energy and effort rather than lasting brain disease, and that it often improves as the mood lifts. The older name for this was “pseudodementia,” which the 2021 Aging and Disease review describes as “a psychiatric disorder disguised as a neurodegenerative disease.”

Depression Dementia
Speed Thinking problems develop over weeks to months Decline develops gradually over years
Main thinking problem Trouble concentrating and paying attention True short-term memory loss
Knowing the date and place Usually not disoriented Can be disoriented
Awareness Notices and worries about memory slips Less likely to notice or be concerned
Speaking, writing, movement Usually not impaired Affected as the disease progresses
Self-care Neglected early Neglected later
Outlook Can go into remission with treatment Can be stabilized but not reversed

The table combines what Harvard Health and Sharp HealthCare describe. The two conditions also overlap: Sharp notes that depression is a risk factor for dementia, though not a direct cause, and BrightFocus says depressive symptoms may come before dementia, so depression in later life is sometimes an early sign. Harvard Health says there is no simple test to tell them apart, so a trial of treatment for depression is often worthwhile. Either way, the answer starts with a proper assessment.

When to call the doctor, and what to tell them

Call your parent’s doctor if low mood, withdrawal or loss of interest lasts two weeks or more, or sooner if they stop eating or drinking. The Alzheimer’s Association says there is no single test for depression; a doctor needs a full evaluation, because medicine side effects and other medical conditions can cause the same symptoms. It suggests asking for a referral to a geriatric psychiatrist, who specializes in depression in older adults.

Bring notes. Doctors rely on families, because the person with dementia may not be able to describe how they feel. Write down:

  1. What changed and when, in plain words: “Stopped going to church in September; cries most afternoons.”
  2. How long it has lasted and whether it came on over days, weeks or months.
  3. Sleep, appetite and weight.
  4. Anything they have said about being a burden, guilt or death, word for word.
  5. Every medicine, including over-the-counter ones and supplements, and any new medicine or dose change.
  6. Life events, such as a move or a bereavement.

What treatment usually involves

The doctor decides on treatment, and it depends on the person. In general terms, the Alzheimer’s Association says the most common approach combines medicine, counseling, and gradually reconnecting the person with activities and people that bring them happiness. Points families often ask about:

  • Talking therapies. The Alzheimer’s Society says talking therapies, including CBT and counseling adapted to the person’s memory and communication, can help in the early to middle stages but are unlikely to help in the later stage, where sensitive listening and sensory activity may help more.
  • Antidepressants. These are widely used. The Alzheimer’s Society and BrightFocus both say they seem less effective in people with dementia than in other people, so the doctor will weigh benefits and side effects. Dementia Australia suggests asking what side effects to watch for. Never start, stop or change a medicine without the doctor.
  • Activity-based approaches. BrightFocus mentions reminiscence, behavioral activation and music therapy as options in later stages.

What helps at home, day to day

Treatment works best alongside daily life that gives your parent comfort, contact and small successes. These ideas come from the Alzheimer’s Association, the Alzheimer’s Society and Dementia Australia:

  • A predictable routine. Keep meals, walks and bedtime at the same times, and plan harder tasks such as bathing for their best time of day.
  • Things they enjoy, more often. List the activities, people and places that make them smile, and build them into the week. Our ideas for activities for dementia patients at home are sorted by ability.
  • Daylight and movement. Regular physical activity, including time outdoors, helps mood. The Alzheimer’s Association suggests exercise, especially in the morning. In Florida, a morning walk avoids the worst heat; bring water.
  • Company. Social contact and companionship ease isolation, which the Alzheimer’s Society lists among the causes of depression.
  • Music. BrightFocus lists music therapy among the approaches that may help in later stages; playing favorite songs at home is an easy place to start.
  • A useful role. Folding towels, setting the table or watering plants gives a sense of purpose. Celebrate small successes.
  • The right words. Acknowledge sadness, show you understand, and express hope. Telling someone to “cheer up” or “snap out of it” rarely helps. Reassure them often that they are loved and will not be left.

