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Other psychiatric problems complicate dementia


The vast majority of elderly people with dementia and almost half with milder memory problems also have psychiatric disorders that can include depression, apathy and agitation, scientists said yesterday.

Rather than dismissing these problems, doctors and family members should recognize that they can often be relieved by medications, activities and understanding.

"Almost any one of these symptoms in older people with memory problems tend to be explained away," said Dr. Constantine G. Lyketsos, a psychiatrist at the Johns Hopkins School of Medicine who led the study.

"Recognizing that these occur frequently and are treatable - probably more treatable than the memory symptoms - is the message I would want to get out."

In the study, published in today's Journal of the American Medical Association, researchers found that about 80 percent of elderly people with Alzheimer's disease and other forms of dementia suffer from one or more psychiatric problems. The leading ones were apathy, depression and agitation.

Emotional difficulties were also found in more than 49 percent of people who suffered from "mild cognitive impairment," a less profound degree of memory loss that does not rob people of their ability to live independently, manage a household, drive or carry out other basic activities.

In this group, the leading problems were depression, apathy and irritability.

While many people can be helped with antidepressants and other medications, drugs are not always necessary, Lyketsos said.

For instance, some patients who become agitated when they are left alone might feel calmer if they are placed in a day treatment program where they can engage in activities. A trained care-giver can also help a patient cope.

The study was the first to document the prevalence of psychiatric problems in people with mild cognitive impairment. It confirms the results of an earlier study of dementia patients in Utah, but was the first that examined a racially and culturally diverse group.

Dr. Ira Katz, an expert in psychiatric problems among the elderly, said the study suggests that the suffering of people with Alzheimer's and other cognitive illnesses can be alleviated.

"There is a lot that can be done about this disease, especially if one goes beyond the symptoms that everyone is most aware of, which are the memory deficits," he said.

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