[Click! Health] Beware of Dementia... Pay Attention to Depression in Old Age

[Asia Economy Reporter Lee Chun-hee] Recently, as awareness of dementia has increased, younger generations are also visiting hospitals out of concern for dementia. However, a significant number of these cases are diagnosed with depression rather than dementia. Since depression can be a risk factor that may lead to dementia or serve as a prodromal symptom, it is important to have prior knowledge of the symptoms and treatment methods.

Depression refers to a disorder that causes decreased motivation, feelings of sadness, and various mental and physical symptoms, leading to a decline in daily functioning. Among the elderly aged 65 and older, 2 to 3 out of 10 experience this common mental health issue. People with late-life depression often complain of memory decline. Sometimes, severe cognitive problems appear as if they have dementia, which is called ‘pseudodementia.’ This means that although it is not true dementia, symptoms similar to dementia can appear.

Despite the common occurrence of late-life depression, the treatment rate is very low. If depression is not properly managed, it can lower quality of life, affect physical illnesses, and increase mortality. However, late-life depression can be sufficiently treated and improved with medications such as antidepressants. Antidepressants have fewer side effects compared to sleeping pills or tranquilizers and are safe to use alongside other medications. Most elderly patients can take them without discomfort. Additionally, physical illnesses, medications being taken, recent stressful events, and unstable environmental factors can also cause late-life depression, so a comprehensive evaluation and intervention of these causes are important parts of treatment.

Professor Park Ji-eun of the Department of Psychiatry at Seoul National University Hospital said, "The reason why late-life depression must be properly diagnosed and treated is that it has a high likelihood of progressing to dementia," adding, "Depression leading to dementia is accompanied by changes in cognitive function, so continuous monitoring of cognitive function abnormalities is necessary."

Patients with late-life depression can be broadly divided into two groups. The first group is ‘early-onset depression,’ where depression begins in their 20s or 30s and continues into old age. The second group is ‘late-onset depression,’ where there were no problems when young but depression occurs after middle age. This group is more likely to have accompanying degenerative brain changes and requires particularly careful monitoring. Also, if cognitive problems accompany depression from the early stages, or if depressive symptoms improve during treatment but memory does not, or if there is a poor response to antidepressant treatment, the possibility of an underlying neurodegenerative disease should be considered.

The most important point in distinguishing depression from dementia is ‘how cognitive function has deteriorated.’ More than 80% of dementia cases are caused by neurodegenerative diseases such as Alzheimer’s disease. In these cases, memory gradually worsens over a long period. Depression patients report that ‘memory suddenly got worse’ or ‘memory fluctuates depending on mood,’ whereas patients with degenerative dementia report that ‘memory gradually worsens little by little.’ It is necessary to assess not only current cognitive function but also memory from 2 to 3 years ago. This is why comparing memory from last year and this year is also important.

When affected by depression or dementia, daily activities may decrease. It is important to distinguish whether the decrease is due to lack of motivation and reluctance caused by depression (‘not doing’) or due to cognitive problems causing mistakes and inability (‘cannot do’). Preventing dementia is also important. One of the key dementia prevention methods is properly treating depression. Especially in people with mild cognitive impairment (MCI), the presence of depressive symptoms accelerates dementia progression, so caution is needed.

Professor Ji-eun Park, Department of Psychiatry, Seoul National University Hospital

Professor Park advised, "If depression occurs with aging, be sure to visit a hospital for treatment and check the possibility that dementia may be progressing in the brain," adding, "If you are being treated for depression, even if symptoms improve, continue to visit the hospital regularly to have your cognitive function checked."