Understanding Depression and ADL Decline in Dementia: The Impact of Subtype and Social Frailty

Date of Submission

2026

Degree Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department Chair

Stephanie Felgoise, PhD, ABPP

First Advisor

Donald P. Masey, Psy.D.

Second Advisor

Robert A. DiTomasso, Ph.D

Third Advisor

Kelly A. Kearns, Psy.D.

Abstract

The interplay of depression and dementia alters the ability to complete activities of daily living (ADLs). When depression occurs concurrently with or because of dementia, it has a more significant link to disability than the impairment of depression or dementia. This occurrence often increases older adults’ risks and a faster progression of the disease. Patients with different types of dementia have varying experiences in the interplay among dementia, depression, and ADL impairment. Moreover, the dementia type can cause variations in awareness and symptoms, influencing different levels of ADL impairment, relative preservation of awareness, and depression levels.

The present study examined the extent to which dementia severity and ADL loss predicted depression and whether these associations varied by social frailty and dementia subtype. The findings indicated that dementia severity and ADL impairment did not significantly predict depression when considered simultaneously; however, dementia subtype, particularly Lewy body dementia, was associated with significantly higher levels of depression. A key implication of this research was to help providers target more specific interventions for depression based on dementia subtype rather than treating all subtypes similarly. These findings supported the need for more personalized, subtype-informed interventions rather than a one-size-fits-all approach.

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