Depression in Dementia and Vice Versa

Transcription

1 Depressin in Dementia and Vice Versa Practical suggestins t imprve quality f life in peple with dementia and their carers. Dr Sfia Rbleda, Clinical Psychlgist

2 Overview Brief verview f nrmal ageing prcesses Brief verview f mst cmmn causes f dementia Depressin in ld age & in peple with dementia Tips n imprving quality f life when depressin is detected (fr bth carers and peple with dementia)

3 Nrmal Ageing Prcess Primary (natural) versus Secndary (due t disease) aging changes. It is imprtant t knw what ccurs naturally and what des nt. Ignrance f distinctin between the tw can have serius negative cnsequences - E.g. Depressin AND Dementia are nt a natural part f ageing. Whilst Dementia is a prgressive degenerative disease, depressin is very treatable.

4 Primary & Secndary Ageing PRIMARY AGEING CHANGES SECONDARY AGEING CHANGES Recall frm memry slwer. Depressin and anxiety Prcedural memry remains relatively intact. Reduced ability t adapt and selfregulate in the face f envirnmental changes (e.g., cld/ht weather). Smewhat reduced reactin time and speed f thinking. Smewhat slwed speed at which nerve cells cnduct infrmatin. Strke resulting in lss f language ability Pr health utcmes due t lifestyle chices (smking, lack f exercise) Parkinsn s disease results in drastic changes in speed f mvement and thught. Dementia may result in dramatic changes in persnality. Surce: Pachana (2016)

5 What is Dementia An umbrella term used t describe a grup f symptms that are caused by disrders affecting the brain. It is nt ne specific disease. Dementia affects thinking, behaviur and the ability t perfrm everyday tasks. Brain functin is affected enugh t interfere with the persn s nrmal scial r wrking life. Dementia can happen t anybdy, but it is mre cmmn after the age f 65 years. Peple in their 40s and 50s can als have dementia. Sme cmmn symptms may include: Prgressive and frequent memry lss Cnfusin Persnality change Apathy and withdrawal Lss f ability t perfrm everyday tasks.

6 What Causes Dementia There are ver 100 identified causes f dementia! The mst cmmn cause f dementia is Alzheimer s Disease (affects 50 70% f peple with dementia) The 2 nd mst cmmn type f dementia is Vascular Dementia (20% f peple with dementia) Other cmmn frms include: Frnt-Tempral Lbar Degeneratin, Lewy Bdy Dementia, Alchl-related dementia. Smetimes these diseases are cmbined

7 What Causes Dementia Each disease has its wn mechanism fr affecting the brain and leading t the previusly discussed symptms. In a nutshell (althugh understanding is still pr): In Alzheimer s disease, the cnnectins between the neurnes are disrupted, the neurnes die, and the brain shrinks in size. In Vascular dementia, strkes and/r lack f bld flw t vital areas f the brain in charge f cgnitive functins leads t irreparable damage. In Frnt-tempral lbar degeneratin, the frntal and/r tempral lbes atrphy r shrink. In Lewy-Bdy dementia, prteins inside the neurnes defrm/affect their cellular structures and lead t cell death.

8 Mst Cmmn Causes

9 Caregivers There are apprximately 200,000 Australians prviding unpaid care t a persn with dementia. 91% f peple with dementia in the cmmunity rely n an infrmal carer This is ften the spuse r child f the persn 22% rely slely n infrmal care & have n access t frmal care 81% f c-resident infrmal carers prvide mre than 40 hurs f care per week. Caregivers prvide wide-ranging supprt Activities f Daily Living (ADL s) Persnal care Making decisins abut treatment Caring fr persn with dementia increases risk f depressin % f carers experience depressin vs 17% in nn-carers. (Surce: Alzheimer s Australia, 2015: Numbered-Publicatin-42.pdf)

10 Depressin in Old Age The prevalence fr clinically-significant symptms f majr depressin r dysthymia was 10-15% fr cmmunity dwelling lder adults. (Haralambus et al., as cited in AIHW, 2015) Hwever, the prevalence f depressive symptms in residential care is 32%, with ther surces estimating that it may be ver 50% (AIHW, 2013).

11 What is Depressin Mre than tw weeks f either depressed md (sad, empty, hpeless) r lss f interest/pleasure alng with near daily: Weight lss r weight gain OR decrease/increase in appetite Insmnia r hypersmnia Psychmtr agitatin r retardatin Fatigue r lss f energy Feelings wrthless r inapprpriate guilt Diminished ability t think r cncentrate Recurrent thughts f death Fr lder peple: Physical cmplaints mre cmmn Difficulties sleeping Symptms described differently i.e., nerves

12 Symptm Similarities In later years, the mst prminent symptm reprted in depressin is a significant lss f memry (especially shrt-term). Medicatin side effects can mimic bth depressive disrders and mild dementia must duble check.

13 Depressin: Develpmental Risk & Prtective Factrs Surce: Fiske, Lebach-Wetherell, & Gatz, 2009

14 Depressin: Cgnitive-Behaviural Mdel Surce: Fiske et al., 2009

15 Impact f Dementia n Md Dementia evkes lss: What is lst fr the persn with dementia? What is lst fr their caregivers? Pair up and think f a few examples.

