Dementia

The death or permanent dysfunction of nerve cells in the brain causes dementia.  All information is stored on nerve cells.  As dementia kills the brain, victims lose intellectual function and develop psychiatric complications.  Many individuals develop behavioral problems that vary from individual to individual; personality or temper may change.  Early dementia stages exhibit anxiety and depression while the middle stages of the illness often produce many other psychiatric problems.  Some psychiatric symptoms are treatable with medications that may improve the quality of life for the person with dementia as well as the family.  The following are psychiatric complications of dementia:

Depression

Depression is a disorder of the brain and not a human failure.  Mood is controlled by nerve cells in deep brain regions called the brain stem.  Destruction of nerve cells in the brain stem makes some people depressed.  Depression may present as sadness or irritability, loss of weight, withdrawal from family, and talking about death.  Depression is a chemical imbalance of the brain and is not caused by a weak spirit.  A person cannot make himself or herself feel better.  It is recommended that a doctor be consulted, as medication is available to treat depression.

Auditory Hallucinations

The brain stores the recognition of many sounds and voices on nerve cells.  Alzheimer’s disease and other dementias damage parts of the brain in the temporal lobe, the area that remembers or interprets the spoken word.  When these dying brain cells do not function correctly, a person may hear voices or sounds that are not real.  These false sounds are real to the person with auditory hallucinations, however.  The hallucinations may be voices, music, animals, or disturbing sounds.  The hearing nerve cells are usually not effected.  It is recommended that a doctor be consulted, as medication for auditory hallucinations may be available.

Visual Hallucinations

The brain stores many visual images on nerve cells.  The brain area for vision is usually spared by dementia and Alzheimer’s disease but the nerve cells that interpret vision are damaged.  When damaged vision nerve cells do not function correctly, a person will see things that aren’t there.  Alzheimer and dementia may cause an individual to see animals, dead relatives, strangers, and frightening or disturbing things.  These visions are very real to the person with dementia and arguing will not help.  It is recommended that a doctor be consulted as visual hallucinations are often improved with medication. 

Delusions

One out of every three people with dementia will develop delusions.  These individuals may accuse family of stealing, cheating, or lying.  Such false beliefs are caused by damage throughout the brain of someone with dementia or Alzheimer’s disease.  Do not argue when such an individual makes false statements, simply change the subject or distract the patient.  It is recommended that a doctor be consulted as these false ideas are caused by the disease and may improve with medication.

Temper and Personality

Most dementia kills brain cells in the frontal lobes where the information concerning social graces, self-control and manners is stored, and personality or temperament may change.  Some people become irritable, hit others when angry, use profanity, and act very different from their normal behavior.  Severely hostile or disruptive behavior (e.g., hitting) may improve with medication but annoying or embarrassing behavior (e.g. cursing) should be ignored.

Sundowning

Many people with dementia are friendly and calm until 3 or 4 o’clock in the afternoon when they become restless and uncooperative.  Psychiatric symptoms may become more apparent in the late afternoon or early evening.  Distress and disorientation may continue until early morning.  An individual exhibiting these symptoms may nap during the morning or early afternoon.  This behavior is called “sundowning” because when the sun goes down the patient gets up.