Impacts Of Psychiatric Disorders On Dementia
Psychiatric disorders are frequently the main clinical focus because they bring about distress directly and can exacerbate other morbidity. These states increase the demands placed on relatives and other caregivers and, thus, the levels of caregiver stress, and they also result in higher rates of resource utilization. Psychiatric symptoms in dementia have also been linked to more severe cognitive and functional disabilities and faster progression to severe dementia and death. It has been estimated, for example, that nearly one-third of all dementia treatment costs are accounted for by psychiatric symptoms. These symptoms also shape the quality of life for many individuals with dementia. They are also major drivers of transfers to residential care, where they cause higher morbidity and strain on caregivers.
Psychiatric Disorders Linked To Earlier Alzheimer’s Onset
Depression and anxiety are linked to earlier onset of Alzheimer’s disease , new research shows.
Investigators found the age of onset of AD is about 2 years earlier among patients with depression and 3 years earlier among those with anxiety vs those without these disorders. In addition, having more than one psychiatric diagnosis pushes the age of AD onset even earlier.
The findings underline the importance of screening for cognitive decline in older patients, including those with psychiatric conditions, study author Zachary A. Miller, MD, associate professor of neurology, University of California San Francisco Memory and Aging Center, told Medscape Medical News.
“I think that as part of healthy aging, we should be doing some level of screening for cognition, just like everyone should get a colonoscopy at age 50,” said Miller.
Patients should be monitored if they have symptoms of depression or anxiety, or if these are not well treated and “if they have cognitive complaints in addition to those psychiatric and mood concerns, we definitely want to know who they are,” he added.
The findings will be presented at the American Academy of Neurology 2021 Annual Meeting in April.
What Is Alzheimers Disease
Alzheimer’s disease is a progressive brain disorder that slowly shrinks the brain and destroys brain cells. This destruction is irreversible and causes a continuous decline in the thinking, remembering, behavioural and social skills of the affected person. It is usually seen in people over the age of 65 years but can occur in much younger people. The cause of AD is not understood completely but is believed to be a result of an abnormal build-up of proteins in and around brain cells.
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What Is The Main Cause Of Dementia
Alzheimers disease is the biggest cause of cases of dementia, along with vascular dementia, but there are also a large number of dementia cases caused by Dementia with Lewy bodies. In younger patients, inherited Alzheimers disease accounts for a large number of cases, but Huntington and Frontotemporal lobar degeneration is another cause.
Links Between Psychiatric Disorders And Dementia
The earliest descriptions of the primary dementias included psychiatric disturbances alongside the cognitive and functional symptoms. Alois Alzheimer identified anxiety, hallucinations, delusions, and agitation amid confusion and dense impairments of memory, orientation, and knowledge that would define the illness named for him. His contemporaries, Arnold Pick, Paul Sérieux, and Joseph Dejerine, described midlife deterioration of conduct and language, which are the first descriptions of frontotemporal dementia . From these beginnings, primary dementias came to be viewed narrowly as cognitive disorders, but in the past 35 years, observations of the ubiquity of psychiatric disorders in dementia and that patients experience one or more disturbances of mood, behavior, perception, and thought content have been replicated numerous times.
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Psychiatric Aspects Of Dementia
Relationship Disclosure:International Review of PsychiatryPsychiatric Clinics of North America
Unlabeled Use of Products/Investigational Use Disclosure: Dr Onyike discusses the unlabeled/investigational indications and evidence for efficacy and risks of prescribing antidepressants, antipsychotics, and other psychotropic agents for treating psychiatric aspects of dementia, as well as the alternatives to making these prescriptions, which include behavioral interventions, care programs, caregiver support and training, environment modulation, and structured recreation.
Better Understanding Of Alzheimers
The authors also propose that the findings could alter our understanding of how the biology of Alzheimers leads to psychiatric symptoms in people who develop the disease.
The discovery, says senior study author Dr. Lea T. Grinberg, who is a principal investigator and associate professor in neurology at UCSF, that the biological basis for these symptoms is the early Alzheimers pathology itself was quite surprising.