16 Depressin in Dementia Dementia increases the risk f depressin. Depressin in dementia presents as: Unhappiness Withdrawal Inactivity Fatigue Tearfulness Lss f interest Sleep r appetite disturbance Lw self-esteem Negativity r hpelessness Suicidal ideatin Depressin is a cmmn BPSD (Behaviural & Psychlgical Symptm f Dementia), with a prevalence f arund 30%. Behaviur differs frm usual.

17 Depressin as a BPSD BPSD: A desperate attempt t cmmunicate an underlying unmet need? T feel safe and secure T feel lve and cnnectin T feel like a sense f belnging T feel a sense f purpse and usefulness T feel engaged and ccupied A persn with dementia may lse the cgnitive side f things, but their emtinal side will always remain and even expand. Like a lst sense, i.e., visin & hearing.

18 Scial Islatin: PWD N ne wants t spend time with me nw that I have a diagnsis. It is like they think I n lnger cunt and I am nt a persn anymre. It makes me s sad and I end up sitting at hme wishing life was different. Smetimes my scial death makes me mre sad than the changes t my brain and the lss f my memries. It makes me s angry. I just want t be cunted as a persn again. I have lst almst all f my friends and the few I have I see nce a year r even nce every 2 years. I have ne friend wh I see abut every 4 mnths. I ve lst all my friends and I d lve t meet mre peple my age. (Surce: Alzheimer s Australia 2015)

19 Scial Islatin: Caregivers

20 Assessing Depressin In lder adults withut dementia: Geriatric Depressin Scale (GDS) Hamiltn Depressin Rating Scale (HAM-D) In lder adults with dementia: Crnell Scale fr Depressin in Dementia (CSDD) GDS Depressin/dysphria subscale f the Neurpsychiatric Inventry (NPI) Dysphria subscale f the NPI-Clinician versin (NPI-C) Exclude delirium, infectin, cnstipatin, and/r chrnic pain. Differentiate frm apathy: lack f interest r behaviural inactin withut emtinal distress.

21 Treatment fr Depressin: Late Life As with yunger adults, CBT is supprted fr lder adults with depressin (Lebwitz et al., 1997). Meta-analyses fund medium effect sizes amng RCTs f CBT fr late life depressin (Laiidlaw, Kishita, & Chellingswrth, 2016). Hwever, lw rates f seeking mental health services prevent diagnsis and treatment. Depressin in the cntext f dementia is amenable t treatment and shuld be treated. (Fiske et al., 2009)

22 Treatment fr Depressin: Late Life a: Efficacy has been demnstrated fr cntinuatin treatment f lder adult patients wh respnded t acute treatment with pharmactherapy r pharmactherapy + IPT. b: Efficacy has been demnstrated by nly ne study r nly ne set f investigatrs. (Surce: Fiske et al., 2009)

23 Practical Interventins: PWD Psychscial & Envirnmental: Prvide meaningful rles Reminiscence/ life-stry wrk hat-is-reminiscence-therapy/ Md-enhancing music/chirs VgeNL6qbFs Animal-Assisted Therapy Multi-sensry stimulatin Exercise: Walking, dancing, tai chi Grup physical activity sessin Swimming r hydrtherapy Review medicatins Antidepressants and chlinesterase inhibitrs fr Alzheimer s Disease.

24 Practical Interventins: Carers Cgnitive Behaviur Therapy By trained prfessinals (psychlgists, GPs, psychiatrists, RN s) Medicare Better Access sessins f psychlgical treatment. Mdifying beliefs, self-critical thinking New strategies t cpe with caring demands Behaviural Activatin Imprve engagement in pleasurable activities Multi-cmpnent interventins Infrmatin, educatin, skills-training, psychscial therapies Alzheimer s Australia: DBMAS: BeyndBlue: Scial supprt grups Respite Care Mixed Evidence

25 Warning: Suicide The highest age-specific suicide death rates are bserved in males 80 years and ver (ABS, 2014) Up t 75% f lder adults wh cmmit suicide visited a physician within a mnth befre their suicide (Cnwell, 2001). Patients wh suicide are the same wh might have expected a high rate f recvery. Underscres the seriusness f underdiagnsis and under-treatment f depressive disrders in later life (Cnwell, 2001).

26 FEATURE Warning: Suicide Rate (per 100,000 ppulatin) Age grup (years) Surce: Figure 6.4.3: Rate f suicide deaths per 100,000 ppulatin, by age grup and sex, 2012

27 Cnclusins Depressin AND Dementia are nt a natural part f ageing. Whilst Dementia is a prgressive degenerative disease, depressin is very treatable. Bth the PWD and caregiver are impacted by the changes invlved in a diagnsis f dementia, including reduced engagement in scial and ther meaningful activities, which places them at an increased risk f develping depressin. Depressin is treatable fr bth PWD and their carers. Lack f treatment can have serius cnsequences, including increased risk f suicide.

28 Questins?