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The link between depression and cognitive impairment

It has been a minute since my last blog post, and I do apologize!   Things got a little busy the last two weeks and I’m grateful to say, they are still busy this week.  The clinic is picking up pace; I just got the letter today; Resurgence is now in network with United HealthCare!  It’s definitely worthy of a celebration.  I have been busy learning my new billing program, doing FEES, meeting new patients, and handing out brochures.  I am thrilled to meet all my new clients!  It feels so wonderful to be back helping people again!

Today I am going to talk about the link between depression and cognition, and I’ll put up a video of some activities you can add to your daily routine to reduce your risk of dementia!  (When I say, “I” in combination of computer stuff, I mean Daniel; he’s my go-to person for all things related to the computer. Thanks, Daniel!!)

Depression is a real problem here in the US; It affects 5-8% of people, occurring in women 2x more than in men.  Depression can last several months, can reoccur and it can completely change a person’s life.  Depression doesn’t just cause sadness, it can cause changes in the sleep/wake cycle, changes behavior, physical health, and activity levels.  Also, it changes people’s cognition.

First, let’s review cognition, just in case you didn’t read my last blog post.  Put simply, cognition is the ability to think.  It involves attention, memory, sequencing, organizing, problem solving, error awareness, and putting all of it together to execute or complete a task.  For more information about cognition, please read the BLOG post titled, “Wait, an SLP can help with thinking???

Our ability to think is influenced by many factors.  We have a hard time thinking about anything when we:

  • are hungry
  • are tired
  • have to use the bathroom
  • are sick or in pain
  • or in times of high emotion (extreme sadness, anger, happiness)

My last blog addressed the pathway a thought takes through the brain and nerves in order to communicate that thought-  What’s very important, is the role of our neurotransmitters in the whole thinking process.

Our central nervous system, which is our brain and nerves, is dependent on those neurotransmitters (and neuropeptides, which I don’t get into) to relay messages.  Researches have found more than 100 neurotransmitters in our central nervous system.  Each have a specific receptor cell that triggers the continuation of the message through our nerves.

Now, I talk about neurotransmitters because they play a key role in depression in addition to thinking!  Bear with me for a few more lines…

Our brain relies on these neurotransmitters which are chemicals that help relay messages through our bodies.  The common neurotransmitters and their functions are as follows:

  1. Acetylcholine– it excites!  It controls heartbeat, triggers muscle contractions, and has a key role in memory and brain function
  2. Dopamine– another exciting neurotransmitter; it controls movement coordination in addition to influencing memory, learning, and behavior.  It’s also known as the pleasure neurotransmitter because the brain releases it during pleasurable activities.
  3. Endorphins:  create the feeling of euphoria.  They also provide energy and inhibit pain signals.
  4. Epinephrine– what we know as adrenaline.  It increases our heartrate and breathing (as well as slows our digestion) to prepare for the fight or flight response.  It also assists in fast decision making when presented with dangerous situations.
  5. Gaba– regulates mood, but is also an inhibitory neurotransmitters, therefore low levels are associated with anxiety, restlessness, and irritability.
  6. Serotonin– regulates appetite, our sleep cycle, blood clotting, and REGULATES MOOD.  (many anti-depressants increase serotonin levels in the brain)

So, we have all these neurotransmitters that influence learning & thinking, like acetylcholine and dopamine.  And neurotransmitters that affect our mood, like GABA, serotonin, dopamine, and endorphins.

AND, if we really think about it; if our body is producing an excess of epinephrine (like it does when there is chronic stress) our brain is not focusing on learning or being happy; it’s focused on survival.

I mean, we, in the western, developed world, are no longer running from lions.  But , we FEEL like it somedays.  The thing of it is, running from a lion is supposed to be a rare occurrence, where as, the daily stress of rushing from home to work, then from work, to pick up the kids, to eating drive-thru, taking Johnny to baseball and Suzy to dance, then getting them home, feeding them a snack, helping with their homework, answering the email, cleaning the kitchen, changing the laundry, and walking the dogs, and spending quality time with the significant other… and doing that day after day, after day, after day.  It takes a toll on the body. And mind.  AND, I DIDN’T EVEN MENTION MONEY!!

Chronic stress is a killer; there are documentaries about it that are on my watch list, but I don’t know enough about it to get in depth at this time.  I do know that chronic stress will change our brain, and not for the better…  It throws everything off balance because we are NOT supposed to live like that for a prolonged period of time.

Our minds and bodies are not supposed to live in chronic depression either.  But here we are.  So many people are suffering from it.

ALL of this to say, the balance of these neurotransmitters is extremely important to our “normal” brain and nerve function.  Researchers have found low activity levels of serotonin, noradrenaline, and dopamine in major depression, along with hyperactive GABA and glutamate.  In other words, a lack of the neurotransmitters that are supposed to excite your system, and a large amount of the ones that inhibit your system.

So, doesn’t it make sense that if our brain is low on serotonin and dopamine- causing our mood to be come unregulated (mood swings, disturbed sleep cycle) that we would also have problems with our learning, memory, and thinking?  Because when we can’t sleep, we can’t think.  And when we can’t think, we don’t think.  And when we don’t think, we lose brain mass.  When we lose brain mass it becomes harder to think, so we don’t, and we lose more brain mass… and the cycle continues.

In a class I took from Peter Johnson, back in 2016, he said an alarming statistic:

People who suffer chronic depression for 10 years or more are TWICE as likely to develop dementia.


If we don’t use our brain, we lose our brain.  And we seriously lose our brain.  It gets smaller when we don’t use it and can be seen on imaging studies like MRI’s and CT scans.  Additionally, the loss of volume (the brain getting smaller) in specific parts of the brain, can suggests specific neurodegenerative diseases, like Alzheimer’s dementia, Parkinson’s disease…

And, since it is within my “scope of practice,” (the fancy way I say I’m qualified to address these problems in speech therapy), I would like to help people who are suffering from depression, to ward off dementia by providing skilled speech therapy services.  Because what’s vital to anyone keeping their ability to think, is…


And boy, do I have the knowledge, skills, and tools to really make people think!

Make sure you sign up for updates on my website to receive the upcoming video about tips and tricks to prevent cognitive impairment!

Until next time…


Michelle Hill MS CCC-SLP is a speech language pathologist and Owner/Founder/CEO of Resurgence Neuro Rehab.




Breazeale, Ron PhD.  “Thoughts, Neurotransmitters, and the Body-Mind Connection.”  July 17, 2012.  https://www.psychologytoday.com/us/blog/in-the-face-adversity/201207/thoughts-neurotransmitters-body-mind-connection?amp

Johnson, Peter, PhD, CCC-SLP.  “Cognitive Therapy for Dementia:  Effective Evaluations & Therapuetic Interventions.”  PESI INC, 2016.

Uddin, Sahab et. al.  “Medicine that Causes Memory Loss:  Risk of Neurocognitive Disorders.”  International Neuropsychiatric Disease Journal 8(1):  1-18, 2016.  www.sciencedomain.org

Wang, Yao-Chin et al.  “Increased Risk of Dementia in Patients with Antidepressants:  A Meta-Analysis of Observational Studies.”  Behavioral Neurology.  Vol 2018, Article ID 5315098.  https://doi.org/10.1155/20185315098

Werner, Felix-Martin and Covenas, Rafael.  “Classical Neurotransmitters and Neuropeptides Involved in Major Depression:  a Review.”  International Journal of Neuroscience, 120, 455-470, 2010.

Great news! Resurgence patients can now manage appointments & billing online 24/7.