As people age, it’s not uncommon to experience various changes in memory, mood, and mental clarity. Sometimes these changes are subtle and fairly easy to reconcile. But other times, they can feel distressing and disorienting. As various changes progress, you may not understand what you need or how to take the best care of yourself.
Furthermore, many mental health issues and cognitive impairment can present with overlapping symptoms. This overlap may complicate diagnosis and treatment, potentially delaying relief and support. Therefore, understanding these differences (or their intersection) is an important part of the aging process. Having this knowledge can help you feel more empowered and grounded as you move through this phase of life.
Understanding Cognitive Changes in Aging
Changes in cognitive function are a typical part of the aging process, and not all changes inherently indicate a problem. These changes may vary in type and presentation, but they can generally include:
- Slower information processing: Routine tasks may take a bit longer than they used to. It can feel harder to recall certain names or events, even if you sense the information is still there.
- Occasional forgetfulness: It’s normal to occasionally misplace your keys or overlook an important appointment. Occasional forgetfulness may be a result of normal shifts in attention. If these moments don’t interfere with daily life (and can be improved with reminders or notes), they are generally not a cause for medical concern.
- Mild difficulty multitasking: Older adults may find it more challenging to juggle multiple tasks at once. For instance, it can be logistically and emotionally harder to cook dinner while also talking on the phone. This change doesn’t necessarily indicate cognitive dysfunction. Instead, it may simply speak to a normal shift in how the brain allocates information.
Cognitive decline, on the other hand, goes beyond these expected changes. Persistent cognitive impairment refers to a progressive deterioration in thinking and reasoning. This impairment affects one’s quality of life.
Some key risk factors of neurological diseases include:
- Frequent memory loss that disrupts daily life: This includes forgetting recently learned information, repeating the same questions or stories in a short time, or relying heavily on memory aids for support.
- Language difficulties: This can include difficulties finding the right word or keeping up with a conversation without needing to pause or deliberately focus on what was just said.
- Disorientation or confusion about time and place: This includes feeling lost in familiar environments or feeling confused about the time or date. Over time, this affects mental functioning, as it becomes harder to stay connected to the daily routine.
- Poor judgment and decision-making: Key warning signs of poor decision-making may include falling for known or obvious scams or suddenly making impulsive choices. There may also be changes in physical appearance, particularly with neglect around personal hygiene.
Understanding Major Depressive Disorder in Older Adults
Despite popular misconceptions, depression is not an inherent part of aging. Depression is a significant concern and should never be dismissed as a “part of the process.” That said, depressive symptoms can look different in older adults than it does in younger people. Late-life depression symptoms may include:
Irritability or apathy: Older adults with depression may not always outwardly present as sad. Instead, they may appear more irritable or emotionally disconnected. Apathy, which refers to the lack of interest in typical hobbies or relationships, may indicate a deeper form of internal suffering.
Fatigue: Persistent tiredness is a key feature of depression, and this fatigue can exacerbate other coexisting sleep problems. This fatigue can affect motivation, making everyday tasks feel daunting.
Social withdrawal: Some people with depression isolate or withdraw from others because they feel so poorly about themselves. Socializing can feel draining, and it may be hard to find joy or connection within relationships. However, this withdrawal can also magnify depression symptoms, reinforcing a painful cycle.
Feelings of worthlessness or intense guilt: Some older adults may worry about being a burden to others or ruminate about past regrets. While these feelings are common in major depression, they may be misunderstood by others.
Physical complaints: Depression symptoms sometimes show up somatically with headaches, stomach issues, muscle pain, and digestive concerns. These symptoms may persist despite medical treatment, especially if the root cause is more psychological. With that, research shows there also tends to be a strong relationship between depression and chronic pain, and it can be hard to discern which symptoms contribute to which condition.
When Depression and Cognitive Impairment Coexist
Research shows that older adults with dementia are at a higher risk of developing depression, especially in the early stages when they have insight into their declining abilities. Subsequently, depression can worsen cognitive symptoms.
Furthermore, chronic depression may increase the risk of developing dementia over time. This may be because untreated depression can contribute to lasting brain changes and inflammation that raise the risk of cognitive deficits.
Don’t Dismiss the Emotional Pain
It’s important to avoid dismissing the gravity of depression in the face of cognitive decline. While grief, fear, and anger are common reactions to any adverse situation, late-onset depression is not inevitable, and it is treatable. If you or a loved one is experiencing depressive symptoms, seeking care can be invaluable. Remember that emotional well-being matters just as much as cognitive function, and the right treatment can reduce the intensity of emotional distress.
Seek a Comprehensive Evaluation
Since depression and mild cognitive impairment can overlap, it’s important to seek an evaluation from a provider well-versed in working with older adults. A comprehensive assessment is multifaceted and may include medical history, mood assessments, cognitive tests, and brain imaging. This evaluation can help clarify whether symptoms are due primarily to depression, early dementia, or both. Accurate diagnosis increases the likelihood of receiving effective treatment.
Address the Depression (Even When Cognitive Impairment is Present)
Some people assume that treating depression among older adults is ineffective if cognitive decline is present. However, this is not true and often perpetuates ageist stigmas and ignorance around mental health. Addressing depression can result in meaningful shifts in behavior, mood, sleep, energy, and social engagement. Furthermore, reducing depressive symptoms sometimes makes cognitive rehabilitation efforts more effective.
Stay Connected to Meaningful Activities
Mood disorders and cognitive changes often result in themes of withdrawal or apathy. This makes sense, especially if certain activities no longer feel as rewarding or accessible. However, pulling away from what you once loved may also feel like a form of self-abandonment. It may be helpful to focus on taking small steps. You may need to modify certain interests, but actively trying to rekindle a sense of connection to the world can make a big difference in cultivating a sense of inner meaning.
Focus on Basic Self-Care
Sometimes, good enough really is good enough. When someone is struggling with their mental health, it’s important to have compassionate and realistic expectations about change. It’s easy to get wrapped up in a concept about what “ideal” coping should look like, but staying self-compassionate is often more important than aiming for perfectionism. Basic self-care invites you to takes things one step at a time. Focus on how you can stack certain habits together, like getting out of bed at the same time each day or taking a shower every morning. This gently builds a self-compassionate momentum that can feel more manageable over time.
Don’t Overlook Caregiving Stress
If you’re looking after a loved one navigating depressive symptoms and cognitive decline, caregiving can feel emotionally taxing. You may find yourself oscillating between intense feelings of anger, guilt, uncertainty, fear, or overwhelm. This emotional toll may spill into the relationship and make caregiving harder over time. Remember that you deserve support. Loneliness can be a real problem for caregivers, but attending caregiver support groups or seeking your own therapy can offer you a much-needed sense of validation.
Therapy for Depression and Cognitive Impairment in Austin, TX
If you or a loved one is navigating depression, cognitive changes, or both, you may feel emotionally overwhelmed. You’re not alone, and therapy can offer a compassionate space to process your feelings and needs. Therapy can also help you reconnect with your inner strength and reestablish a sense of meaning as you navigate this complex situation.
For caregivers, therapy provides a supportive environment to be seen and supported. Regardless of the current circumstances, your needs also matter. It can be crucial to sometimes name the exhaustion and love that often coexist within the caregiving role.
Whether you’re just beginning to notice changes or have been struggling for some time, I would be honored to support you during this time. I offer trauma-focused, compassionate care for older adults experiencing grief, depression, anxiety, and medical concerns.
Please contact me today to schedule an initial consultation.