Depression in Individuals with Alzheimer’s

Rationale

According to Canet (2018), Alzheimer’s disease (AD) is a neurodegenerative disease that is characterized by a progressive impairment of cognitive functions associated with synaptic and neuronal loss. With age comes new hardships within the family structure, career, and health which makes it even worse for someone with a cognitive impairment. AD occurs when the nerve cells in the brain die as well as a loss in tissue in which the brain shrinks drastically (Alzheimer’s Association, n.d). According to Teri & Wagner (1992), demented patients can appear clinically depressed in which they may suffer from dysphoric mood, lose interest in previously enjoyable activities, and experience trouble sleeping and eating. Through my research I am looking to find answers to my probing question: In what ways can the mental health profession assist with depression in individuals with Alzheimer’s?

How can mental health professionals ease their minds as negative thoughts arise? According to García (2017), depression is common among patients with Alzheimer’s disease and has been linked with poor physical health, increased caregiver burden, higher use of psychoactive drug, more rapid cognitive and functional decline, and higher rates of institutionalization and mortality. The most common treatment for depression in Alzheimer’s involves a combination of medicine, counseling, and gradual reconnection to activities and people that bring happiness (Alzheimer’s Association. n.d.). García (2017) suggest that Cognitive Behavior Therapy-Depression in Alzheimer’s disease (CBT-DAD) may be an effective intervention for reducing depression in patients with mild AD with the inclusion of their care giver. Livingston et al. (2005) recommended, behavioral management techniques focused on the caregiver, including psychoeducation and interaction training and behavioral management techniques focused on the person with dementia, including techniques focusing on pleasant activities and problem solving, multisensory stimulation, active music therapy and cognitive stimulation (as cited in Forstmeier et al. ,2015 ). Heyn’s (2002) research focused on how physical activity helped with the cognitive function and mental health of older adults diagnosed with Alzheimer’s disease.

Literature Review

According to the research of de la Rubia Orti et al. (2018), a short protocol of music therapy can be an alternative medicine to improve emotional variables in Alzheimer patients. The study was completed in Valencia, Spain and I believe that the results might vary a little if done within the United States of America due to the different cultures and values. Participants within this study gave a sample of saliva as well as completed the Hospital Anxiety and Depression Scale [HADS] test in which both were done before and after the music therapy session. Majority of the article focused on the physiological components of Alzheimer’s alongside depression and anxiety. The HADS test, despite being a self-report scale that is very simple, with few questions, and only for patients who are still aware of their emotions, is considered appropriate for this study (de la Rubia Orti et al., 2018). The study resulted in having a positive impact on Alzheimer’s disease patients emotional and physiologic consequences since cortisol levels decrease.

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Teri and Wagner compares and contrasts the symptoms of depression and Alzheimer’s disease. There was also an exploration of the Diagnostic and Statistical Manual of Mental Disorders (DSM) 3rd edition which was current at the time of the articles production in 1992. Both neuropathological and clinical research has attempted to determine whether the existence of one disorder predisposes an individual to the development of the other (Teri & Wagner, 1992). The discussion of the issues with assessing depression in Alzheimer’s disease patients covered the topics of the availability of psychometric and normative depression measures information, the memory loss characteristics causing a challenge when assessing, and the ideas of the caregiver on the patient’s depressive symptoms may be skewed.

Garcia (2017) only studied one patient that is a 75 year old married man with his wife being his primary caregiver. More participants could be used to recreate the study to discover more valid or add more to back the truth within the findings. The study used a Global Deterioration Scale and the Cornell Scale for Depression to assess the participant. The components of this approach, cognitive–behavioural therapy for depression in Alzheimer’s disease (CBT-DAD), include pleasant events therapy, problem-solving therapy, exercise, and education, as well as cognitive restructuring for the caregiver (Garcia, 2017). With the incorporation of multiple ways to reach the patient the offerings throughout this study offers the patient and caregiver various ways to bring out a more positive attitude.

Writer (2008) stated that depression is very common in Alzheimer’s disease patients throughout the stages of the disease. According to Writer (2008), researchers have discovered that treating depression in patients with Alzheimer’s disease can have a significant impact on the well-being of these patients. Moods can improve within 2-3 weeks. The discussion was heavily centered on antidepressants and their side effects. Doctor‘s typically suggest staying on the medication for about 6 months to ensure the effectiveness of the medication. The side effects of the different medication discussed can cause different issues in younger people than with Alzheimer’s disease patients and a difference in men and women. 

