3.1. Identify reasons why a person with dementia may become depressed

This guide will help you answer 3.1. Identify reasons why a person with dementia may become depressed.

Many people with dementia experience changes in mood and behaviour. Depression is a common complication that can strongly affect quality of life. Depression is more than feeling sad. It is a medical condition that affects thoughts, feelings and daily activities. People with dementia can find it hard to explain their feelings. This guide covers some of the reasons why someone with dementia may become depressed.

Loss of Independence

Dementia slowly affects memory, thinking and reasoning. People may notice they forget names, misplace items or struggle with everyday tasks. This can lead to frustration as they lose confidence in their own skills. Over time, many people need help with dressing, eating or washing. Relying on others can make them feel like a burden. The sense of losing control over their lives fuels low mood.

Key reasons include:

• Feeling embarrassed about mistakes
• Shame in needing regular help
• Less choice about what to do each day
• Restrictions on leaving the house alone

The change from being independent to needing support is tough. It can trigger negative thoughts and hopelessness.

Social Isolation

Dementia can make socialising difficult. People may struggle to follow conversations or recognise friends and family. They can feel left out even when surrounded by others. Friends might visit less often. Some people feel stigmatised, or believe others are judging them. This can lead to withdrawal from social activities.

Common sources of isolation:

• Friends or family visit less often
• Feeling embarrassed by memory problems
• Avoiding groups or public places
• Losing interest in hobbies or groups

Isolation often leads to loneliness and sadness.

Communication Difficulties

As dementia advances, it becomes harder to communicate. People may struggle to find the right words, follow conversations or understand humour and sarcasm. This can be frustrating and humiliating. When someone cannot express their needs or feelings, they may feel misunderstood.

Communication problems can cause:

• Misunderstandings with carers or family
• Frustration from not being able to make yourself heard
• Withdrawal from conversation
• Feelings of abandonment

Not being able to share worries or ask for help increases the risk of depression.

Grief and Loss

People with dementia experience many types of loss:

• Loss of memories, especially treasured ones
• Loss of skills, like cooking or driving
• Loss of relationships, as friends drift away
• Loss of sense of identity or purpose

Losing these things can leave someone feeling empty or grieving for the life they had. This persistent sadness can turn into depression.

Some experience “anticipatory grief”, mourning future losses such as moving into care or losing full independence.

Physical Health Problems

Dementia often occurs in older age, when long-term health conditions are common. Pain, illness, disability, and sensory loss (like poor hearing or eyesight) affect mood and limit what someone can do. Infection or chronic diseases can make people feel tired or uncomfortable. These conditions may go untreated if the person cannot explain symptoms, leading to pain and distress.

Sources of low mood:

• Persistent pain
• Difficulty walking or moving
• Fatigue and poor sleep
• Loss of appetite
• Unmanaged health issues

Discomfort and illness can lower motivation and increase the risk of depression.

Changes in Environment

Many people with dementia have to move home. It may be to live with family, move in with carers, or enter a care home. Even smaller changes, such as furniture being moved, can cause confusion. People often feel disorientated or “out of place”. Familiar routines and surroundings help people feel safe. Losing these anchors can create stress and sadness.

Factors include:

• Moving out of their own home
• Different routines in supported living or care homes
• New faces providing care
• Loss of personal belongings

Being unsettled and missing home comforts makes adapting difficult. Fear of the unknown can cause worry and sadness.

Fear and Anxiety

Dementia causes confusion and unpredictability. People may lose track of time, become unsure where they are, or not recognise family members. This can be frightening and make every day seem uncertain. Anxiety often comes before or along with depression. People can develop fear of being left alone or of needing more care.

Common worries include:

• Getting lost outside of the home
• Forgetting important details, like medicines
• Not recognising loved ones
• Having an accident or fall
• Worrying about money or who will make decisions

Ongoing worry wears people down and can lead to loss of hope.

