Ninety-eight percent of people with Alzheimer’s disease develop this symptom first, according to one study. People at risk should pay special attention to this dementia symptom.
Dementia – eighth leading cause of death!
Currently, more than six million Americans are living with Alzheimer’s disease (AD), a form of dementia that affects memory and the ability to function normally. It is the sixth leading cause of death in the United States and is also common in the EU, but exactly how it develops can be different for each person. A new study has now found that in people with late-stage Alzheimer’s dementia (LOAD) – those who first develop symptoms after age 65 – 98% of patients develop a symptom first. Read on to find out which symptom may appear before others in late-onset cases and how to recognize it.
In late-onset dementia, depression is the first symptom to appear in 98% of patients
Experts have long reported that the majority of dementia cases begin with mild cognitive impairment. However, research suggests that in late-stage Alzheimer’s disease – defined as cases in which the first symptoms appear after age 65 – depression may be the first symptom.
According to a 2017 study published in the journal BMJ Open, depression as the first symptom of late-stage Alzheimer’s disease occurs almost as frequently as cognitive impairment – a fact that distinguishes it from early-onset cases of the disease. “We found that depression and cognitive impairment were the first symptoms experienced by 98.5 percent and 99.1 percent of individuals in a study of late-stage Alzheimer’s disease (LOAD) and 9 percent and 80 percent, respectively, of early-stage Alzheimer’s disease (EOAD),” the team wrote.
These data suggest that depression is an additional first symptom in the vast majority of late-onset Alzheimer’s cases, while it is relatively rare for it to be the first symptom in early-onset cases. This is of particular importance because the National Institute on Aging estimates that 90 percent of Alzheimer’s cases are considered late-onset cases.
Depression may present differently in Alzheimer’s patients
Although depression is considered common in Alzheimer’s disease, it can be more difficult to detect than depression in the general population. “It can be difficult to recognize depression in an Alzheimer’s patient because dementia can cause some of the same symptoms,” explains the Alzheimer’s Association. “In addition, it is often difficult for people with Alzheimer’s to articulate their sadness, hopelessness, guilt and other feelings associated with depression because of cognitive impairment,” experts say. Common symptoms of depression and dementia include apathy, loss of interest in activities, social withdrawal, isolation, difficulty concentrating and difficulty thinking.
The organization also notes that depression associated with Alzheimer’s disease may look somewhat different than depression in the general population. Depression in Alzheimer’s patients may be less severe, last for a shorter period of time, or occur at short intervals. Alzheimer’s patients with depression are less likely to talk about or attempt suicide than other people with depression.
Treating depression may help slow the progression of Alzheimer’s
In Alzheimer’s patients, abnormal amounts of amyloid – a naturally occurring protein – combine to form plaques that are deposited between neurons in the brain. This disrupts cell function and contributes to cognitive impairment, experts say. According to Harvard Health Publishing, there is evidence that depressed people with abnormal levels of amyloid in the brain experience faster declines in cognitive ability, which also affects memory and thinking.
“Our research found that even low levels of amyloid deposition in the brain can affect the relationship between depression symptoms and cognitive abilities,” said Jennifer Gatchel, HMS, assistant professor of psychiatry and geriatric psychiatrist at Mass General. “This raises the possibility that depression symptoms could be a target in clinical trials to delay the progression of Alzheimer’s disease. More research is needed in this area,” she said.
Gatchel adds that depression “may be among the early changes in the preclinical stages of dementia syndromes” and that its detection could provide “a clinical window for close monitoring of at-risk individuals and for potential interventions to prevent or slow cognitive decline.”
Treatment can improve quality of life for Alzheimer’s patients
Recognizing depression is the first step toward treating it. However, for Alzheimer’s patients, this can present its own set of challenges. “Because of the complexity of diagnosing depression in Alzheimer’s patients, it may be helpful to consult with a geriatric psychiatrist who specializes in identifying and treating depression in older adults,” the Alzheimer’s Association recommends.
They add that the National Institute of Mental Health has established its own set of guidelines for diagnosing depression in Alzheimer’s patients. “Although the criteria are similar to the general diagnostic standards for major depression, less emphasis is placed on verbal expressions and irritability and social isolation are included,” the experts say.
Once diagnosed, many Alzheimer’s patients benefit from a combination of medications, counseling and lifestyle interventions, including “gradually reengaging with activities and people that bring pleasure.”
Talk to your doctor today about whether screening or treatment is right for you.