Caring For The Caregivers
A final consideration regarding dementia and depression concerns care partners of people with dementia. Caregiving is a stressful responsibility and increases the risk of depression for the caregiver. One recent report found that more than two of every three caregivers scored high on a test of depression. The risk for depression was greater among caregivers who were older, or had attained a lower educational level, or had less support from other family members.
Depression risk was also increased when the severity of dementia was greater in the care recipient. A healthier care partner will enjoy a better quality of life and will also have more to offer the care recipient.
Resources:
Readings:
Asmer MS, Kirkham J, Newton H, et al. Meta-analysis of the prevalence of major depressive disorder among older adults with dementia. J Clin Psychiatry 2018 79. Pii: 17r11772. doi: 10.4088/JCP.17r11772.
Kubo Y, Hayashi H, Kozawa S, et al. Relevant factors of depression in dementia modifiable by non- pharmacotherapy: a systematic review. Psychogeriatrics 2018 Sep 23. doi: 10.1111/psyg.12371.
Bassiony MM, Warren A, Rosenblatt A, et al. The relationship between delusions and depression in Alzheimer’s disease. Int J Geriatr Psychiatry. 2002 Jun 17:549-56.
Menon AS, Gruber-Baldini AL, Hebel JR, et al. Relationship between aggressive behaviors and depression among nursing home residents with dementia. Int J Geriatr Psychiatry 2001 16:139-46.
Disease:
Depression Linked To Dementia In Later Life
A retrospective study of 13,535 long-term Kaiser Permanente members found that depressive symptoms in mid-life were associated with a 20% greater risk of developing dementia. Depression in later life was associated with a 70% increased risk. Depression in both mid- and late-life posed an 80% increased risk. The study appears in the May issue of Archives of General Psychiatry.
Depression commonly occurs in individuals with cognitive impairment and dementia, the researchers wrote. Although some studies have found that depression coincides with or follows the onset of dementia in older adults, most studies and several meta-analyses have concluded that depression precedes dementia and is associated with approximately a 2-fold increase in the risk of developing cognitive impairment or dementia.
Note from Kermit Cole, In the News Editor:It is interesting to note the fact that the risk factor for dementia in this cohort is only 20% greater for depression occurring between 1964 and 1973 but there is a 70% increased risk factor for depression occurring between 1994 and 2000. Antidepressants would have been the treatment of choice for depression arising from 1994 to 2000. Apart from any considerations of the specific time-course of the contribution depression might make to the development of dementia, it is reasonable to assume that between 1994 and 2000 most people diagnosed with depression would have received antidepressants.
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Study: Depression In Middle Age Linked To Dementia Later On
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Middle-aged men and women suffering from depression may be more susceptible to dementia down the line, a recent study reports in the Archives of General Psychiatry.
Previous studies have linked depression in older adults with dementia and Alzheimers disease, but it has never been clear which came first: was depression a risk factor for dementia or an early symptom? The new study sought to look at depression at younger ages to see if the condition preceded memory decline.
We wanted to look at whether depression is truly causal, or if its a reaction to cognitive impairment, or if the changes in the brain are causing both depression and cognitive decline at the same time, says study author Dr. Deborah Barnes of the University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center.
To clarify the timing of depression and memory loss onset, the research team conducted a life-course study that first looked at the incidence of depression in midlife. The team included more than 13,000 people ages 40 to 55 who were part of the Kaiser Permanente Medical Care Program of Northern California and participated in a health examination called the Multiphasic Health Checkup between 1964 and 1973.
Further, people with late-life depression were twice as likely to have Alzheimers disease as those who were depression-free, and those with both midlife and late-life depressive symptoms had more than a three-fold increase in vascular dementia risk.
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Brain Changes In Depression And Dementia
Prior work suggests possible mechanisms that make people living with depression more susceptible to dementia.
Individuals with depression exhibit hyperactivity in the area of the brain that stimulates the adrenal glands to produce more glucocorticoids, such as the stress hormone cortisol. Higher cortisol levels can damage the hippocampus , a part of the brain that is important for cognitive function and memory.
Scientists have also identified that people living with Alzheimers may experience atrophy of the hippocampus. Dr. Brenowitz clarified for MNT:
Those with depression exhibit reduced hippocampal volumes. This is thought to be due to increased stress hormones, because the hippocampus is a more susceptible region to health insults , it is also more susceptible to Alzheimers disease.
She explained that the hippocampus is a vulnerable region that might be tipped into a nonideal state, where we end up with some sort of volume loss that can be independent of Alzheimers.
Dr. Brenowitz continued, There could already a hit from depression, and then more likely to have Alzheimers disease or be more susceptible to that pathology.
Research suggests that other mechanisms that contribute to cognitive decline may also be at work.
Depression may contribute to dementia through vascular disease, increased inflammation, depressed nerve growth factors, or increased accumulation of amyloid a protein in the brain strongly associated with Alzheimers disease.
Depression Anxiety Linked To Earlier Onset Of Alzheimer’s Disease: Study
Having depression is known to increase the risk for developing Alzheimer’s disease. However, a new study has found that depression and anxiety are linked to earlier onset of Alzheimer’s disease .
