All too often, when family members notice a change in an elderly loved one’s condition, there is a the sharp pang of fear that this is the first sign of dementia’s onset. However, what most people don't realize is there are reasons, such as depression or hearing loss, that can cause these distressing changes in behavior. Determining what the underlying factor causing the change is often complicated because the symptoms of hearing loss, dementia and depression can all appear separately yet also have complex linkages between the conditions. Here's a few helpful ways of determining whether it's dementia or another health issue.
Hearing Loss and Dementia
Among the symptoms of hearing loss is the inability to concentrate on conversations, which can appear similar to signs of dementia to non-professionals. The reality is that those with hearing loss might only hear mumbled fragments of conversations when many people are speaking and struggle to put together discussions due to the inability to parse sounds.
A compounding issue is that increasingly studies point to the fact that hearing loss can increase the likelihood of developing dementia. According to the 2013 Hearing Loss and Cognitive Decline in Older Adults study that involved 1,948 older adults, those who suffered from hearing loss exhibited cognitive decline at rates 30 to 40 percent greater than those with normal hearing after six years. The jury is still out as to what causes the increase in rate of cognitive decline, but certainly hearing loss poses an obstacle to social engagement and lack of sensory input can make our loved one’s lives more difficult. In more hopeful news, Improvement of Cognitive Function After Cochlear Implantation in Elderly Patients study published in 2015 suggests that cochlear implants can improve cognitive function in those with hearing loss, meaning that it is important to seek medical consultation early when hearing loss is observed.
Dementia or Depression? According to the Alzheimer’s Association, the first thing to know about dementia is that it “is not a specific disease,” rather it “describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities.” The two most common types of dementia are Alzheimer’s disease, which accounts for somewhere between 60 to 80 percent of all cases, followed by vascular dementia, frequently resulting from a stroke. All that said, dementia is a complex condition and interacts with a number of other maladies such as depression.
The Canada Review of Alzheimer’s Disease and Other Dementias states that “diagnosis is often challenging because the frequency of symptoms which are common to both [depression and dementia].” For example the common dementia symptoms include loss of interest in enjoyable activities and hobbies, withdrawing socially, memory lapses, changes in sleeping patterns and impaired concentration. However, there are certain distinctions that are more common to one condition than another. With regard to the response to loss of cognition, those with dementia frequently exhibit denial and lack of concern regarding their change of behavior, whereas those with depression tend to be preoccupied by their deficits and are concerned. The table below lists a number of key symptoms of depression and dementia and distinguishing characteristics that can help identify the problem.
Ability to Concentrate Loss of concentration and focus is common as well as uncertainty and concern about making mistakes. Concentration is normal early on, but becomes worse as condition progresses over a long period of time.
Interests and Motivation Loss of interest and pleasure in combination with sad mood, and expressions of hopelessness. Often taking place over weeks. Loss of interest and initiative that takes place over a longer time-frame (months/years) and is unaccompanied by expressions of sadness.
Energy and Activity Level Decrease in energy and frequent complaints of fatigue. General normal energy, but lower activity due to lack of initiative and attention.
Mood and Outlook Frequent, persistent sad mood. Expressions of lack of hope. Stimulation and engagement do not improve mood. Mood and demeanor is normal most of the time, fluctuating with circumstance and responsive to stimulation.
Thoughts of Self-Harm or Suicide Common Uncommon
Sleep Changes in sleep patterns over weeks, increasing or decreasing. Gradual changes in sleep cycle (months/years), such as more frequent nighttime awakenings and sleeping during the day.
Language Use Language use is normal, but may be expressed slowly. Language use is impaired. Examples include forgetting names for common items like “pen” or “lamp.”
Depression and Dementia
While determining whether your loved one suffers from one condition or the other is critical, it is also important to recognize that occasionally one condition masks another or indeed leads to the other. In fact, a great number of those afflicted with dementia also suffer from depression and due to the similarities of symptoms, it may be difficult to distinguish when depression develops.
For this reason, it is important to look for significant changes in mood, such as uncharacteristic sadness, discouragement or tearfulness in loved ones. One particularly important sign that a loved one may also suffer from depression is when changes happen rapidly, which is indicative of a psychological change rather than cognitive. Indeed, for those who are more aware of their dementia in the early stages are often more likely to exhibit signs of depression.
When you visit family for the holidays, keep a mental check list of changes in behavior from the last time you visited so you can be proactive with their health. And most importantly, once you have identified changes and specific behaviors, always consult a physician so you can ensure that the condition is treated and addressed in the best way possible.
If your loved one's condition requires supportive services so they can remain independent but you are unsure of what care options are available, next week we will provide a helpful breakdown of the options.