Recognize and Treat Depression

to Reduce Risk of Alzheimer’s Disease

Cordula Dick-Muehlke, Ph.D.

Evidence is mounting that the occurrence of depression across the lifespan can increase risk for Mild Cognitive Impairment (MCI), a high-risk dementia state, and Alzheimer’s disease as well as other forms of dementia.

  • Among 486 people ages 60-90 followed as part of the Rotterdam Study, those who had at least one episode of depression that required attention of a general practitioner, psychologist, or psychiatrist during life were2.6 times more liked to develop Alzheimer’s disease than their peers who were depression free. When researchers compared individuals whose depression first occurred prior to versus after age 60, the former, with an early onset, were at greater risk for Alzheimer’s disease than the latter, those with a late onset. In this 2008 study, early onset depression increased risk for Alzheimer’s disease nearly 3.76 times. In comparison, late-onset depression elevated risk 2.34 times.
  • As part of the Framingham Heart Study, 949 older adults who initially had no cognitive impairment were followed for 17 years. Older adults who were depressed at the start of this 2008 study had a 76% greater risk of developing Alzheimer’s disease than those who were not.
  • In a just published 2012 meta-analysis of 12 studies investigating depression as a risk factor for MCI and various forms of dementia, researchers found depression increased risk across the board. More specifically, depression increased risk for Alzheimer’s disease by 66%, for vascular dementia by 89%, for any form of dementia by 55%, and for MCI by 97%. Depression, the authors concluded, should be considered a major risk factor for both MCI and dementia.

Recognizing Depression
In a survey of just over 235,000 adults in the U.S. conducted by the Centers for Disease Control, nearly one out of 10 reported experiencing depression in the prior two weeks. Among older adults, age 65-plus, 1 out of 7 acknowledged being currently depressed. 

Depression is characterized by a persistent blue mood that interferes with daily life and may ultimately lead to suicide. Depression may evidence itself in a variety of symptoms, and, particularly among older adults, may not involve feelings of sadness. For this and other reasons (e.g., hesitance to report depressive symptoms due to stigma, lack of physician time, and overlap of symptoms with other conditions), depression may be missed in older adults. Even when identified, depression may be inappropriately dismissed as a normal part of aging, given the losses associated with older adulthood.

Common symptoms of depression among older adults include:

  • Anxiety or worries
  • Appetite and weight changes, either increased or decreased
  • Exaggerated or unexplained physical complaints
  • Excessive or inappropriate guilt
  • Feelings of discouragement or hopelessness
  • Fixation on death, suicidal thoughts or attempts
  • Irritability or demanding behavior
  • Lack of attention to personal care
  • Lack of motivation and energy
  • Loss of interest in normally pleasurable activities
  • Loss of self-worth (e.g., worries about being a burden, feelings of worthlessness, self-loathing)
  • Memory difficulties
  • Neglecting personal care (e.g., skipping meals, forgetting medications, neglecting personal hygiene)
  • Prolonged grief after loss
  • Sadness, lack of playfulness, inability to laugh
  • Sleep disturbances, such as daytime sleepiness, difficulty falling asleep, multiple mid-night awakenings, early morning awakenings
  • Slowed movement and speech, or agitation and restlessness
  • Social withdrawal and isolation (i.e., reluctance to be with friends, engage in activities, or leave home)

An evaluation should be sought if you or someone who know is experiencing one or more of these symptoms daily for two or more weeks, as depression may be present.

Depression is a Highly Treatable Risk Factor for Alzheimer’s Disease

Depression can be treated successfully with anti-depressant medication, talk therapy, and a variety of lifestyle strategies. Anti-depressant medication can address changes in neurotransmitters, or chemical messengers, in the brain associated with depression. Talk therapy can provide an opportunity to address the cognitive and emotional factors underlying depression. A therapist can help you let go of dysfunctional thought patterns, such as perfectionism, self-criticism, and negativity that can contribute to a low mood, and better manage feelings such as sadness and anger, whether stemming from the losses of aging or other causes. Finally, lifestyle strategies, such as detailed in the sidebar, are an important for keeping depression at bay over the long haul. 

Promote Happiness to Protect Your Brain

  • Become aware of and challenge negative thinking. Focus on the positive.
  • Develop a compassionate attitude toward yourself and set realistic expectations.

  • Create opportunities to laugh. Humor is contagious.

  • Engage in regular exercise – a natural mood booster.
  • Resist the temptation to withdraw and actively seek social support from friends and loved ones.

  • Engage in activities that bring or used to bring you joy.

  • Eat a healthy, low-fat diet, rich in complex carbohydrates, antioxidants, and omega-3 fatty acids.

  • Get a good night’s sleep. Lack of sleep can worsen depression.

  • Seek professional help if depression is distressing or long-lasting.