Question: My father, a widower in his early 70’s, has been diagnosed by his family doctor with early Alzheimer’s or dementia (I’m not sure which, or if there is any difference). Dad seemed to begin losing memory and interest in life after Mom died 18 months ago, as they were very close.

Because I have been concerned about him being home alone, my wife and I talked him into moving into an assisted living facility on a “trial basis.” He had let his grooming go and would not eat regularly at home, but he can still dress himself, bathe (when reminded), and seems to make sense when he wants to. But he is miserable there, refuses to become involved with the other residents, and stays in his room most of the time in the dark. My wife and I visit several times each week, but this appears not to be enough.

His long-time family doctor saw him briefly, heard the symptoms we described, and prescribed Aricept and an anti-depressant for him. But Dad still seems to be lonely and is not perking up any. I have been reading your column for some time now, and wonder if it would be a good idea for us to hire a companion for Dad so that he has company when my wife and I are not there. We are very concerned about him. Can you help point us in the right direction?

Answer: It appears that your father was in good shape until your mother died, after which his present symptoms began. While we certainly don’t pretend to be medical experts, it would appear that your father might be more depressed than demented. In fact, severely depressed individuals often have many of the same symptoms as dementia. For this reason, physicians should exclude depression in their patients before giving a diagnosis of dementia or Alzheimer’s.
Some of the questions doctors ask to rule out depression deal with abnormal sleeping habits, loss of weight, and/or bouts of sadness. During these examinations, those who are depressed may well discuss their symptoms and loss of memory, while those with dementia or Alzheimer’s are more apt to be unaware of their loss of memory or, if they are aware, try to hide these lapses. When depression contributes to a person’s mental downturn, it should be treated immediately.
Further, because many seniors take a number of medications – sometimes uncoordinated by their several physicians -- a doctor should ensure that the medical history includes an investigation into the drugs a person may be taking that could cause cognitive deficiencies or have an effect on the central nervous system. In addition to prescriptions for heart ailments, diabetes, ulcers, hypertension, certain painkillers, and various psychiatric medications, doctors should also consider the potential effects of such over-the-counter medications as anti-inflammatory drugs, cold medications, and diuretics, not to mention vitamins, herbs, and supplements.

Because of inappropriate diagnoses, dementia may be unjustly fingered as the culprit when depression or, possibly, medications are the true problem. That is why geriatricians, who specialize in treating older adults, are so necessary in treating today’s seniors.

Taking the NextStep: Individuals are known to live more productive and happier lives for a longer time when placed in the least restrictive environment possible. While assisted living is only one notch above independent living, it is a quantum leap given the lifestyle your father enjoyed at home with your mother. We suggest that you secure an independent assessment from a geriatrician or internist who is knowledgeable about these issues before you take any more steps that will cause further diminution of your father’s mental status and lifestyle.