It suggests these people with neuropsychiatric symptoms are not at risk of developing Alzheimers disease they already have it, she explains.
There are around 5.7 million people with Alzheimers disease living in the United States. This figure is likely to reach almost 14 million by 2050.
If doctors could diagnose the disease more accurately, and earlier, it could save the nation trillions of dollars in care and medical costs.
Alzheimers is the leading cause of dementia and has some specific biological features. The main hallmarks are two types of abnormal proteins found inside and around the brain cells in people who have died with the disease.
The abnormal proteins found inside the brain cells are known as tau tangles and the ones found between the cells are called beta-amyloid plaques.
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Psychiatric Disorders Foreshadow Cognitive Decline And Dementia
Primary psychiatric disorders usually develop in youth and early adulthood, although late-life variants of depression, anxiety, mania, and psychosis are recognized. In contrast, primary dementias are generally conditions of midlife and late life, although youth and young-adult presentations occur. Psychiatric disorders preceding cognitive dysfunction and dementia have long been recognized in schizophrenia, since Emil Kraepelin described dementia praecox as a chronic disintegration of cognition and conduct beginning in youth. Schizophrenia is now viewed as a heterogenous psychosis in which cognitive dysfunction is common, and progressive cognitive decline and dementia rare. Schizophrenia is believed to arise from aberrant neurodevelopment, with deficiencies in dopamine and glutamate neurotransmission culminating in the disintegration of mental function in early adulthood. Most cases of schizophrenia feature static deficits in attention, executive functions, and social reasoning from the outset, alongside the illness-defining hallucinations and delusions. These cognitive disabilities undermine treatment adherence and psychosocial adjustment.
Common Mental Illnesses In The Elderly
If a senior is displaying signs of mental illness, its important to recognize the symptoms and seek treatment as soon as possible. Some of the common mental illnesses the elderly experience are:
- Depression. Depression is considered the most common mental disorder among seniors. Social isolation plays a major role in emotional wellness, so when a senior spends long periods alone because they are unable to drive or live far away from friends and family, depression can easily set in. It is also a symptom of dementia and tends to get overlooked as a treatable ailment.
- Late onset bipolar. Most bipolar patients are diagnosed in early adulthood. Late onset bipolar can be difficult to diagnose because of its similarities to dementia symptoms like agitation, manic behavior and delusions.
- Late onset schizophrenia. This disorder also presents a challenge to diagnose. It can manifest in adults after age 45 and appears as the patient ages. Symptoms are similar to dementia, once again, with hallucinations and paranoia the most common, but these symptoms are milder than when this illness appears in younger adults.
Mental illnesses are treatable, but the trick is a correct diagnosis. Even if a senior had good mental health throughout their entire life, the risk of mental illness in later years is still there. Seek medical treatment as soon as possible if there are any noticeable changes beginning to occur.
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Who Can Diagnose Dementia
Visiting a primary care doctor is often the first step for people who are experiencing changes in thinking, movement, or behavior. However, neurologists doctors who specialize in disorders of the brain and nervous system are often consulted to diagnose dementia. Geriatric psychiatrists, neuropsychologists, and geriatricians may also be able to diagnose dementia. Your doctor can help you find a specialist.
If a specialist cannot be found in your community, contact the nearest medical school neurology department for a referral. A medical school hospital also may have a dementia clinic that provides expert evaluation. You can also visit the Alzheimers Disease Research Centers directory to see if there is an NIA-funded center near you. These centers can help with obtaining a diagnosis and medical management of conditions.
Brain Samples From A Large Cohort
For their study, Dr. Grinberg and colleagues used brain tissue samples from the BBAS. The BBAS is a large and unique bank that stores the brain tissue that scientists retrieve during postmortems in São Paulo, where an autopsy follows every death.
This allowed them to study autopsied brain tissue from 1,092 adults aged over 50 who died between 2004 and 2014 and who were representative of São Paulos general population.
In addition, the BBAS records included data from postmortem interviews with reliable informants on the psychiatric symptoms and mental capacity of the deceased.
