Don’t assume age is to blame for changes in memory, attention, and decision making.
Depression has a way of sucking the joy and meaning from life. Chronic feelings of hopelessness, apathy, or despair are part of the condition. It may also bring physical symptoms, such as weight loss, sleep disturbance, fatigue, and aches and pains. But depression can be sneaky, causing subtle changes in thinking skills that you may not attribute to the condition. “Very often, one of the first signs of depression in people ages 70 or older is a change in thinking,” says Dr. Helen Farrell, a psychiatrist with Harvard-affiliated Beth Israel Deaconess Medical Center.
WHAT’S THE CONNECTION?
Depression may involve the interruption or reduction of chemical messengers in the brain called neurotransmitters, such as serotonin, dopamine, and norepinephrine. These chemical changes may be the cause of your depression (if the brain systems that regulate them go awry), or they may result from other depression triggers, such as the following:
An underlying medical condition. Heart disease, stroke, and an underactive thyroid are among many conditions linked to depression. “We don’t know which comes first, depression or the associated condition. They can drive each other,” says Dr. Farrell.
Medication side effects. Common culprits include beta blockers, such as metoprolol (Lopressor), and benzodiazepines, such as alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan).
Structural changes. These occur as the brain shrinks with age.
Life changes or stressors. “That may include losing loved ones as your peers start to pass away, isolation, or thinking about your own mortality,” says Dr. Farrell.
Some or all of the triggers and brain changes of depression may impair cognition — that is, thinking skills. For example:
Attention. “People who are depressed have trouble staying on task,” says Dr. Farrell.
Memory. You may not recall what you ate for dinner, or you may not remember details of a major life event.
Decision making. You may have a hard time deciding what to eat or which movie to watch.
Information processing. You might have stored a memory but later have trouble retrieving it.
Executive function. You may not have the mental ability to get things done, like paying bills or returning phone calls.
Many symptoms of depression are similar to those of other conditions. Problems with attention, memory, and executive function may also be signs of stress, mild cognitive impairment or dementia, a urinary tract infection, a ministroke, or coronary artery disease.
As a result, depression may be overlooked. “The biggest risk is that someone chalks up cognitive changes to the normal aging process and doesn’t give them the attention they deserve. But when you’re affected by a slowed thought process, it’s not always normal,” says Dr. Farrell. “Reach out to your primary care physician to do a depression screening, and to rule out other medical causes.”
When underlying illness or medication side effects are suspected as depression triggers, addressing those problems may help relieve symptoms. And treatment with medication — such as selective serotonin reuptake inhibitors — or with pill-free therapies (see “Treating depression: Beyond medication”) will go a long way toward improving your thinking skills. “That’s a real target of depression treatment for older adults. Treatment often leads to marked improvement in thinking, memory, and executive function,” says Dr. Farrell.
Changes in your thinking skills, such as attention, decision making, or memory, may be signs of depression.
Your doctor may prescribe pill-free therapy, such as aerobic exercise and talk therapy, either in combination or with medication, or as the only treatment for mild depression.
Aerobic exercise (the kind that works your heart and lungs) improves mood, memory, and thought processing. “For someone age 70 or older, we advise exercise, but check with your doctor to see what’s right for you,” says Dr. Helen Farrell, a psychiatrist with Harvard-affiliated Beth Israel Deaconess Medical Center.
Talk therapy may take the form of grief counseling, if you’ve lost someone dear to you; psychodynamic therapy, to explore your thoughts, fears, or life changes; or cognitive behavioral therapy, to redirect negative thought processes.