Emotional Flatness in Alzheimer’s Can Seem Like Depression

  • Because doctors and lay people alike often leap to the conclusion that an elder with an Alzheimer's diagnosis, and exhibiting lack of interest in his or her surroundings, is depressed, I found a new study undertaken at the University of Florida intriguing.


    In an article titled, "Emotional Flatness Can Be Mistaken for Depression in Alzheimer's Patients," researchers spelled out the difference between clinical depression and what they termed "emotional flatness." The study showed that doctors often prescribe anti-depressants for Alzheimer's patients who aren't clinically depressed. These Alzheimer's patients are just exhibiting a fairly normal response to their surroundings considering the disease they live with.

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    Alzheimer's patients who appear withdrawn and/or apathetic are often thought to be depressed. Onlookers feel that the patient's memory problems, word-finding abilities or other frustrations of Alzheimer's are causing this emotional state and anti-depressants may help them better cope with these symptoms of the disease. Often, this is the right diagnosis - but not always.


    This University of Florida study found that people with Alzheimer's may have a decreased ability to experience emotions. The study was published online in the spring issue of the Journal of Neuropsychiatry & Clinical Neurosciences.


    In the study, patients were asked to place an emotional value on pictures as to how pleasant or unpleasant they found the scenes. While clinical depression could cause people to act less interested in an object, these researchers felt that the Alzheimer's patients, regardless of the pictures, tended to view pictures much the same - meaning they saw them in a middle emotional range.


    "They don't feel as positive toward the positive pictures or as negative toward the negative ones. They're not depressed, but their emotional experience appears to be flattened," said Dr. Kenneth Heilman, senior author of the paper and a professor of neurology at the College of Medicine and UF's McKnight Brain Institute.


    "One important implication of this work is that when an Alzheimer's patient appears emotionally blunted, the clinician or caregiver should not assume the patient is depressed... as other organic factors could be at work," said Dr. Todd Feinberg, a professor of clinical neurology and psychiatry at Beth Israel Medical Center in New York. Dr. Feinberg was not involved in the research.


    I found this study important for caregivers. Most caregivers try very hard to engage their loved ones who have Alzheimer's disease in some activity that will interest their elder. When the caregiver can't seem to get any response that shows a positive or negative effect, he or she is bound to keep trying new approaches.


    To keep trying new approaches isn't bad. However, caregivers are prone to faulting themselves when they can't rouse some interest in their loved one. We try so hard to please, and when we are continually thwarted, we can be the ones who become depressed.


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    If this study about emotional flatness holds true over large numbers of people, this finding will help family caregivers, and even facility caregivers, be less critical of themselves. That is not a reason to stop trying to engage our loved ones. But education helps us understand what we can and cannot expect from our efforts. That, in turn, can help us feel better about our caregiving efforts.


    It does seem to me, a non-medical person, that many clinicians are going to have a hard time discerning the difference between depression and organic emotional flatness, since a type of emotional flatness can be evident in some types of depression. Also, if there is no treatment for this emotional flatness, clinicians may want to try anti-depressants anyway to see if one of the drugs could help the patient feel better.


    As seemingly vague as it is, will this study make a huge difference? I think it gives a potential answer to those clinicians and caregivers who have tried everything imaginable to engage the interest of someone with Alzheimer's disease - and failed. Many of these people have asked doctors to try anti-depressants and those drugs have also failed. Doctors and caregivers can feel they are at the end of the road with treatment options, and they may be.


    So, to me, this study can provide another clue to what is going on in our loved one's head. If your elder seems to you emotionally unreachable, it's not necessarily that you lack some quality that could engage him if only you tried harder.


    This lack of response from your loved one could be a symptom of the disease that has yet to be well studied, and one that, so far, lacks a treatment.

    Studies continue. The knowledge bank grows. The more that is learned about the disease, the more researchers can search for clues to make life easier for those with Alzheimer's, and those who care for and about them.


    Could it be possible that this study will light a fire under a researcher or doctor who has contemplated trying a different type of drug than an anti-depressant to treat this emotional flatness? Maybe. It certainly would be nice if there is a drug or natural remedy that could improve the quality of life for our loved one who may be suffering from emotional flatness. A treatment would also help the caregiver.


    For more information about Carol go to www.mindingourelders.com or www.mindingoureldersblogs.com.  

Published On: July 24, 2010