Jeon Hong-jin, professor of psychiatry at Samsung Seoul Hospital, said symptoms of depression in the elderly are similar to those in the early stages of dementia… In early stages of depression, you lose a lot of weight, become more worried, and have difficulty concentrating on calculations… If you recall sad memories frequently, you may experience depression, not being able to find your destination or losing your sense of direction, and if you are not good at remembering recent events, you may experience early-stage dementia.
Jeon Hong-jin, a professor of psychiatry at Samsung Seoul Hospital, said that although geriatric depression and dementia appear similar on the surface, the symptoms and treatments are different. Professor Jeon especially emphasized that children should check their parents’ health status every two weeks so that depression in the elderly can be detected and treated early. Provided by Samsung Seoul Hospital
A couple in their 70s visited Jeon Hong-jin, a professor of psychiatry at Samsung Seoul Hospital. This is to find out whether her wife, Mr. A, has dementia. In the view of her husband, B, her wife, A, was in the early stages of dementia. Recently, Mr. A has been blinking frequently. She said she often forgets what she puts in the refrigerator, and the number of times she burns food has also increased. Her wife, Mr. A, was also worried that she might be in the early stages of dementia. Ms. A asked her husband to go to the hospital, and the couple received counseling together that day.
The results were unexpected. As a result of a brain magnetic resonance imaging (MRI) test and blood test, no signs of dementia were found in her wife A. Mr. A was diagnosed with geriatric depression. Instead, her husband, Mr. B, was diagnosed with dementia. Ms. B has never shown any symptoms that would suggest dementia, so how did she get this diagnosis?
Professor Jeon said, “There are surprisingly many cases like this couple where people thought they had dementia, but it turned out to be depression, and they were diagnosed with dementia even though there were no symptoms.” The problem is that it cannot be properly treated if the identity of the disease is not accurately known. Even if a patient with depression takes dementia medication, their symptoms will not improve. In the case of this couple, wife A’s symptoms improved significantly after taking antidepressant medication. Her husband, Mr. B, also discovered her dementia at an early stage, which enabled him to respond appropriately.
● Is it depression? Is it dementia?
Whether a person has depression or dementia can be determined through a brain MRI. If the hippocampus and temporal lobe areas of the brain are atrophied, it is in the early stages of dementia. If there are no such signs, the possibility of dementia is somewhat low. This means that there is a high probability of depression. In the case of this couple, wife A, who was suspected of having dementia, had a healthy brain. On the other hand, her husband, Mr. B, had atrophied hippocampus. For this reason, only Mr. B was diagnosed with dementia.
Is it possible to distinguish between the two diseases without going to the hospital? Professor Jeon said, “It is not easy to distinguish between geriatric depression and dementia as accurately as cutting tofu. However, it is possible to some extent if you carefully examine the symptoms,” he said.
First of all, depression is characterized by increased worry. In particular, I often worry about things like, ‘Maybe I have dementia.’ Professor Jeon explained, “Because they cannot distinguish between symptoms of depression and dementia, they self-diagnose themselves with dementia and worry about it.” Because of these concerns, many people go to the hospital themselves and get tested for dementia.
In the case of dementia, the opposite is true. They are completely unaware of the fact that they have dementia or cognitive impairment and do not even acknowledge it. For this reason, there are more cases where family members bring the patient to the hospital and are diagnosed with dementia. The same was true for this couple. Her depressed wife first asked her husband to take her to the hospital. Her husband, who had dementia, had no idea that he had dementia.
Second, there is a difference in sense of direction. When you have dementia, your path becomes confusing. It is not easy to get to your destination on your own. On the other hand, if you are depressed, your ability to find your way is not significantly reduced. If you manage to get to your destination, it’s closer to depression than dementia. Instead, depression is characterized by a sudden loss of concentration in calculation areas such as addition and subtraction.
Third, the pattern of memory decline is different. Dementia generally involves remembering things from a long time ago but not being able to remember recent things. There is also a tendency to repeat old memories. Depression, on the other hand, is more linked to emotions than time. Among the memories I had long forgotten, especially painful and sad memories come to mind. If this happens repeatedly, the depression gets worse.
