Depression can make it difficult to concentrate, focus on details, and absorb new information. And, as was the case with Michael, whom you met at the beginning of this chapter, depression can interfere with sleep, and sleep deprivation can compound cogni-72 tive problems. Research suggests that long-term depression can even lead to a loss of neurons in the hippocampus and amygdala, structures that are important for memory. One study found that these structures were smaller in women with a history of recurrent depression than in women who didn't suffer from depression. In this study, the women with a history of depression performed poorly on verbal memory tests.

Treating depression leads to improvement in memory and other cognitive functions, often within a few months. Michael's experience was fairly typical. The combination of psychotherapy and medication for his depression and sleep disturbance successfully treated these problems and led to the full return of his cognitive function within six months.

In elderly people with severe depression, cognitive symptoms can occasionally be difficult to distinguish from a neurologically based dementia, such as Alzheimer's disease. In fact, the term depressive pseudodementia was coined to refer to this clinical presentation. Depression might also increase the risk of having Alzheimer's disease. But the relationship between depression and Alzheimer's disease is complex; depression can also be an early symptom of this disease. A study in the Archives of Neurology in 2003 found that a history of depression was more common among a group of 1,953 patients with Alzheimer's disease than it was among their relatives without Alzheimer's disease.

There are key differences in the memory loss experienced by people with depression alone versus the memory loss of people with depression and Alzheimer's disease. In people with depression alone, memory and other cognitive functions fluctuate with mood. When mood improves—usually in response to treatment with medication, psychotherapy, or both—cognitive function generally improves, too. In people with Alzheimer's disease and depression, memory and other mental functions don't improve when the depression lifts.

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