According to the study, if people do develop Alzheimer’s disease, those with depression may start experiencing dementia symptoms about two years earlier than those who do not have depression.
The study also suggested that people with anxiety who develop Alzheimer’s may start experiencing dementia symptoms about three years earlier than those who do not have anxiety.
The study will be presented at the American Academy of Neurology’s 73rd Annual Meeting being held virtually from April 17 to 22, 2021.
“More research is needed to understand the impact of psychiatric disorders such as depression and anxiety on the development of Alzheimer’s disease and whether treatment and management of depression and anxiety could help prevent or delay the onset of dementia for people who are susceptible to it,” said study author Zachary A. Miller, M.D., of the University of California, San Francisco, and a member of the American Academy of Neurology.
Miller added, “Certainly this isn’t to say that people with depression and anxiety will necessarily develop Alzheimer’s disease, but people with these conditions might consider discussing ways to promote long-term brain health with their health care providers.”
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Risk Factors For Depression
Some people are more likely to experience depression. According to the National Alliance on Mental Illness, Older women are at a greater risk because women in general are twice as likely as men to become seriously depressed. Biological factors like hormonal changes may make older women more vulnerable. The stresses of maintaining relationships or caring for an ill loved one and children also typically fall more heavily on women, which could contribute to higher rates of depression. Unmarried and widowed individuals as well as those who lack supportive social network also have elevated rates of depression. Conditions such as heart attack, stroke, hip fracture or macular degeneration and procedures such as bypass surgery are known to be associated with the development of depression.
Repetitive Negative Thinking Linked To Protein Deposits
In the study published in Alzheimers & Dementia, 292 people over the age of 55 answered questions, over a two-year period, about their habitual thoughts. The surveys focused on negative thinking patterns, like rumination and worry. Participants also regularly completed self-assessments for depression and anxiety symptoms.
Periodically, the participants were tested for memory, attention, spatial cognition, and language skills. Some people also had brain scans to measure deposits of tau and amyloid in their brains. These proteins are the cause of Alzheimers disease. The researchers found that people who had higher repetitive negative thought patterns experienced more cognitive decline over a four-year period. These individuals specifically showed more decline in memory, which is the first symptom in Alzheimers. The negative thinkers were also more likely to have amyloid and tau deposits in their brains.
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Depression Common With Age
The link between depression and dementia is even more significant considering that depression becomes more common with age. All of the following may put you at risk for depression as you get older:
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the death of a spouse, friends, or family members
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having to move out of your home and into an assisted living facility
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side effects of medicines you’re taking for health conditions.
You’re also more likely to develop illnesses such as diabetes, heart disease, and cancer as you get older. These conditions can increase your risk for depression, and vice versa. Depression can make a chronic illness worse, says Dr. Cremens.
Statistics Is The Grammar Of Science
Dr. Brenowitz, senior researcher Dr. Kristine Yaffe, and their colleagues pooled data from four large preexisting groups of participants to make a total of around 15,000 people aged 2089 years.
The four groups are part of ongoing studies investigating risk factors for either cardiovascular disease or body composition and reduced function in older people.
Next, the researchers employed a complex statistical method called imputation . They wanted to understand whether depression in early adulthood is associated with an increased risk of dementia.
Dr. Brenowitz defined imputation as rying to make associations that would not be otherwise possible. She explained to MNT:
Imputation is assigning missing data a value. The idea behind it is: We are missing data from these older adults on their . So, we are trying to assign a value to what we think their depressive symptoms were. And, to do that, we need to have data on other people we think are similar: people that are exchangeable.
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You Can Change Your Thinking Brain And Life
I was depressed for decades and tried to end my life which resulted in a serious brain injury. I had to learn the basics of living, thinking, and being again. This time around, I learned healthier, happier, kinder ways of thinking. By consciously working with and altering my thoughts, behaviors, and emotions, I transformed my world which in turn, changed my physical brain and its default mode of operation.
Today, I live a brain-healthy lifestyle incorporating mental health practices daily to maintain the balance and happiness Ive found. Ive made friends with my mind and have even learned to put it to work FOR me instead of AGAINST me. You can do it too.
To not get pulled down by your mind, youve got to change the automatic negative thoughts playing in your head. At first, this is going to feel like trying to swim upstream, but with persistence and time, it can be done.
Light Shed On Link Between Depression Dementia
Researchers deem depression an independent risk factor for dementia
HealthDay Reporter
WEDNESDAY, July 30, 2014 — Older people with depression are more likely to develop dementia, but researchers have been unable to explain the exact nature of the relationship between the two.
Specifically, they haven’t been able to figure out the direction in which the relationship works — does depression help bring on dementia, or does dementia cause people to become depressed?
A new study published online July 30 in the journal Neurology sheds more light on the mystery.
Depression is a risk factor for dementia, researchers report, and people with more symptoms of depression tend to suffer a more rapid decline in thinking and memory skills. While the study found an association between the two, it did not prove a cause-and-effect relationship.
Depression accounted for about 4.4 percent of the difference in mental decline that could not be attributed to dementia-related damage found in the brain, the researchers said.
