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When a person is not thinking clearly, it can be caused by many different issues. Depression is one of them.
There are many different levels of unclear thinking. It can range from simply focusing on overly negative and self-critical thoughts to the delusions and hallucinations of psychotic depression. Causes can be just as wide ranging – from a host of medical conditions and medications to injuries to environmental factors to substance abuse.
The critical task for the physician is two-fold: first to determine if the person is a danger to themselves or others and then to precisely pinpoint the cause. He or she will consider a long list of physical conditions including:
- Reaction to drugs, alcohol, or prescription medications (or sudden withdrawal from them)
- Exposure to carbon monoxide or other toxins
- Heat stroke
- Hypothermia
- Head injury such as trauma or stroke
- Dehydration that causes electrolyte imbalances
- Low blood sugar
- Low oxygen levels
- Any medical illness in an older adult (something as seemingly innocuous as a urinary tract infection can cause mental changes or confusion in the elderly)
- Certain nutritional deficiencies
- Seizure disorders
- Kidney or liver failure
- Hypothyroidism (for more information see Second Opinion, Hypothyroidism Episode 512)
- Brain tumor
- Sleep deprivation
Once physical conditions are considered and rejected, the physician will consider:
Late onset depression and cognitive impairment often occur together, suggesting a close association between them.1-2 However, it is not known whether depression leads to cognitive decline or vice versa.2-3
There are things you can do to keep your brain sharp. The Mayo Clinic recommends:
- Exercising your mind. This includes crossword puzzles, reading, and interacting with people.
- Staying physically active (which improves blood flow).
- Eating a healthy diet.
- Developing a system of reminders and cues, such as keeping a diary.
- Learning relaxation techniques.
When a depressed person is not thinking clearly, it is less likely that they will reach out for help. It is up to their family and friends to help them get the medical support they need.
1 Migliorelli R, Teson A, Sabe L, Petracchi M, Leiguarda R, Starkstein SE. Prevalence and correlates of dysthymia and major depression among patients with Alzheimer's disease. Am J Psychiatry 1995;152: 37-44.
2 Jorm AF. History of depression as a risk factor for dementia: an updated review. Aust N Z J Psychiatry 2001;35: 776-81.
3 Schweitzer I, Tuckwell V, O'Brien J, Ames D. Is late onset depression a prodrome to dementia? Int J Geriatr Psychiatry 2002;17: 997-1005.
Learn more about Depression in Later Life:
Key Point 2: Finding the appropriate treatment for depression often takes time and trial. Proper treatment can result in dramatic improvement in mental and physical health, so it is important to take the time necessary to find the treatment that works best for you.
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