According to Thompson (2008), people with Alzheimer’s disease often suffer from depression, anxiety, and other behavioral symptoms as this debilitating disorder takes its toll on their brain. Dr. Powers stated, “The disease damages brain cells that sustain mood, so [feelings of depression or anxiety] are organic to the situation”(Thompson, 2008). Experts believe that one in five individuals with Alzheimer’s disease will suffer from clinical depression. Due to the natural damaging of those particular brain cells there is no real way to optimize prevention. It is difficult to diagnose depression in Alzheimer’s disease patients. According to Thompson (2008), dementia itself can cause symptoms that are commonly associated with depression, such as apathy, lack of interest in people or activities, loss of sleep, and isolation. The use of psychotherapy is not helpful for the Alzheimer’s disease patients due to their significant cognitive loss causing them the struggle with processing what is going on within the session and being able to transfer it into real life situations.

Conclusion

Understanding what AD patients are battling and exploring different ways to better assist them in just one of their mental health area of needs such as depression is now becoming a need. De la Rubia Orti et al’s innovative focus on utilizing music therapy to help with depression in Alzheimer’s disease patients and assessing their saliva before and after was creative. Thompson’s information about the disease and the understanding that psychotherapy may not be effective for these patients due to their cognitive loss and trouble processing what the therapist is doing with them provided room for a new element to reach the patients. I believe that being able to assist this population and better serve them within the community of mental health can help decrease the inclination of Ad patients dealing with depression.

References

• Alzheimer’s Association. (n.d.). Brain Tour Part 2. Retrieved April 27, 2019, from https://www.alz.org/alzheimers-dementia/what-is-alzheimers/brain_tour_part_2
• Alzheimer’s Association. (n.d.). Depression. Retrieved April 28, 2019, from https://www.alz.org/help-support/caregiving/stages-behaviors/depression
• Canet, Geoffrey (2018). “Central Role of Glucocorticoid Receptors in Alzheimer’s Disease and Depression”. Frontiers in neuroscience (1662-4548), 12, p. 739.
• Forstmeier, S., Maercker, A., Savaskan, E., & Roth, T. (2015). Cognitive behavioural treatment for mild Alzheimer’s patients and their caregivers (CBTAC): study protocol for a randomized controlled trial. Trials, 16, 526. doi:10.1186/s13063-015-1043-0
• de la Rubia Ortí, J. E., García-Pardo, M. P., Iranzo, C. C., Madrigal, J. J. C., Castillo, S. S., Rochina, M. J., & Gascó, V. J. P. (2018). Does Music Therapy Improve Anxiety and Depression in Alzheimer’s Patients? Journal of Alternative & Complementary Medicine, 24(1), 33–36. https://doi-org.library.capella.edu/10.1089/acm.2016.0346
• García, A. J. M. (2017). Cognitive-behavioural treatment for depression in Alzheimer’s disease patients: a case study. Psychogeriatrics, 17(3), 200–201. https://doi-org.library.capella.edu/10.1111/psyg.12203
• Heyn, P. (2002). A meta-analysis of the effects of exercise training and physical activity on health-related physical fitness, cognitive and physical functioning, and behavior of individuals with alzheimer’s disease and related cognitive disorders (Order No. 3069447). Available from ProQuest Central. (305438880). Retrieved from http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F305438880%3Faccount
• Teri, L., & Wagner, A. (1992). Alzheimer’s Disease and Depression. Journal of Consulting and Clinical Psychology, 60(3), 379–91. Retrieved from http://search.ebscohost.com.library.capella.edu/login.aspx?direct=true&db=eric&AN=EJ451108&site=ehost-live&scope=site
• Thompson, D., Jr. (2008, December 26). Helping Someone With Alzheimer’s Cope With Depression and Anxiety. Retrieved from https://www.everydayhealth.com/alzheimers/alzheimers-depression-and-anxiety.aspx
• Medically Reviewed by Cynthia Haines, MD
• Writer, H. (2008, December 1). Alzheimer’s: Medications for Treating Depression, HealthyPlace. Retrieved on 2019, May 11 from https://www.healthyplace.com/alzheimers/medications/alzheimers-medications-for-treating-depression