“This is a risk factor we should take seriously,” said lead author Robert Wilson, senior neuropsychologist at the Rush Alzheimer’s Disease Center at Rush University. “Treating depression can reduce the risk of dementia in older people.”
The study involved over 1,700 people, with an average age of 77, who had no thinking or memory problems at the start of the study.
However, the researchers found no relationship between depression and dementia-related damage in the brain.
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Studies Show Depression Dementia Link
The study was one of three published in the July 6 issue of Neurology, suggesting a link between late-life depression and dementia.
In a separate study that included just over 1,200 older participants, having two or more episodes of depression late in life doubled the risk of dementia, but not a lesser form of cognitive decline known as mild cognitive impairment.
In a third study, symptoms of depression showed little change during the development and progression of Alzheimerâs disease.
âThe association between depression and dementia has been a major topic for more than two decades, and it is increasingly clear this association is real,â Alzheimerâs researcher Yonas E. Geda, MD, tells WebMD.
Geda is an associate professor of neurology and psychiatry at the Mayo Clinic College of Medicine in Rochester, Minn.
In an editorial published with the studies, Geda suggested several possible explanations for the observed link between late-life depression and dementia, including:
- Major depression may directly damage the part of the brain associated with learning and memory via inflammation or the release of stress hormones.
- Depression may be in response to early, but medically unrecognized, memory declines.
- Depression may act synergistically with biological factors that have been linked to dementia to cause cognitive decline.
- The same biological factors that lead to depression late in life also lead to dementia.
Depression Increases The Risk Of Alzheimers Disease
Being depressed increases the risk of developing Alzheimers disease and other forms of dementia, a new study reports. The study found that men and women with a diagnosis of depression were at increased risk of getting a dementia diagnosis, and the risk persisted even more than 20 years later.
The study, in PLOS Medicine, consisted of two parts. In one, researchers in Sweden tracked nearly 120,000 men and women over 50 who had been diagnosed with depression, comparing them with peers who were not depressed. They followed them for up to 35 years, with an average follow-up time of more than 10 years.
They found that Alzheimers disease or other forms of dementia developed in 5.7 percent of those who had depression, compared to just 2.6 percent of those who were not depressed. Dementia was particularly prevalent in the first year after a depression diagnosis: those with a depression diagnosis were more than 15 times as likely to develop dementia than their peers without depression. But even 20 years later, the risk of dementia remained elevated in those who had depression.
For the second part of the study, the researchers studied more than 25,000 pairs of brothers or sisters, in which one sibling had depression and the other did not. They found that a sibling with depression was more than 20 times as likely to develop dementia than their brother or sister who was not depressed. Again, the risk remained elevated more than two decades later.
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Antidepressants Linked To Dementia Including Alzheimers
New Canadian research finds antidepressants may be contributing to Alzheimers and other dementias.
According to the University of Regina research, popular SSRI antidepressant medications, such as Prozac, Paxil, Lexapro, Zoloft, etc., are associated with a twofold increase in the odds of developing some form of cognitive impairment, such as dementia, including Alzheimers.
This association was even stronger for people who took antidepressants before the age of 65.
The study doesnt prove cause and effect. However, the link is significant and needs to be carefully evaluated in consideration of how often these medications are prescribed, from ordinary cases of sadness to insomnia, pain, and hot flashes. They are even becoming popular drugs for children.
Theyre being prescribed off label, meaning for non-depression related situations. Theyre being prescribed to very young children and to the very old, said Dr. Darrell Mousseau, a professor in the department of psychiatry at the University of Saskatchewan and the studys senior author.
Theyre almost becoming the antibiotic of this century: If youve got a disease, take an SSRI. Its going to help you in one way, shape or form.
The study involved looking at a total of nearly 1.5 million people who were pooled from five studies. The findings showed that people with dementia were twice as likely to have been exposed to an antidepressant compared with people without dementia.
What The Study Revealed
Researchers looked at 40,770 people with dementia and 283,933 people without the disease between 2006 and 2015 to see if the drugs were associated with an increased risk of the condition.
The researchers were based at the University of East Anglia in the United Kingdom, Purdue and Indiana Universities in the United States, and other institutions. It was funded by the U.K.-based Alzheimers Society.
The study found that people with dementia were more likely to have taken the stronger class 3 anticholinergic drugs before they developed dementia. The increased risk varied for different types of drugs, but went up to 30 percent in certain cases.
Dr. Gayatri Devi, a neurologist at Lenox Hill Hospital in New York City and author of The Spectrum of Hope: An Optimistic and New Approach to Alzheimers Disease and other Dementias, explained that the study was a strong one due to its large size and the use of U.K. healthcare databases.
Unlike many other studies which rely on patient recall, this study did not, which was a major strength, Devi told Healthline. Anticholinergic medications can potentially lower the levels of the brain chemical acetylcholine, which is an important messenger in memory pathways. In this study, use of some anticholinergic drugs, even as far back as 20 years, previously raised the risk for dementia.
She pointed out that not all anticholinergic drugs are the same, and some classes didnt show an increased risk of dementia.
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