Depression in the caregiver

The person caring at home is at risk too. BrightFocus reports a study in which more than 2 in 3 caregivers scored high on a depression test, with higher risk for caregivers who are older, have less family support, or care for someone with more severe dementia. The Alzheimer’s Association lists signs to notice in yourself: irritability, guilt or worthlessness, hopelessness, sleep problems, fatigue, losing interest in things you enjoy, trouble concentrating, appetite changes, and aches that do not go away.

If that sounds like you, see your own doctor. The Alzheimer’s Association says depression can be effectively treated. Accept help, join a support group, and take regular breaks. Our guides to self-care for dementia caregivers and respite care for dementia in Florida cover how.

Urgent signs: when to get help now

  • Call or text 988 (the 988 Suicide & Crisis Lifeline) if your parent talks about suicide, ending their life or not wanting to live, or if you are having those thoughts yourself. It is free and confidential and answers any time, day or night. You can also chat at 988lifeline.org.
  • Call 911 if someone is in immediate danger or has harmed themselves.
  • Call the doctor the same day if your parent stops eating or drinking, or becomes suddenly more confused.

Never dismiss talk of death as “just the dementia.” Take it seriously every time.

Florida help for depression and dementia

  • Memory Disorder Clinics. Florida’s Alzheimer’s Disease Initiative funds 17 Memory Disorder Clinics across 13 service areas, offering diagnosis and referral for Alzheimer’s and related dementias. See our guide to Memory Disorder Clinics in Florida.
  • Elder Helpline, 1-800-963-5337. The Department of Elder Affairs’ line connects you to elder services in every Florida county.
  • Aging and Disability Resource Centers. Florida’s 11 Area Agencies on Aging work as ADRCs. In our areas: Area Agency on Aging for Southwest Florida, (239) 652-6900; Area Agency on Aging of Palm Beach/Treasure Coast, (561) 684-5885; Alliance for Aging in Miami, (305) 670-6500. Ask about the Alzheimer’s Disease Initiative’s caregiver counseling, support groups and respite care.

Where our companion care fits

Loneliness and long empty days feed low mood. A steady companion can keep up the routine, walks, music and conversation that the doctor and the guides above recommend, and notice when your parent seems lower than usual. Our caregivers are screened for dementia care experience, and you watch each caregiver’s video interview before choosing. We send 3 caregiver video profiles within 48 hours, and your parent has one consistent companion. Our care is non-medical and does not replace the doctor. The rate is $35 an hour · minimum 25 hours a week. No long-term contract. Stop anytime with 7 days’ notice. We serve Southwest Florida, Palm Beach, the Treasure Coast, Miami and the Keys. Call (689) 333-6079 or read about our dementia companion care service.

FAQ

Frequently asked questions

Is depression common in dementia patients?

Yes. The Alzheimer’s Association says up to 40 percent of people living with Alzheimer’s or another dementia may have significant depression, especially in the early and middle stages. A 2021 review found rates differ by type and are highest in vascular dementia.

Is depression a symptom of dementia?

It can be. Depression is common alongside dementia, partly because the diseases behind dementia can affect parts of the brain that control emotion, according to the Alzheimer’s Society. BrightFocus notes that depressive symptoms can come before dementia is diagnosed. It is still a separate condition that can be treated, so tell the doctor.

Can depression cause dementia?

Sharp HealthCare says depression is a risk factor for dementia but does not directly cause it. Studies summarized by Healthline link depression to a higher later risk, but researchers are still working out whether depression raises the risk or is sometimes an early symptom.

Can depression be mistaken for dementia?

Yes. Depression can cause poor concentration, slowness and forgetfulness that look like dementia. Harvard Health says this kind of decline often improves as mood improves, and that people with depression are usually not disoriented. A doctor’s assessment is the way to tell.

Can depression make dementia worse?

Yes. The Alzheimer’s Society says depression can increase problems with thinking and memory caused by dementia, and Harvard Health says each condition can worsen the other. It is worth raising with the doctor.

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