Identifying Depression vs. Dementia in Older Adults

By Tina Harralson
Vice President, Clinical Science

Depression is the most prevalent mental health issue among older Americans, yet it is under-recognized and often left untreated or under-treated. If not addressed, depression can exacerbate chronic illnesses, lead to higher medical utilization including increased use in medications and emergency room visits, and impair social functioning. The good news is that research shows depression in older adults is treatable in about 80% of cases.

Are depressive symptoms different in older adults?
While the symptoms of depression like sadness, loss of pleasure in daily life, fatigue, trouble concentrating, and changes in sleep and appetite are universal, the symptoms of depression in older adults may be misconstrued as symptoms of chronic illness or dementia, or even dismissed as a product of old age.

Depression or dementia?

Symptoms Depression Dementia
Memory Self-awareness of memory issues and problems concentrating Indifference to presenting issues and problems with short-term memory
Mental function Rapid mental decline Slow, gradual decline
Disorientation Not usually Yes
Writing, speaking and motor skills impairment Not usually Yes


Pseudodementia or dementia?
Pseudodementia is cognitive impairment that mimics dementia, however, the underlying cause is mental illness—most often depression. If mistaken for dementia, it may go untreated or mismanaged. Individuals with pseudodementia may have a history of affective (mood) disorders, complain of cognitive decline rather than appear indifferent to it, and may suffer from both short-term and long-term memory issues. Neuropsychological testing may be required to diagnosis pseudodementia.

It is important to know the differences in depression, pseudodementia and dementia.  Depression and pseudodementia can be treated with anti-depressants and therapy. Treatment can positively impact medical outcomes, as well as improve quality of life for the patient and their loved ones. A dementia diagnosis may not be reversible, but proper management can lead to better quality of life.