Depression, Dementia and Aging


 Depression is Not a Normal Part of Aging




Depression can occur in persons already diagnosed with Alzheimer’s disease or other types of dementia. Dementia and depression can cause increased intellectual decline. Depression is a treatable illness. If the depression responds to treatment, the person with dementia will have a better quality of life and will be better able to cope with losses caused by dementia. The diagnosis of depression needs to be made by a medical doctor, advanced practice nurse, or a mental health professional such as a psychiatrist or clinical psychologist.


Using mnemonic devices was the way I got through medical school. The mnemonic which I use to remember the symptoms of depression is SIG E CAP.  Just think of someone by that name. Here’s how it works.



S     sleep changes, sad, suicidal, self-esteem changes, restless

I       loss of interest, ignoring responsibilities, irritable

G      increased guilt (real or imagined)


E      decreased energy, feeling empty



C     crying, concentration changes

A     appetite & appearance changes, aches, anxiety, agitation

P     decreased pleasure, hopeless, helpless


Interestingly, many of the symptoms of depression and dementia are overlapping. Always consider depressive symptoms first. Then dementia. In private practice, I treated a middle-aged female who periodically became depressed. But she would never feel depressed. At the peak of her depression, she appeared to be severely demented and confused. With antidepressant treatment, her dementia-like symptoms totally disappeared. It was almost magical to see the pseudo-dementia disappear. If the dementia-like symptoms don’t disappear with antidepressant treatment, then dementia is more likely the diagnosis. However, an individual can be demented and depressed at the same time. Their dementia can actually improve if one looks for depression and adequately treats it. Many physicians and caregivers are quick to attribute dementia as the culprit.


A new fact I learned today. There is a free service called 411 Service.  Simply dial 800-373-3411 (800-FREE-411). You’ll get free directory assistance from your cell or land line. The catch is, however, that you do have to listen to a short (only 20 seconds) ad before you can ask your question, but really, that’s a small price to pay for a free service.  I haven’t tried it het, but will be curious as to what people think of it. 


And a new vocabulary word today.   Codicil [kod-uh-suh] 


  1. a supplement to a will, containing an addition, explanation, modification, etc., of something in the will.
  2. any supplement; appendix

Which type of specialist (neurologist, psychiatrist, gerontologist or family doctor should a dementia patient see for diagnosis and follow-up)?

3 Tips for Today


  1. Buy whatever kids are selling on card tables in their front yards.
  2. Treat everyone you meet as you want to be treated.
  3. Admit your mistakes.


 Question:  “Which type of specialist (neurologist, psychiatrist, gerontologist or family doctor should a dementia patient see for diagnosis and follow-up)?


Answer:  My suggestion would be (if possible) to do the following:

a.      Have a neurologist specializing in dementia do the initial evaluation, workup and diagnosis.

b.      Have the same neurologist do all the follow-up visits. If this is not possible then the second best option would be to have a good gerontologist for follow-up.

c.      Have an open and understanding psychiatrist in the wing in case the patient develops pyschiatric symptoms such as depression, anxiety, delusions, etc. However, the primary provider may also be willing to do this. I am very fortunate. My particular neurologist is a world reknowned Dr. who is a dementia expert and does ongoing research in the field. He prefers to have a psychiatrist handle any emerging psychiatric symptoms/problems.

d.   An internist or family doctor can best be utilized to follow through with any and all physical/medical problems.


This seems like the patient would need a lot of physicians for his/her care. But I think it provides the best overall care and treatment.


Let’s continue with my story. Yesterday I finished my post discussing my diagnosis of Bell’s Palsy in June 2007. So after 6 weeks of steroids and an antiviral agent, I thought all was well and I returned to work at the hospital. I continued to have intermittent tremors and some trouble concentrating. But I covered the attention span and concentration issues fairly well (so I thought). Others around me commented on how hard I was working and that I was doing a good job. The Doc later told me I had enough cognitive reserve to be able to cover and to compensate so that I appeared and acted normally.


In mid-September 2007, I again drove to work on a Monday morning as usual. I remember moderating a morning meeting at 8:15. At the end of the meeting the last thing I remember was that I asked a question to the participants. “But why aren’t we going over these papers?” Little did I know we already had done that. They rushed me to the local emergency room. For the next few months I remember very little. I have vague dream-like memories of being in several hospitals, getting tests and seeing many Drs. Finally in October 2007, I was diagnosed with Lewy Body Dementia at the University of California San Francisco (UCSF) at the Aging and Memory Center.


Tomorrow……… reactions and how this new diagnosis altered my life forever.


Dr. David

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