Changes in mood and personality

Overview

We all feel our moods change from time to time. People living with dementia, however, can experience an absence of interest in or concern about emotional, social, spiritual, philosophical or physical life.

They may become depressed or withdrawn and lose interest in activities they used to enjoy. Sometimes, they may lose the ability to manage their emotions.

It is important to remember that even in the later stages of dementia, the person is still able to experience a variety of emotions such as joy, love, fear and sadness. Provide support to ensure they are able to enjoy each day as fully as possible.

What is depression?

Depression is a condition in which people feel sad, hopeless or irritable most of the time. People with depression also experience anxiety and feelings of isolation. The number of people with depression rises over the age of 65.

Up to 40 to 50 per cent of people with dementia experience depression at some point. Depression can make the symptoms of dementias worse. For example, depression can cause increased forgetfulness, confusion, and anxiety.

It is important to diagnose depression in people with dementia because depression may respond to treatment.

The symptoms of depression can be similar to symptoms of dementia. Therefore, it is often difficult to identify depression in people with dementia. There are some common signs of depression to be aware of:

• Loss of interest in previously enjoyed activities
• Lack of energy
• Problems sleeping
• Increased confusion
• Loss of appetite and weight

If you are concerned about depression, speak to the person's doctor.

What is apathy?

Apathy is a word that describes loss of interest, motivation and/or persistence. It means not caring and not being social with others. The person with dementia may develop this apathy (become apathetic) and feel unmotivated to do anything. Apathy can be a symptom of depression but it can also occur separately from depression.

It can be distressing for a caregiver or family member to see the person with dementia withdrawing from social gatherings and other activities. Understanding the causes of apathy and how to respond to it can be helpful.

Possible causes

Possible causes of depression

• In the early stages of dementia, the person may experience depression after hearing their diagnosis.
• Social isolation may also cause depression in some people with dementia.
• Fatigue is associated with depressive symptoms.
• Depression can be a side effect of certain medications. Ask the person's doctor to review the drugs they are currently taking.

Possible causes of apathy

• Apathy happens because the frontal lobe, an area of the brain responsible for planning, judgment, and insight, becomes damaged.
• Apathy may also happen to a person with dementia who does not understand what is happening.

If you are worried about any of these symptoms, talk to your family doctor.

Tips and strategies

Responding to depression

• Encourage pleasant activities that the person can still enjoy, such as short walks or outings.
• Set realistic expectations. If you expect too much from a person, they may feel frustrated and discouraged.
• Establish a consistent daily routine. This will help reassure the person as well as reduce confusion.
• Counselling, cognitive behavioural therapy, and group therapy may be helpful.
• Antidepressant medications may help. Talk to the person's doctor about the options.

Responding to apathy

• Try to engage the person with dementia in activities that they enjoy.
• Make sure that they can participate at all levels and that they are not overwhelmed.
• Try introducing a small amount of the activity at a time.
• Choose flexible activities that can be changed to suit the person’s needs.
• Emphasize more on the process of doing things and not the results.
• Avoid activities where the person may not be able to complete the task.
• Make the person feel valued and productive.
• Be ready to help the person start an activity.
• Make the person with dementia feel included in groups.
• Have the person participate in activities that do not require active participation, such as listening to music.
• Some people with dementia may respond to a type of medication called a cholinesterase inhibitor. You may want to discuss this with a doctor.