Dementia, Depression, and Cognitive Decline in Older Adults

From wrinkles to graying hair, no part of the body escapes the aging process.

From wrinkles to graying hair, no part of the body escapes the aging process. While the mind is no exception, there is a critical difference between the normal cognitive effects of aging and more serious cognitive decline, including depression, delirium, and dementia.

Geriatric depression

According to the CDC, estimates of depression in older adults requiring home healthcare or hospitalization range from 11.5% to 13.5%. These are rough estimates only, however, as depression in this demographic is often misdiagnosed as a normal part of aging.

Physical disabilities, chronic pain, lifestyle constraints, and loss of former mobility may all play significant roles in the onset of depression in older adults.

However, not all patients share the same symptoms. Signs of depression may range from difficulty concentrating and slowed thinking to weight fluctuation, feelings of worthlessness and guilt, or even suicidal ideation. In older adults who are recovering from illness or injury, even one of these symptoms may lead to difficulties in rehabilitation.

Screening for depression

While more in-depth tools can (and should) be used to diagnose depression, there is a simple assessment available to all healthcare and rehabilitation professionals that may help gauge the severity of a client's depression. The assessment?

Ask them.

The U.S. Preventive Services Task Force has found an effective screening tool for depression in the following two questions:

1. Over the past two weeks, have you ever felt down, depressed, or hopeless?
2. Have you felt little interest or pleasure in doing things?

The client's answers to these questions cannot be used to diagnose, but they do provide a useful benchmark which the healthcare professional can then use to refer their client to the appropriate mental health specialist or medical practitioner.

Related: Aging Process: What is Happening to the Body and What Does it Mean?

Characterizing cognitive decline

Though some symptoms may overlap, depression and dementia are not the same. Depression is characterized by a disturbance in mood; dementia is characterized by a global decline in cognitive capacity over a period of months or years, resulting in decreased executive function and irreversible memory loss.

The most notable form of dementia, Alzheimer's Dementia, accounts for 60-80% of cases, with the CDC reporting as many as 5 million Americans living with Alzheimer's.

Slowing the progress

Despite the finality in the terms "irreversible memory loss" and "cognitive decline," there are ways in which healthcare and rehabilitation professionals can help slow the progression of dementia, particularly Alzheimer's.

In the fight against cognitive decline, exercise is key. Physical activity has been tied to better cognitive function and slower decline, even in those who have already been diagnosed with dementia. Even more encouraging, exercise can also help reduce symptoms of depression, which may occur in tandem with dementia.

Related: Understanding Dementia in the Geriatric Population

Staying active, staying sharp

For rehabilitation professionals, maintaining strength, balance, and mobility in clients is a key outcome among older adults experiencing dementia, depression, or dementia and depression.

Some simple tips to remember:

• Focus on task-specific interventions
• Use simple, one-step instructions
• Make activities enjoyable
• Avoid criticism
• Be consistent with activities and caregivers

This article is based on the 3-hour on-demand video course Depression, Cognitive Changes, and Dementia in Older Adults, authored by Suzanne Greenwalt, PT, DPT, CCS, GCS. View the course.