DEAR DOCTORS: After our dad died, we realised our mum has some memory problems. Now she's having angry outbursts, which is new. It may be depression, but my brothers and I worry about dementia. We suspect it's been happening for a while and she was hiding it. How do we know which it is?
DEAR READER: It's common for someone grieving the loss of a loved one, particularly a long-term spouse, to become depressed. It's also not unusual for an older adult to resist letting the people around them know they are experiencing symptoms of cognitive decline. And when it comes to the symptoms of depression and cognitive decline, there can be a degree of overlap. This includes sadness, irritability, anger, lethargy, mood swings, being fearful and even experiencing memory lapses. All of this means that it can take time, patience and probably a bit of professional help for you to understand what's causing the changes that you and your family have noticed with your mum.
Unfortunately, there is no single test for dementia at this time. Instead, diagnosis requires a multifaceted approach. This often begins with cognitive tests that are designed to assess a person's ability to think, judge and reason. Another piece of the puzzle can come from neurological tests, which evaluate how well someone's nervous system is delivering sensory information to the brain. This includes balance, reflexes, co-ordination, strength and muscle tone, and also the senses of smell, sight and hearing. Both cognitive and neurological tests will also provide an important baseline against which any future changes can be measured.
Lab tests, such as blood count and urinalysis, can help uncover physiological causes for changes to behaviour and cognition. These can include vitamin deficiency, hormonal imbalance or blood glucose issues. If preliminary tests indicate the need, a lumbar puncture, also known as a spinal tap, may be recommended. The collected cerebrospinal fluid is then analysed for indicators of any inflammatory conditions, infection or the presence of specific proteins that are associated with Alzheimer's disease.
While brain scans don't definitively diagnose dementia, they can offer clues. They can also help to rule things out. This includes bleeding, stroke or a tumour, any of which can affect someone's mental and emotional state. It's also important to check medications, as side effects or interactions can also affect cognition and mood.
Although dementia may seem like the larger emergency, depression also presents a danger. It can lead to isolation, poor sleep, poor diet and a decrease in the ability to care for oneself and overall quality of life.
Depression also affects the body physically. Studies have shown that older adults who suffer from depression can be at increased risk of heart disease and stroke. It would be a good idea for your mother to see her healthcare provider, and for someone in the family to join the appointment. Whether the outcome turns out to be depression or cognitive issues, you will have taken the first step to addressing them. This will put your mother on a more secure footing for the future, and give you and your family a better understanding of how to help her. Universal Features Syndicate
Dr Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health.