A Tough Diagnosis: Is It Alzheimer’s or Depression? By Ron Kauffman Before you can treat a problem, you have to know for certain what is the problem? Getting a reliable initial early diagnosis of Alzheimer’s disease, a form of dementia, can often be difficult, as both depression and Alzheimer’s disease can have similar symptoms, signs and behaviors. The challenge has to do, in part, with the problems of today’s health care crisis – a growing number of patients, too few specialized geriatric physicians and too little time to do a complete patient assessment. If a physician is not trained in geriatrics or is not familiar with the more subtle aspects of Alzheimer’s disease, it is possible that signs and symptoms of cognitive problems may be misdiagnosed. And too frequently that misdiagnosis is as depression. If a doctor assumes that the patient’s symptoms are depression related, he may miss the opportunity to render a proper diagnosis, and in doing so might prescribe an incorrect drug for a problem that doesn’t exist, while missing the true diagnosis of very early Alzheimer’s disease. If your loved one is showing memory loss or changing behavior, document the changes you notice and accompany your loved one to the doctor’s appointment. Be sure that you report and discuss all of the signs and symptoms that you have noticed with the physician. Don’t be afraid to demand the necessary time with the physician to provide enough information to assure the likelihood of an accurate diagnosis – it matters. Depression can be described as feelings of sadness. Everyone, at one time or another, experiences mood changes or feelings of being down or “blue.” These negative feelings can be caused by a myriad of factors ranging from loss of a favorite pet to divorce or loss of a job. Typically these examples trigger feelings that we collectively refer to as normal depression. There is another common form of “normal” depression referred to as grief induced depression. Among seniors it is often the result of some of the incredible changes they have to deal with including death of a spouse, loss of their friends due to relocation, illness or death, loss of their personal independence, or as a result of the awareness of their own issues of aging or physical decline. Alzheimer’s disease and depression are relatively common problems. They both impact the brain, both can impair memory and thought processes, and both can disrupt our daily activity. Dementia of the Alzheimer’s type has as its main symptom, memory loss but other functions can also affected. Cognitive decline can involve many signs: a diminished orientation to time and place; poor reasoning and logic, a lack of problem solving ability; loss of good judgment; diminished command of language and vocabulary, and a change in personality and emotions. These are outward indications of a problem and can present themselves individually or as a combination of several problems. But the results of the decline are typically seen as a deterioration of a person’s social and functional abilities. For people over the age of 80, Alzheimer’s disease is the most common form of dementia. With proper testing by a physician trained in geriatric medicine, AD can be diagnosed with about a 90% assurance of accuracy. There is no substitute for a complete physical exam and mental evaluation. If there is any question in your mind as to whether your loved one has depression or is showing what you may believe are signs of Alzheimer’s disease, a neurological evaluation including neuropsychological testing can help determine brain function related to problem solving, processing information and judgment. Using the right physician to help make the proper determination – a geriatric physician, geriatric neurologist or internist with geriatric medical training - is critically important when there is a possibility that the problem may be either depression or Alzheimer’s disease. In some patients, both depression and dementia may occur at the same time because some people with early Alzheimer's disease may react to the challenges of their dementia by showing signs and symptoms of depression. It cannot be overstated that getting an accurate diagnosis is critical because medical treatments of dementia and depression are very different. What is also important to note is that not everyone showing signs of impaired thinking or diminished memory has dementia. Depression is fairly common, and may be associated with difficulties in thinking and memory, and its presence does not exclude the possibility of dementia. However, depression with or without dementia is treatable. Ron Kauffman is a Certified Senior Advisor, and an expert on issues of aging and care giving. He is the author of Caring for a Loved One with Alzheimer’s Disease, which is available at www.seniorlifestyles.net. He can be reached at 561-626-4481 or by email at drron407@bellsouth.net.