The team excluded 637 brain samples that showed abnormalities that were not related to Alzheimers disease. This left 455 samples from people who either had signs of Alzheimers disease, such as beta-amyloid plaques and tau tangles, or no signs of neurodegeneration.
To assess the amount of Alzheimer-related neurodegeneration, researchers evaluated each sample using a method called Braak staging to measure tau tangle burden, and a CERAD neuropathology score, to measure beta-amyloid burden.
The investigators evaluated psychiatric symptoms using a 12-item neuropsychiatric inventory and cognitive status using a tool called the CDR-SOB score.
They then analyzed the psychiatric and cognitive evaluations against the measures of Alzheimer-related neurodegeneration for all of the 455 brains.
Mental Health And Dementia What Is Happening In The Brain
Firstly lets take a look at what is happening in the brain for people with either dementia or living with mental health problems. For a simple and visual summary of how the brain works see the following image:
Im not a neuro-psychiatrist and do not claim to have extensive knowledge of the brain and its workings! But two things Id like to clarify about mental health and dementia before I start:
Mental illnesses are disorders of the brain, dementia is a disorder of the brain: it is inevitable that they will overlap.
Mental illness and dementia are NOT the same thing.;
What is dementia?;Most simply put, it is a change in the physical structure of the brain through death of nerve cells, and the breaking down or disruption of connections between nerve cells. There are many reasons for this depending on the type of dementia diagnosed e.g. reduced blood supply or bleeds, or clusters of unwanted protein matter damaging the cells. There are different types of dementia, and if you want to know more about this I highly recommend the set of YouTube videos produced by the Alzheimers Society on different types of dementia.
What is mental illness?;Im not even going to attempt to define mental health problems!Regan summarises mental health as a positive experience of self, individual resources including self-esteem and optimism, the ability to sustain relationships and resilience.
What Types Of Tests Can Be Expected
At the initial diagnostic appointment, the doctor will examine the patient physically and ask questions about medical history and symptoms related to memory loss. Its helpful to bring a family member to answer some of these questions during this first appointment. During this visit, cognitive tests will typically be conducted to measure focus, memory, and decision-making skills. This appointment doesnt have to be difficult, as most physicians are empathetic and kind when discussing concerns with a patient and their family.;;
;If the doctor feels that more exploration of possible brain health issues is required, his team will schedule brain scans, blood tests, and a psychiatric evaluation.
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Alzheimers Is A Brain Disease
People diagnosed with Alzheimers disease may display similar traits to those with mental illness. However, Alzheimers disease is more accurately defined as a brain disease, specifically, a progressive neurodegenerative condition. The American Psychiatric Association describes the brain disorder as a group of symptoms that lead to a decline in mental function severe enough to disrupt daily life.
The progression of the various stages of Alzheimers leads to memory loss, which affects ones ability to reason, learn, and make sound decisions. A person with Alzheimers can lose the ability to communicate effectively, and eventually, accomplishing simple daily activities becomes an overwhelming challenge.
Alzheimers disease is treatable, but not curable. Treating Alzheimers disease helps to slow its devastating progression and assists in providing quality of life through the multiple stages of the disease.
Dementia affects both mental and physical health, but it is not strictly defined as mental illness. Unlike mental illness, dementia is a disease that primarily affects seniors. Mental illness is nondiscriminatory and can be prevalent at any age. Yet while it differs from dementia, one in three seniors suffers from mental illness.
How Is Alzheimer’s Disease Diagnosed
To diagnose Alzheimers, doctors may:
- Ask the person and a family member or friend questions about overall health, use of prescription and over-the-counter medicines, diet, past medical problems, ability to carry out daily activities, and changes in behavior and personality
- Conduct tests of memory, problem solving, attention, counting, and language
- Carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem
- Perform brain scans, such as computed tomography , magnetic resonance imaging , or positron emission tomography , to rule out other possible causes for symptoms
These tests may be repeated to give doctors information about how the persons memory and other cognitive functions are changing over time. They can also help diagnose other causes of memory problems, such as stroke, tumor, Parkinsons disease, sleep disturbances, side effects of medication, an infection, mild cognitive impairment, or a non-Alzheimers dementia, including vascular dementia. Some of these conditions may be treatable and possibly reversible.
