Dear Lala

Dementia is a syndrome resulting from progressive decline in intellectual capacity of the individual. It is characterized by loss of ability to memorize, to solve the problems of everyday life , which interferes with your relationships and social and professional activities . The goal of treatment is to control the symptoms of dementia. The treatment depends on the disease that is causing the dementia. Some people need to be hospitalized for a short period .

Interrupting or changing medications that worsen confusion can improve brain function

Increasingly, evidence points to the benefits that some types of mental exercises can bring to improve dementia

Depression is a disease state . Depression causes symptoms such as depression and lack of interest in any activity . It is a disorder that can come with or without the feeling of sadness and undermines the psychological , social and work functioning

Treatment of depression is substantially medicated . There are 30 available antidepressants . Contrary to what some fear , these medications are not like drugs , leaving the jubilant person and cause addiction. Treatment is simple and , in general , does not disqualify or numbs the patient

Dear Dr.Nelson Elias,

Thanks for the interesting answer. Is it possible to treat early to avoid depression and

dimentia.

Lala

Dear Lala

Its a pleasure

Dr. Elias has provided an excellent response. I would only add that wherever possible elders manifesting both dementia and depression should be treated "in place" at home or residential care settings rather than in acute psychiatric hospitals (which can do little but medicate them). As elders with dementia may behave in ways that mimic psychosis and appear dangerous they are often involuntarily hospitalized. This process is traumatic in every respect, aggravates the individual's confusion, and increases their agitation, even when it ends in admission to a geripsychiatric facility (of which there are far too few anywhere).

There are pharmacological options to treat early stage Dementia which can delay the deterioration and help with behaviour and mood symptoms.

As is known, in an elderly patient depression is often initial symptom of dementia (of different origin) and on the other hand mental deterioration can be a final stage (in the senility) of a Major Depression. Nevertheless depression is present, at various degree and stage, together with other neuropsychiatric symptoms, in about one half of all the dementia syndromes and also MCI (Lyketsos et al 2002). For that reason, it seems a good practice in the elderly patient to promptly treat either depression (especially with SSRI) or cognitive impairment when possible.

The most effective remedy for depression may well be neurofeedback. It is also helpful for the dementias. Once the training is begun for dementia, the training likely needs to be maintained on some schedule in order to maintain gains. In the very first case of which I am aware, neurofeedback was begun after dementia had been diagnosed. Recovery was effected with the training, and with maintenance sessions dementia was never again an issue until the gentleman died fifteen years later, In another such case, the man had reached the point of no longer recognizing his wife. After neurofeedback, he could be released back to his family and with continued training dementia was never again an issue for the rest of his life. More generally, it may be expected that with neurofeedback once can push back the threshold of dysfunction by a couple of years at least. Neurofeedback can be done on a home training basis if a caregiver is available. A less challenging and more accessible technology is what is called audio-visual stimulation. This technology was formally evaluated some years ago in Florida under the colorful moniker of the "Ponce de Leon" project. Nice gains in cognitive function were demonstrated. On the auditory side, The Listening Program is worth a try.

It is interesting to see that most responses advocate for medication (that are moderately effective). However, as Siegfried pointed out there are other, non-pharmaceutical, ways to treat these conditions. Physical Activity and exercise have shown some remarkable outcomes in terms of treating depression and dementia. Physical activity has shown to enhance brain plasticity (Erickson et al., 2013). In terms of depression, we can see great success of physical activity as well. }. Older people with already existing major depressive symptoms were examined in a study that tested the antidepressant efficacy of exercise and pharmaceutical treatment (Blumenthal et al., 1999)}. After the trial period of 16 weeks the results indicated good antidepressant efficacy of the exercise, medical treatment and the combination of both, with no differences between the groups. Looking at the reduced risk of exercise training (and also reduced costs) and other positive effects (fitness) this might indeed be the way forward.

