Recognising psychological issues in someone with dementia requires careful observation and a good understanding of potential stressors (see Assessment of Psychological Factors). These signs can sometimes overlap with dementia itself.
Below are some common signs of psychological distress to look out for:
1. Changes in Mood
Does the person seem persistently sad? Are they expressing feelings of hopelessness or becoming more withdrawn? Have they become unusually irritable or anxious, worrying about things they didn’t before?
2. Behavioural Changes
Since a person with dementia may struggle with expressive communication, psychological distress is sometimes communicated through behaviour.
The person may demonstrate responsive behaviours such as aggression, agitation, or restlessness. These changes can signal feelings of fear, paranoia, or anxiety.
Repetitive actions or compulsive behaviours may also indicate obsessive-compulsive tendencies, especially in types of dementia like Frontal Temporal Dementia.
3. Changes in Thought Patterns
Delusions (false beliefs that aren’t in keeping with reality), hallucinations (seeing or hearing things that aren't there), paranoid thoughts, and irrational fears can occur in psychotic disorders but can also be linked to conditions like Lewy Body Dementia, Advanced Dementia, or Delirium.
A full biopsychosocial assessment is important to understand the cause of these changes and determine the best treatment.
4. Changes in Sleep Patterns
Sleep disturbances, such as insomnia, frequent waking, or excessive sleeping, can be related to low mood, depression, or other psychological conditions. It’s important to know the person’s baseline sleep patterns so that changes can be identified.
Changes in sleep should be assessed alongside physical and social factors, including medication changes or infections, and a medical assessment should be carried out by the person's GP.
5. Social Withdrawal
A loss of interest in social activities or interactions can sometimes signal low mood or psychological distress. It’s important to explore the reasons for this withdrawal.
As dementia progresses, a person may develop apathy, which can look like depression but is different. Recognising apathy in people with dementia is crucial, as it can significantly impact their quality of life. Apathy can lead to increased social withdrawal, physical inactivity, and a lack of engagement in life. As a result, it may reduce the person’s overall well-being and create a cycle of further cognitive and emotional decline.
People with dementia who experience apathy may show signs such as:
- Loss of Initiative: They may stop starting tasks or lose interest in things they once enjoyed, such as hobbies or daily activities.
- Reduced Verbal Interaction: They may speak less and show little desire to engage in conversations.
- Physical Inactivity: They might become less physically active, spending long periods sitting without engaging in movement or exercise.
- Neglect of Personal Care: They may stop looking after themselves, including neglecting hygiene, dressing appropriately, or eating regularly.
- Flat Affect: They may display little emotional expression, appearing indifferent to both positive and negative news.
- Lack of Reaction: They may show no reaction to events that would usually provoke a response, such as a change in routine or the death of a loved one.
- Difficulty with Planning or Goal Setting: They may struggle to make decisions, plan activities, or set goals, which can further contribute to a sense of helplessness or withdrawal.
Apathy is thought to be caused by several factors, which can include:
- Neurological Changes: Damage to the frontal lobes of the brain, which are responsible for motivation, planning, and goal-directed behaviour, can lead to apathy. This damage is common in various forms of dementia, especially in frontotemporal dementia.
- Changes in Brain Chemistry: Neurotransmitters like dopamine, serotonin, and noradrenaline, which are involved in motivation and emotional regulation, can be reduced in the brain in conditions like dementia. This reduction can contribute to symptoms of apathy.
- Vascular Changes: In vascular dementia, changes in the brain’s white matter (due to reduced blood flow) can disrupt communication between different regions of the brain, which may lead to symptoms of apathy.
The treatment of apathy in people with dementia primarily involves non-pharmacological interventions. These may include:
- Structured Activities: Engaging the person in regular, meaningful activities that they enjoy can help to stimulate interest and motivation.
- Routine and Familiarity: Maintaining a consistent routine and providing a predictable environment can help the person feel more secure and engaged.
- Physical Exercise: Encouraging regular physical activity can improve mood and help combat some symptoms of apathy.
- Cognitive Stimulation: Mental exercises, puzzles, and discussions may help the person stay mentally active and involved.
- Social Interaction: Facilitating social interactions with family members or peers can help reduce social withdrawal and encourage emotional engagement.
While medications for apathy in dementia have been explored, the evidence is not strong enough to support them as first-line treatments. Current treatments focus on enhancing engagement and quality of life through structured activities, social support, and environmental modifications.
6. Cognitive Decline
Psychological distress can also show as a decline in cognitive function that goes beyond the usual progression of dementia, such as losing interest in social activities and hobbies earlier than expected. It’s important to consider the possibility of low mood, depression, or other psychological disorders.
(See Assessment of Psychological Factors »)
7. Expression of Suicidal Thoughts
Any mention of life not being worth living, self-harm, or suicidal thoughts must be taken seriously. These should be referred to a medical professional for immediate assessment and treatment.
See section on Treatment of Psychological Distress »