● Young and middle-aged depression
When you suffer from depression, the feeling of depression naturally becomes stronger. But other symptoms also appear. Professor Jeon said, “The way depression manifests varies depending on age.” It’s good to know the difference.
‘Young depression’ in teens and 20s is characterized by severe mood swings. They are sensitive to other people’s tone of voice and facial expressions, and are prone to getting emotionally hurt. As the brain awakens at night, we live a life where day and night change. They eat mainly at night and have a strong tendency to binge eat. As this kind of life continues, they may not be able to adapt to school or work.
In the case of youthful depression, people are not aware of it in the beginning, but feel depressed after the intermediate stage. From this point on, you may be caught up in the thought that you have done something wrong and that someone is watching you. Although they do not harm others, they may become reclusive loners who confine themselves at home.
The pattern of ‘midlife depression’ after the age of 40 is somewhat different. People of all ages feel the most depressed and their motivation is greatly reduced. There are many times when I don’t want to do anything and just want to lie down. Unlike youthful depression, people have a poor appetite and eating is difficult. Symptoms are usually worse in the morning. This is because the secretion of the hormone that copes with stress (cortisol) decreases in the morning. Because of this, it is very difficult for office workers to go to work in the morning and for housewives to do housework in the morning.
Another characteristic of midlife depression is that it can lead to ‘health anxiety’. Since they cannot find the cause of their physical symptoms, they begin to worry that they may be seriously ill. In fact, depression can cause symptoms such as headaches, pain, general weakness, chest tightness, and slight breathing difficulties, regardless of age. However, at a young age, you feel these symptoms less often because you are physically healthy.
● Depression in elderly people, many physical symptoms
Elderly depression has a strong tendency to be ‘somatized’. Since many people suffer from chronic diseases, headaches, back pain, and body pain often occur as a result. Professor Jeon expressed this as “feeling the sadness in your body.”
Symptoms of memory decline are also more severe than in other age groups. Due to loss of appetite and inability to eat properly, secondary complications such as pneumonia may worsen. Another major characteristic of depression in the elderly is that insomnia gets worse along with depression.
The moodiness gets worse. There are many times when I suddenly lose my temper or become irritated. You may repeat the same words. These symptoms are similar to early stages of dementia and require careful observation or examination.
Hypochondria is also a typical symptom of depression in the elderly. When physical symptoms appear, I go to the hospital and take medication. There is also a strong tendency to subjectively feel more pain than the actual pain. I also take more painkillers. However, because the pain does not go away easily, I cannot move and I do not like exercising. Afterwards, I don’t want to go out, and I can’t actually go out.
If this kind of life is repeated, depression may lead to dementia. There are many cases where people do not have any symptoms of depression until middle age, but then develop depression after reaching old age. Professor Jeon said, “Depression appears in about 30% of dementia patients.”
● Parents’ status should be checked every two weeks.
According to Professor Jeon, 5 to 10 out of 100 elderly people in Korea suffer from depression. However, only about half of patients receive treatment. The remaining half is left unattended. Professor Jeon said, “As the number of elderly people living alone increases, a ‘blind spot’ appears,” adding, “Children play a very important role because elderly people do not recognize depression even when it occurs.” Therefore, children should check their parents’ status regularly. Professor Jeon said, “You should check your parents’ symptoms by phone or in person once every two weeks.”
Typically, four symptoms must be checked: low motivation, low memory, insomnia, and loss of appetite. If these symptoms appear consistently for two weeks or become worse, you should suspect geriatric depression. In general, in the case of dementia, symptoms of insomnia and loss of appetite are relatively rare. However, in the case of vascular dementia, it may be accompanied by loss of appetite.
You should also look at changes in weight. When seniors suffer from depression, they lose motivation and lose interest in everything. I don’t even try to go out of the house, and because I eat poorly, I have no choice but to lose weight. Professor Jeon said, “In the early stages of depression, people lose about 5 to 10 kg of weight in about three months. “We need to take a close look at this,” he said.
Once you are diagnosed with geriatric depression and begin treatment, your motivation will begin to recover approximately 2 to 4 weeks later. However, compared to younger depression, the treatment period is longer. Professor Jeon said, “Treatment is required for at least 6 months, usually 1 to 2 years.”
Reporter Kim Sang-hoon corekim@donga.com
2023-10-06 16:40:00
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