Indeed, a sole focus on medication as a form of treatment does not always provide the greatest effect. So, both for the treatment of depression and for the management (not treatment as it is not reversible) of dementia, both non-pharmacological therapies (such as CBT or psychotherapy for depression; and cognitive interventions, exercise interventions, etc.) and pharmacological treatments should be employed.

In my previous response, I mainly addressed the issue of dementia. With respect to depression, the following data point may be of interest: In a case series of 300 service members suffering from PTSD, about a third reported depression ratings in the 6-10 range out of 10. With infra-low frequency neurofeedback, 80% of these reduced their depression scores to less than half in under ten sessions (most in under five), and reduced them to clinical insignificance within twenty sessions.

The systematic clinical success with both depression and dementia suggests that both conditions can be fruitfully modeled in terms of the behavior of neural networks, and that neurofeedback impinges effectively on that behavior. In consequence, the self-regulatory capacity of the brain is enhanced with respect to both cortical activation and the functional connectivity of our intrinsic connectivity networks.

Thank you for the interesting question and discussion to date.

My response will focus on depression.

The use of biofeedback options includes the use of breathing for optimum Heart Rate Variability (HRV) through an interface such as mycalmbeat or heartmath. These can be taught fairly easily and are useful where anxiety and depression are emerging due to challenges in maintaining self-regulation due to loss of supports or changes in circumstances, common in elderly populations. Learning to breathe for calm is then an added stress regulation skill that the patient can carry forward into many circumstances.

Colleagues and I have usefully combined the breathing for better HRV and calm with psychodynamic therapies. As to the latter, the use of brief psychodynamic psychotherapy is often very useful in the elderly patient with depression as it provides an opportunity to focus on the issues around the emergence of depression that have been highlighted in the collaborative formulation as contributing to the presenting problem. CBT is of course useful, but brief psychodynamic psychotherapy offers an alternative. The relational context of shifting self-regulation is acknowledged in this approach and patients often find the experience of collaborating intensely in this way very meaningful as well as effective. When we consider that some aspect of grief or loss can often underlie these later life depressions, an opportunity to work through these losses and look positively toward the future is an important non-pharmacological approach as part of an overall management plan.

Dietary cocoa flavanols reverse age-related memory decline in healthy older adults

http://www.sciencedaily.com/releases/2014/10/141026195046.htm

New research suggests that high consumption of green tea may reduce your risk of dementia. However, it is important to note that this result is based on a preliminary study consisting of just under 500 participants and the result is yet to be published in a peer-reviewed scientific journal.

http://dementiaresearchfoundation.org.au/blog/green-tea-and-its-link-dementia-risk

Being overweight dramatically speeds up the onset of dementia with each extra BMI point bringing on disease 6.7 months early

http://www.telegraph.co.uk/news/health/elder/11837438/Body-Mass-Index-predicts-how-soon-Alzheimers-will-develop.html

EEG biofeedback or neurofeedback can be surprisingly helpful with both depression and dementia. Outcomes are of course variable depending on a number of factors, but the training is usually quite worthwhile. We use mainly training in the infra-low frequency region (Slow Cortical Potentials) in order to re-normalize the functional connectivity of the core networks. Training in the conventional EEG range is also useful, but for us plays a secondary role, particularly in the early stages of training.

In the case of dementia, the training has to be repeated on some schedule in order to maintain gains. The periodicity of the schedule is a function of how advanced the condition is. Eventually one might end up doing daily training. Under such conditions, the training would be conducted in the home setting with the help of a family member or professional caregiver. 

Depression can be treated by acupuncture.

Dementia can be treated by acupuncture or magnet therapy. However, I would like a partner to do the clinical trial to treat dementia.

http://happypinmasterhealer.com/emotional-disorder-acupuncture-treatment/

http://universalenergyhealing.us/head-magnet-treatment-test-applications/

https://universaltcm.com/yang-qi-functions-relationship-health/