Introduction:
Depression is found in a limited number of elderly Parkinson patients; this should not be taken lightly. Sadness is something experienced by everyone from time to time, and the diagnosis of Parkinson disease causes a deep amount of sadness in the elderly. This is different from depression, in which the sadness is temporary, and depression is long-lasting.
What Do Parkinson and Depression Cause in the Elderly?
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It causes emotional disturbances and extreme mood swings, affects mental health, harms the quality of life, affects both the cognitive and motor function of the patient, and results in other psychiatric comorbidities in patients with Parkinson disease. Studies show that patients with major depression have suicidal tendencies.
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The diagnosis of Parkinson disease is primarily made by movement abnormalities like rigidity, tremors, bradykinesia, etc. However, the treatment of this disease focuses on the non-motor findings too. This is because, throughout the disease, patients experience other symptoms apart from functional motor disability. They start developing neuropsychiatric disturbances, which may include depression, anxiety, psychosis, and insomnia.
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Parkinson disease is seen mostly in older age group patients. These patients are already going through their toughest phase of life, old age and to go through this disease is not very easy for them. So many of them go into depression which makes it more difficult to treat them. These psychological aspects of the disease are more distressing than the motor aspects.
How to Diagnose Depression in Elderly Parkinson Patients?
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Depression is very commonly associated with this neurodegenerative disease in older adults. However, there is no gold standard for its diagnosis.
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Depression is best diagnosed clinically, including cardinal symptoms of depressed mood. There are a few rating scales to assess and detect the stage of depression, like the geriatric depression scale (GDS-15). Clinical and neurological symptoms are both required in the diagnosis of depression in geriatric Parkinson patients.
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Depression is seldom misdiagnosed as apathy, but in these cases, patients will be unresponsive to antidepressant treatment. Special attention and care should be taken by family members and the concerned doctor’s team in comorbid psychiatric symptoms and natural history of symptoms to help confirm the etiology of depression when present in this disorder.
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One should never neglect any changes in mood and discuss them with the doctor and family members. The patient has to go to every doctor’s appointment along with a family member and must get checked for depression once a year.
What Could Lead to Depression in Older Parkinson Patients?
Parkinson disease leads to changes in the brain chemicals that control the emotions of a person, and depression is seen to worsen this effect. The factors that cause depression in older Parkinson disease (PD) patients can be environmental, biological, and psychological.
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Environmental Factors: Certain patients find it difficult to accept the diagnosis of the disease, and to add to this, the drugs prescribed to them might mimic signs of depression. Especially older patients would have already been through many tough times in their life, and to be diagnosed with a disease that would change their entire lifestyle must be difficult to digest.
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Biological Factors: In much older Parkinson patients, depression is diagnosed many years before the diagnosis of Parkinson disease. Hence, depression might be a part of the underlying Parkinson disease or just a psychological reaction. Parkinson disease and depression both affect the neurotransmitters of the brain leading to mood changes and movement limitations.
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Psychological Factors: When older people have to live with this lifelong condition of Parkinson, they usually undergo emotions like hopelessness, sadness, and frustration, which might give birth to depression. Along with these above-mentioned feelings, older patients also undergo lifestyle changes due to retirement, not having a supportive family or friends, and loss of independence. These above-mentioned factors can lead any person into a state of depression.
What Symptoms Should We Look For in Parkinson Disease Patients With Depression?
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They have poor hygiene.
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Loss of appetite.
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Always feel sad.
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Inability to wake up from bed in the morning.
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No sense of purpose.
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Complaints of pain in different parts of the body.
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Feel they are a burden to the family.
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Have suicidal symptoms.
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Reduced physical activities.
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Always feel tired.
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Extreme mood swings.
What Is the Best Treatment Approach for Depression in Older Parkinson Disease Patients?
The symptoms associated with each Parkinson patient vary, and so does the treatment approach. The two main treatments for these patients are to start them on antidepressant drugs and give psychological counseling alongside the drug treatment. Certain antidepressant medications might interfere with the Parkinson disease drugs given to the patient; hence it is advisable to consult the doctor concerned to prescribe medications accordingly.
Family members should make sure that the patients follow the given treatment strictly to get the desired results. Older Parkinson patients might be undergoing anxiety along with depression. This should be reported to the doctor, and antianxiety medications should be taken along with the other prescribed drugs.
What Is the Role of Psychological Counseling?
Apart from the above-mentioned treatment, psychological counseling plays an important role in treating depression in elderly Parkinson patients, as 90 % of the time, elderly Parkinson patients go through depression due to loneliness.
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Cognitive Behavioral Therapy: This therapy is used by psychologists to reverse negative thoughts and bring behavioral changes to the lifestyle of these patients. Talking to a counselor regularly will help them express their feelings and feel relieved. Counselors also advise them to do some physical activities and make a few lifestyle changes to eliminate depression and anxiety.
According to the patient, the psychologist advises them to do activities of their interest, like gardening, painting, writing, singing, jogging, cooking, etc., to keep them occupied and happy. Most importantly, the patient should be associated with a good social help group, and their family members should be given counseling about their condition and the care to be taken.
Conclusion:
Sometimes, love and care from society and family are all they want to get through this Parkinson disease. Old age in itself is not easy to go through; adding Parkinson disease to it makes it more difficult for the elderly to go through all alone. In this age group, many have lost their beloved, and there is no support from the children as well. Consulting a doctor and starting treatment is important, but along with that, psychological treatment involving psychologists and family and friends is equally important. It is suggested that a holistic and comprehensive treatment plan should be formulated for such patients in order to overcome the disease.
