Depression: Let’s Consider the Impact

My lunchtime routine goes something like this; consume food and beverage, visit with co-workers or seminar participants, and then the multi-tasking begins, I check email, TMZ updates (a guilty pleasure I know), and Medscape updates for new articles. This past Thursday in the midst of my daily ritual, a title catches me off guard. “Patients With Newly Diagnosed Dementia May Become Suicidal” are the black, bold type words that make me look twice. My first thought, not one of shock or surprise because I know depression is an expected reaction to a diagnosis of dementia, if one knows anything about the disease. Problem was, I had not seen it in such stark terms, suicidal, newly diagnosed, and suicidal in early stages of dementia. I keep thinking. These are people functioning at a high level, able to execute the suicidal plan if not treated and if so desired. So, I touch the link, read the summary provided by Medscape, research and read the entire article.

Here is the abstract for you to read if you wish.
http://www.alzheimersanddementia.com/article/S1552-5260(09)00104-6/abstract

Basically, a literature review identifying patterns of increased suicidal thought reports and requests for euthanasia in patients with a recent diagnosis of dementia. The article suggests that protocols be established to identify, treat and monitor for significant depression and suicidal risk. They also suggest modifying thought patterns of the medical community and the concept that depression of this severity, with this population, is not a concern.

Depression is significant, and diagnosis can be difficult in a patient with dementia for many reasons. Overlap exists in behavioral changes seen with progression of dementia and depression, i.e. loss of appetite, weight increase or decrease, varying sleep patterns, poor concentration, loss of interests, apathy, decreased concentration and attention, indecisiveness, fatigue, loss of energy, restlessness. Difficult or not, diagnosis is important or as we just read, effects are significant. If everyday, people with dementia walk around thinking of suicide, and request to be euthanized we have to alter our view on depression and be more aggressive with its identification.

Regardless of the cause of dementia there is self-awareness in the onset of the disease of functional abilities changing, and the core of that person shifting. Initial awareness of difference and decline is a key factor. Depression is likely to occur. As the patient looses the ability to recognize their own decline, depression may or may not lessen. I am a big believer that awareness and orientation is inconsistent. We do not know specifically which parts of the brain have been destroyed or preserved, so we have to be cautious. When I talk with people who have dementia it is likely, at times, a moment of clarity will shine through. I see that person searching and grasping for reality and knowing that they are not living in it. That must be a scary place in which depression hides in the corner and waits for that prime moment to assault. The person with dementia will have difficulty grasping the abstract concept of depression as their disease worsens, and describing it as language breaks down. I mean, even the normal, non-cognitively impaired person often has a hard time putting their symptoms of depression into words, and understanding why they are experiencing the behavioral changes that occur with depression.

Let’s all begin to pay closer attention to those we care about who have dementia. At the beginning, recognize the fragility of mental state, know that essentially this person’s concept of what life would be like in old age has, in an instant, changed forever. As deterioration occurs, keep in mind that the dementia may cause behavioral symptoms, but depression can exacerbate these. Depression is not just possible, but probable. Talking to physicians, openly, about concerns as soon as they occur, and looking at all options to manage depression will make a difference. I am taking a proactive approach with the people I know who have or care for someone with dementia. I am going to warn them of the severity of depression’s impact on well being, especially when life already presents the challenge of dealing with dementia. I will advocate for quick diagnosis of depression which left untreated, may likely have devastating effects.

Photo by Chalmers Butterfield

What is it?

Dementia, not a pretty picture… Typical progression of the disease includes a decline in cognitive function, memory, communication, physical abilities, to the point that the person living with dementia is unable to care for themselves. So, first we see the thinking fade away, recent memories, then those from days past, problem solving skills, attention, and communication. Then this horrific disease attacks a person’s physical being. As if the war on their mind was not enough, they lose coordination, vision disturbances occur, senses change. In the end, it all goes, the person with dementia cannot tell you want they want and need, cannot remember who they are or where they are, cannot walk, feed themselves, use the bathroom on their own, and then goes the ability to swallow, something as basic as eating and drinking become physically impossible. As I said, it is not a pretty picture.
What I know, and see everyday, is that people are living with dementia. The CDC says that as many as 5.3 million American’s are living with dementia caused by Alzheimer’s disease (which is responsible for over half of the cases of dementia). What I also know is that our population is aging, and these numbers are growing exponentially. Now the question is what do we do with this fact? How will we care for all of these people as they age? How will we prepare their families to cope with dementia? We need to start the conversation now. Knowledge is power. The more people know about this disease the more empowered they (or we) will be to kick it!