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Depression & Cognitive Impairment

 

Introduction

Depression and anxiety are causes of significant illness across all ages, backgrounds and ethnicities. Symptoms may be triggered by a number of predisposing factors including previous mental illness, medical conditions and personal and social circumstances.

Advancing age is often accompanied by loss of physical health and independence and of employment as a result of retirement; the death of a spouse, siblings or friends, and relocation of residence. Consequent upon these life style changes in a person’s circumstances over and the general perception that activity levels decline with advancing, signs and symptoms of depression, anxiety and cognitive impairment may be overlooked and thus the diagnosis and management of underlying illness is delayed.

Symptoms

Recognising symptoms of depression and anxiety can be a challenge. Not all people experience typical features such as depressed mood, anxiety, loss of interest in activities, poor motivation, social withdrawal, and loss of confidence and self-worth. Some people may instead present with other difficulties such as misuse of alcohol and drugs or a number of physical symptoms that might include lack of energy, unexplained or aggravated aches and pains, sleep disturbance, poor concentration or memory difficulties. These symptoms may mask the presence of an underlying mood disorder.

Diagnosis

There is a complex relationship between depression and physical illness, particularly in advancing age. Medical problems can cause depression in older adults either directly or as a psychological reaction to the illness. Depression and anxiety can arise in stroke, Parkinson’s disease, cancer, diabetes, multiple sclerosis, thyroid disorders and neurodegenerative diseases with cognitive impairment to name but a few. Any chronic medical condition, particularly if it is painful, disabling, or life threatening, can lead to and /or exacerbate depression.

The distinction between physical and mental illness can be challenging, as memory difficulties may be attributable to cognition impairment or depression or both. Cognitive impairment and depression often have similar symptoms including poor concentration and memory, reduced speech, delayed thought processes, apathy and loss of initiative. A decline in mental agility should never be assumed to be part of the normal aging process. Accurate evaluation and diagnosis of the symptoms of depression and cognitive impairment is required to direct and prescribe appropriate, treatment, support and other interventions.

Symptoms of depression and anxiety can arise at different stages of progressive cognitive impairment.  Awareness alone of developing cognitive difficulties, such as forgetfulness, can lead to changes in mood. Furthermore, attempts to mask memory difficulties from others and the worry that others will notice this forgetfulness may compound the initial psychological symptoms. Contributing to the development of depression and anxiety is often the erroneous belief that nothing can be done for memory problems, as well as the fear associated with a diagnosis of cognitive impairment.

Treatment

Psychological and behavioural symptoms may arise as cognitive impairment progress, these can include more marked changes in mood, abnormal beliefs and behaviours which can lead to management challenges and significant stress and burden to the carer.  Specialist assessment, investigation and management are required to optimise the patient and carers life.

In this situation the importance of treating coincidental symptoms of depression and anxiety cannot be overestimated as these symptoms, alone, will significantly exacerbate the patient’s illness and the stress of their carers. Indeed, anxiety and depression and can become the primary cause of individual’s cognitive difficulties and may resolve with treatment of the depressive episode thus optimizing individual’s cognitive function.  A complete approach to cognitive impairment is always essential when treating a patient with mood and cognitive symptoms and must include consideration of medical, psychological, social and pharmacological interventions as well as providing flexible and individual advice and support for management of the patient and carer.  

Re:Cognition provides a programme of complete cognitive care not only for our patients but also for their carer, when this is required.  The following services are to assist both patients and carers.

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