Mental Health Disorders and Dementia: Navigating Comorbidity
Mental health has been a longstanding taboo topic, making it challenging to admit when you or a loved one is struggling. Despite increasing discussions and awareness surrounding the importance of mental health on social media platforms, particularly during the COVID-19 pandemic, mental health remains misunderstood, misrepresented, and stigmatized. As the proportion of older adults in the population accelerates, an increasing number of individuals with Alzheimer's Disease and Related Dementia (ADRD) are also facing these challenges surrounding stigma, representation, and understanding. Family members watching from the sidelines of the disease often feel frustrated and embarrassed by behavioral disturbances consistent with dementia progression. The behavioral and psychological symptoms associated with ADRD are diverse and vary from patient to patient, ranging from more typical symptoms such as forgetfulness, repeating questions, or wandering around to more severe behaviors such as aggression and violence. While initially, it might appear to be the family member's responsibility, society should take responsibility for creating a judgmental and shame-inducing environment when discussing dementia, resulting in a general lack of understanding about ADRD. Increased awareness regarding dementia symptoms and indicators can contribute to destigmatizing ADRD.
How common is it to have both dementia and another mental health disorder? Does having a mental disorder change the likelihood of developing dementia later in life?
Common symptoms experienced by individuals with dementia, such as memory loss, behavioral issues, and detachment, may be perceived as crazy, disruptive, or rude by the general public – largely due to a lack of understanding surrounding the disease. This mirrors the problem faced by individuals with mental health disorders – a lack of knowledge leading to any behavior in misalignment with societal norms being perceived as "wrong" or "embarrassing." Combining mental health disorders and dementia amplifies this issue.
A research study conducted in New Zealand showed that there is an association between mental health disorders – namely depression, psychosis, and substance use disorders – and exacerbated risk of developing dementia and exhibiting earlier onset of dementia symptoms. A number of hypotheses have been proposed to explain the link between poor mental health and dementia risk. For example, depression has been linked to neuroinflammation, which can lead to cognitive problems. However, it's important to note that the association between mental disorders and dementia isn't proven to be causal yet.
Depression, Anxiety, and Dementia
Individuals who have previously experienced depression are at a higher risk of facing it again if they develop dementia later in life. However, distinguishing between symptoms of dementia, depression, and anxiety can be challenging, as many of these symptoms are similar. Unfortunately, it can be difficult to discern if your loved one with dementia has depression or anxiety, as many symptoms of dementia, depression, and anxiety overlap. Both people with dementia and depression can experience changes in their level of interest in their usual activities, cognitive difficulties, and concentration issues. Specifically with Alzheimer’s, depression may be less severe and last for a shorter period of time than those without an Alzheimer’s diagnosis. It has been shown that in community settings, there is a 38% to 72% increased rate of anxiety in those with dementia. Interestingly, anxiety starts to decrease during later stages of dementia. Both people with anxiety and people with dementia experience symptoms such as restlessness, tiredness, and issues concentrating.
At the end of the day, it’s hard to see a loved one suffer, whether that be from mental health disorders, dementia, or both. Here are some suggestions for ways to improve quality of life – for both caregivers and care recipients:
Spend time with friends and family. It’s common for both caregivers and care recipients to feel isolated in the dementia process. Spending time with loved ones is a great way to stay socially engaged and supported. Having a sense of community is important!
Support groups. There are a multitude of support groups for dementia caregivers and care recipients. The Alzheimer’s Association has an extensive list of resources to find a group that fits your needs.
Talk therapy. In today's world, it's unfortunate that seeking help for oneself often carries a certain stigma. However, it's important to recognize that therapy is a wonderful tool that can truly benefit anyone. Caregivers can really benefit from having someone to talk to about everything they experience.
Music and art therapy. Music and art therapy can be great ways for those with dementia to convey their feelings and express their creative side. Research has shown that music and art therapy may help memory, communication, mood, and behavior in those with dementia.
PATH therapy. Problem Adaptation Therapy, or PATH, has been researched as a treatment option for those with depression and cognitive impairment. PATH uses problem-solving skills to help with emotional regulation. Specifically, situations that cause issues for a dementia patient are identified and avoided, and changes are made to help the patient’s mindset. Participants who went through PATH saw a decrease in depression and a greater decrease than those who went through Supportive Therapy for Cognitively Impaired patients.
Mindfulness. Studies have shown evidence that practicing mindfulness can be beneficial for everyone, including those with dementia and their caregivers. Mindfulness is a practice in which a person observes their thoughts without judgment. Meditation, journaling, and following a guided mindfulness exercise are great ways to incorporate this practice into your routine.
Remember that there's no one-size-fits-all solution, but the ultimate goal is to enhance the quality of life for everyone involved. Access to information and online communities is abundant in this digital age, so stay updated on the latest dementia research from trusted sources like The Alzheimer's Association, Alzheimer's Foundation, CDC, and National Institute on Aging.