By Dr. Brent P. Forester, MSc., Geriatric Psychiatrist, Bridges by EPOCH at Westford
Behavioral and emotional disturbances are virtually universal over the course of an individual’s journey through the illness of dementia. These symptoms vary based on the individual but can include:
- Anxiety
- Excessive worrying
- Depressed mood
- Verbal agitation such as yelling, physical aggression
- Pacing and wandering
- Psychosis—seeing or hearing people or things that are not present, or feeling others are trying to harm them
As you can imagine, these symptoms can be severely distressing to the individual with dementia and their caregivers and loved ones. Furthermore, studies have shown that behavioral and emotional symptoms not only adversely affect quality of life, but are also associated with increased morbidity and mortality if they remain untreated.
In order to treat these behavioral and emotional symptoms, the underlying causes must be determined. That is the role of the geriatric psychiatrist, working in collaboration with staff at a community, such as Bridges by EPOCH, in conjunction with the individual’s primary care physician. The causes of behavioral and psychological symptoms can include:
- The environment—such as excessive noise or the ways in which others interact with the person with dementia
- Medical illness—such as infection, pain, constipation
- Medication side effects
In fact, an abrupt change in someone’s mental status, with symptoms such as worsening confusion or agitation, may represent what we call a delirium or an acute confusional state. It is remarkable how often the increased agitation or confusion can be related to easily treatable medical problems such as a urinary tract infection.
Before the appropriate treatments can be implemented, the underlying causes of behavioral and emotional symptoms must first be determined. Often, eliminating an unnecessary medication, or treating arthritic pain or relieving constipation, can resolve the agitated behaviors.
Many effective treatments are behavioral in nature, such as engaging an individual with dementia in meaningful activities or altering the time of day for bathing. Sometimes, psychiatric medications are required along with the behavioral treatments to successfully reduce severe agitation, depression or paranoia.
Although dementia is almost always a progressive illness without any currently available cures, there is much we can do to improve the quality of life for those with dementia and for their caregivers and loved ones. Much of our ability to improve quality of life rests in the careful assessment and treatment of the extremely common behavioral and emotional complications of dementia. One of the most important roles of the geriatric psychiatrist is to help the staff at a community such as Bridges by EPOCH recognize and treat behavioral issues in dementia.