People with memory problems should return to the doctor every 6 to 12 months.
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Social And Economic Impact
Dementia has significant social and economic implications in terms of direct medical and social care costs, and the costs of informal care. In 2015, the total global societal cost of dementia was estimated to be US$ 818 billion, equivalent to 1.1% of global gross domestic product . The total cost as a proportion of GDP varied from 0.2% in low- and middle-income countries to 1.4% in high-income countries.
Recognizing Signs And Symptoms Of Dementia
Dementia symptoms can vary depending on the part of the brain that has been affected, but common signs and symptoms include:;
- Difficulty communicating or choosing words
- Difficulty with visual and spatial abilities, such as getting lost while driving
- Difficulty reasoning or problem-solving
- Difficulty with planning and preparing meals
- Difficulty with coordination and motor functions
- Confusion and disorientation
What Are The Signs And Symptoms Of Dementia
Signs and symptoms of dementia result when once-healthy neurons, or nerve cells, in the brain stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss.
The symptoms of dementia can vary and may include:
- Experiencing memory loss, poor judgment, and confusion
- Difficulty speaking, understanding and expressing thoughts, or reading and writing
- Wandering and getting lost in a familiar neighborhood
- Trouble handling money responsibly and paying bills
- Repeating questions
- Not caring about other peoples feelings
- Losing balance and problems with movement
People with intellectual and developmental disabilities can also develop dementia as they age, and recognizing their symptoms can be particularly difficult. Its important to consider a persons current abilities and to monitor for changes over time that could signal dementia.
Improved Diagnosis Of Alzheimers
The results showed significant links between psychiatric and cognitive measures and patterns of tau tangle burden, but no links to beta-amyloid burden.
Symptoms of anxiety, agitation, depression, sleep disruption, and appetite changes, for example, had links to early-stage Alzheimers in which tau tangles appear in the brain stem. The link was present even though the individuals concerned had shown no noticeable changes in memory capacity before they died.
As Alzheimers progresses, tau tangles start to build up in the outer cortex of the brain. Samples from individuals in which there were signs that this process had begun had links to a higher risk of agitation.
Also, samples from individuals in which tau tangles had already progressed to the outer cortex, were linked to dementia symptoms that are typical of Alzheimers disease, such as a decline in memory and thinking ability and delusions.
The team suggests that the findings could impact trials for drugs that target early Alzheimers disease in which there is a need for measurable outcomes in addition to cognitive decline.
The results could also be added to screening alongside brain scans and blood tests for improving the diagnosis of early-stage Alzheimers.
If we could use this new knowledge to find a way to reduce the burden of these conditions in aging adults, it would be absolutely huge.
Dr. Lea T. Grinberg
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Schizophrenia And Alzheimer’s Disease
Schizophrenia is a severe mental disorder with a prevalence of nearly 1% of the world’s population, and is estimated to have an incidence of 15 per 100,000 people . The nature of this disorder is heterogeneous, which makes its treatment and investigation much more difficult .
The diagnosis of schizophrenia is essentially based on the description of signs and symptoms presented by the patient. To date, there have been no pathophysiological parameters with sufficient sensitivity or specificity to provide a positive diagnosis . According to the DSM-V , the signs must have been present for at least six months, and must also include a minimum of one month of active symptoms to confirm the diagnosis . Arlington, VA: American Psychiatric Publishing.). Schizophrenia is a mental disorder characterized by positive, negative and cognitive symptoms. The positive symptoms may be expressed as delirium, hallucinations and delusions , , . The negative symptoms involve the blunting of affect. The cognitive symptoms are characterized by problems with working memory . Arlington, VA: American Psychiatric Publishing.).
Similarly, psychotic symptoms, delusions and hallucinations are frequent in AD, which is currently the second most prevalent psychotic disorder in the USA, and it may become the most prevalent . The onset of psychotic symptoms in AD is strongly associated with a hastening cognitive decline .