Mental health symptoms vary by disease of dementia. Here's how to differentiate from Alzheimer's

Caption

Outside the Carter Center for the Brain Health Forum

Credit: Ellen Eldridge/GPB

Researchers are looking at ways to recognize dementia early by paying attention to behavioral changes, Dr. Cristina Pritchett with Emory School of Medicine said at the 29th annual Brain Health Forum at the Carter Center.

Older adults experiencing changes in mood, behavior or personality could be at risk for dementia, specially when coupled with cognitive decline, she said.

The main neuropsychiatric symptoms include depression, which can affect up to 40% of patients with dementia. It's characterized by withdrawal, fatigue, irritability and also lack of motivation. It can look different according to the types of dementia. 

"For instance, in frontotemporal dementia, we may see more apathy or loss of empathy," Pritchett said, "whereas in Lewy body dementia, we might see more rapid mood swings that might change within an hour or so."

• RELATED: Dementia diagnoses are widening gap between quantity and quality of life

In the cases of frontotemporal dementia, it might be more like feeling more impulsive or inappropriate in social settings, like making rude comments to people, but in Alzheimer's, it might be a bit more fear- or confusion-driven, she said.

Pritchett said agitation and irritability impact up to 70% of people living with Alzheimer's disease.

"Then we have anxiety, which can be present in 38% to 41% of the patients across all stages of dementia," she said. "And it can be common in Alzheimer's, but also Lewy body, and that can be characterized by fear or tension, feeling restless, repeating questions, feeling like a sense of panic — and that can worsen with changes or overstimulation, but can improve with consistent routines in a calm and predictable setting."

One of the recommended treatments is cognitive behavioral therapy, which is a type of therapy that allows experts to identify behaviors that are not helpful and reframe them for better coping.

Sometimes pain, hunger, fear, loneliness, or being in an overstimulating environment causes anxiety, but communication difficulties can add to frustration, Pritchett said, adding that "it can have a big impact on caregivers and can lead to faster functional decline and also higher placement in facilities."

When agitation happens, it's important to identify the underlying cause, she said, noting that non-pharmacological approaches are preferred.

• MORE: Early onset dementia is making the caregiving crisis worse

Psychosis increases as the disease of dementia progresses, which can affect 20% to 50% of patients, she said. 

"In the case of Lewy body dementia, we might see more vivid visual hallucinations, so people might tend to see things that other people don't see, like animals or people, and these tend to happen more in the afternoon and can happen in up to 75% of the cases," Pritchett said. "In the cases about Alzheimer's, it might come more like paranoia, feeling suspicious, and in frontotemporal dementia, it can happen, but it's less common."

Caregiver support is important because the care of the measure starts by understanding memory loss and behavioral changes and learning about communication, learning how to handle these behaviors and making sure to keep a safe environment.