Changes in Brain Chemistry

Dementia affects the structure and chemicals in the brain. This can lower levels of neurotransmitters like serotonin and dopamine, which help control mood. Alzheimer’s disease and other dementia types can directly increase the risk of depression in this way. It becomes harder for the brain to regulate mood, energy, and responses to stress.

Key points:

• Brain changes linked to dementia affect mood
• Some types of dementia make depression more likely
• Medicines used for other health problems may affect chemicals in the brain

These factors may make someone more sensitive to stress and less able to cope.

Side Effects of Medication

Many people with dementia take multiple medicines for other health problems. Some drugs include depression as a side effect. Others can make people feel sleepy, confused or lethargic, which can harm wellbeing.

Examples of problem medicines:

• Some blood pressure tablets
• Steroids
• Sedatives or sleeping tablets
• Certain painkillers

People may not be able to explain how a new medicine makes them feel. Carers must watch for signs of low mood when medicines are changed.

Poor Sleep

Sleep problems are very common in dementia. These might include difficulty falling asleep, waking up many times, or feeling restless and confused during the night. Poor sleep lowers energy, shortens attention span and makes mood worse.

Sleep disruption can lead to:

• Feeling irritable and short tempered
• Reduced ability to solve problems
• Tiredness and low motivation

Over time, ongoing poor sleep can bring on or worsen depression.

Cultural and Personal Factors

Feelings about dementia may be shaped by personal values, background or experiences. People from some cultures may find it more difficult to accept illness, loss of independence, or needing help. There may be stigma or shame attached to the diagnosis. Beliefs about privacy, dignity or family responsibility can also affect mood.

Personal history matters too. People with past trauma, long-term mental health issues or fewer coping strategies may be more at risk.

Examples:

• Difficulty accepting diagnosis
• Shame or embarrassment about needing help
• Fewer support networks
• Negative experiences with healthcare in the past

All these factors can increase stress and sadness, leading to depression.

Frustration with Care and Support

People with dementia need extra help. Care may not always meet their wishes or needs. They may feel their choices are ignored, or that care routines are inflexible. Feeling powerless or unable to make decisions about daily life can lower self-confidence and lead to hopelessness.

Signs of frustration:

• Repeated complaints not being addressed
• Lack of control over meals, sleep or activities
• Not being treated with respect or dignity
• Unkindness or lack of understanding from staff

These experiences can build up over time and contribute to depression.

Deteriorating Relationships

As dementia progresses, relationships with partners, children or lifelong friends change. Some people may become withdrawn, while others may be left out as friends and family struggle to cope. Misunderstandings, communication breakdowns and emotional distance become more common.

Issues can include:

• Loved ones not visiting or calling as often
• Arguments and misunderstandings
• Family disagreements about care arrangements
• Feeling unimportant or abandoned

Broken or weakened bonds with others often result in sadness, isolation and depression.

Experience of Rejection or Stigma

Some people with dementia feel judged for their condition. Others may keep their diagnosis private because of fear of discrimination. Stigma can come from friends, family, healthcare professionals, or wider society. Being treated differently or less favourably can be upsetting.

Examples include:

• People talking over or about the person, not with them
• Exclusion from decisions or conversations
• Examples of negative language or attitudes
• Being ignored in public places

These experiences can erode self-worth and trigger low mood.

Lack of Hope for the Future

A dementia diagnosis changes how people see their future. Many think about lost opportunities, dependency, and the prospect of further decline. Some people feel little hope or joy, and can worry about becoming a burden. This sense of a limited or uncertain future can lead to depression.

This sense of hopelessness can be made worse by:

• Lack of clear information about what to expect
• Poor planning for care needs
• Uncertainty about where they will live
• Financial concerns and legal issues

When people feel there’s nothing to look forward to, motivation and mood drop.

Final Thoughts

Workers play an important role in recognising signs of depression in people with dementia. Observing changes in mood, behaviour or sleep can help spot when someone is struggling. Even people who cannot describe their feelings may show distress in their actions or routines.

Early support can improve outlook and wellbeing for people with dementia and prevent depression from taking hold.