Managing the Emotional and Mental Health Aspects of Dementia

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By Meera Balasubramaniam, MD

Dementia is a complex condition that not only affects an individual’s cognitive abilities but can also take a toll on their emotional and mental health.

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These changes can be challenging for the individual as well as their family.

However, help is available.

At Penn Medicine Princeton House Behavioral Health, an interdisciplinary team of experts who are sensitive to the needs of older adults provides specialized care for patients experiencing anxiety, depression and other mood disorders that may be associated with dementia.

Millions of People

Dementia is a term used to describe a group of symptoms affecting memory, communication, visual and spatial abilities, reasoning and problem-solving, as well as movement and co-ordination, all of which can impact one’s ability to perform everyday activities.

There are various types of dementia, including Alzheimer’s disease, which is the most common.

Millions of people develop dementia as they get older and an estimated one-third of all people aged 85 or older may have some form of dementia, according to the National Institute on Aging.

Dementia can range from mild to severe and typically progresses with age.

In addition to cognitive decline, there are a range of psychiatric symptoms associated with dementia, each of which can have a significant impact on the individual’s functioning.

The frequency and severity of the symptoms and how they are diagnosed and treated typically differs by the stage of the disease.

Anxiety and Depression

Someone who has been newly diagnosed with dementia may experience anxiety and depression because of the diagnosis and coming to grips with their own cognitive decline. At the same time, anxiety and depression can be among the first symptoms of dementia, especially if they first occur later in life.

That is why it is important for older adults to discuss any symptoms of anxiety and depression with their primary care provider and to seek treatment from a mental health professional.

Some common symptoms of anxiety and depression in older adults include:

  • Obsessive thoughts.
  • Excessive worry or fear.
  • Changes in sleep patterns, sleeping more or less than usual.
  • Persistent feelings of sadness.
  • Feeling hopeless or helpless.
  • Isolation.

Additionally, a person with dementia may become apathetic about life and the things they once enjoyed. Apathy is different from depression in that depression is emotionally painful whereas apathy is a feeling of indifference, like someone couldn’t care less.

Anger and Agitation

Dementia can trigger unpredictable mood swings, including unexplained anger or agitation. These symptoms can manifest in behaviors such as pacing, wandering, verbal abuse and even physical violence.

Often, anger and agitation are in response to an unmet need that the individual is unable to communicate. Maybe the person has a medical problem such as a urinary tract infection, which is common in older adults. Or maybe a change in their routine is causing distress. Or they could be dehydrated.

Any number of things could be triggering the individual, and as they struggle to verbalize what they’re experiencing, they can become angry and agitated.

Paranoia and Hallucinations

Individuals in the later stages of dementia are prone to experiencing paranoid thoughts and visual or auditory hallucinations. They may insist people are stealing from them or become suspicious of people, including friends and family members. They may see things or people that aren’t present or hear things such as music that is not playing or voices that no one else hears.

How to Manage

For patients with dementia, it is critical that their care team, including their primary care physician, neurologist, psychiatrist, and mental health professionals, work together to help the patient and their family manage the condition.

Depending on the severity of the symptoms and the stage of dementia, mental health treatment may include talk therapy, medication or a combination of the two. In addition, a mental health professional can provide support for family members as they care for their loved one.

Some techniques that may help individuals with dementia and their caregivers manage the emotional and mental impact of the conditions include:

  • Creating a sense of predictability by implementing a routine and sticking to it as best as possible.
  • While showering or dressing, allowing the person to do as much as possible to honor their autonomy. When assisting them, do it slowly and explain each step.
  • Helping the individual jot down appointments and to-do lists in a notebook.
  • Offering the individual choices when possible. For instance, asking “Would you rather wear this dress or that dress?” This enables the individual to maintain some sense of autonomy while helping to focus on a limited number of choices.
  • Gently redirecting the individual if they are experiencing paranoia or hallucinations by acknowledging their distress and guiding them back to the present.

Most of all, understanding the emotional and mental impact of dementia and relating to your loved one with empathy and compassion can help them — and you — cope with the condition.

In addition to serving older adults in an inpatient hospital setting, Penn Medicine Princeton House Behavioral Health offers a specialized outpatient treatment program called Senior Link. Senior Link team members are experts in geriatrics and are sensitive to the needs and perspectives of older adults. Senior Link and all Princeton House programs require that a patient is able to attend to conversations in a group setting. Caregivers of patients with dementia might also benefit from Princeton House programs to manage their own emotional reactions to ongoing cognitive and behavioral changes in their loved ones.

Treatment includes a comprehensive evaluation by a board certified psychiatrist or advanced practice nurse, individual treatment planning, evidence-based treatment, group and individual therapy, medication management, family therapy and education, and expressive therapies like art and yoga. Outpatient services vary from nine to 30 hours per week, depending on the specific needs of each person.

For more information about Penn Medicine Princeton House Behavioral Health, call (888) 437-1610 or visit www.princetonhouse.org.

Meera Balasubramaniam, MD, is associate medical director at Penn Medicine Princeton House Behavioral Health’s Hamilton site.

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