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12. Depression and dementia

Dementia means a persistent overall decline in all mental abilities (memory, intellect and personality) without any kind of loss of consciousness. It is usually a slow process. Dementia can sometimes be confused with depression: the two illnesses can coexist, or each can look like the other in isolation.


Depression commonly causes decreased concentration, and this can look like poor memory functioning. If you are unable to concentrate, you do not take the information in for storage, and it is not there for retrieval later – your memory will seem poor. In about two-thirds of elderly depressed people there are signs of memory difficulties if they are very carefully tested. If these difficulties are very marked, they can look exceedingly like someone who is dementing. However, when the depression is treated, the ‘dementia’ goes completely, memory and concentration return. This phenomenon is called pseudodementia.

The opposite situation can occur. People who are beginning to function less well, and are in the process of developing a dementing illness, can become depressed. This may be because they can see what is happening, and become depressed. Occasionally – especially if they are depressed for the first time in late life – this can be a part of the dementing illness itself. Whatever the situation, if an elderly person is clinically depressed, plus or minus dementia, they need vigorous treatment.

Even in advanced dementia, depression can be treated and treatment will often improve the quality of life significantly.

Antidepressant medication needs to be chosen with more care in the elderly, because they have more problems with side-effects.

Antidepressants certainly work well in the elderly – there are no age bars. Electroconvulsive Therapy (ECT) can also be used in the elderly to very good effect. ECT may in fact be a safer option than some complicated regimens of medication. Somebody who is suffering from dementia and depression will not have their dementia worsened by ECT.



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