Angry outbursts, paranoia, hallucinations—any or all these behaviors may be indicative of mental illness, but they also may manifest themselves in individuals who have dementia. While symptoms may be similar, dementia should not be treated as a mental illness but rather as a distinct condition that has separate causes and treatments.
Is Dementia An Illness?
Depending upon which authority you consult, you may see dementia classified as an illness, a disorder or a set of symptoms that characterize a condition. The Centers for Disease Control and Prevention (CDC) describes dementia as an illness of older adults but also as an umbrella term for a group of cognitive disorders that are typically characterized by memory impairment and other difficulties in brain function.
However, the Alzheimer’s Association points out that dementia does not refer to a specific disease. “It’s an overall term that describes a range of symptoms that are associated with a decline in memory loss and thinking skills that is severe enough to interfere with a person’s daily life,” says Claire Day, Senior Vice President of the association’s Delaware Valley Chapter.
Alzheimer’s disease accounts for 60 to 80 percent of all cases of dementia, but Day contends that it would be incorrect to use the terms “dementia” and “Alzheimer’s” interchangeably since there are other forms of dementia such as frontotemporal dementia, vascular dementia and dementia with Lewy Bodies (DLB). In some cases, dementia is part of another medical condition such as Parkinson’s disease or Huntington’s disease.
Mental Illness and Dementia
Many authorities contend that dementia is distinct from mental illness, although they may share symptomatic similarities. In the Diagnostic Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, dementia is listed as a neurocognitive disorder. This classification differentiates dementia from such mental disorders as schizophrenia, bipolar disorder and autism and acknowledges that dementia-related disorders are linked to impairment in the functioning of the brain.
Day observes that diagnostic tools reveal the damage that dementia inflicts on the brain. “Through the PET scans of individuals with dementia, you can see clear deficits,” she says, though she also points out that some cases of dementia are only revealed upon autopsy.
Individuals with a history of mental illness may subsequently develop dementia, but it may be difficult to diagnose when the two conditions co-exist in one person.
“Some of the classic warning signs of dementia may be missed on the initial assessment because it’s attributed to the mental illness,” Day says. “It’s important for families to know what those warning signs and to advocate for a thorough medical workup to ensure that the right diagnosis is given.”
Is Dementia a Mental Disorder?
If we accept the premise that dementia is not a mental illness, could it be classified as a mental disorder? While it may be splitting hairs to accept one term over the other, the medical definition of a mental disorder as “a physical or mental condition that is not normal or healthy” seems to fit.
However, unlike many mental disorders, there are discernible neurological impairments that cause dementia. For instance, as Day observes, Alzheimer’s disease is caused by plaques and tangles in the brain.
Those with dementia may suffer not only from memory loss and confusion but also from such behavioral symptoms as anxiety, agitation, anger, paranoia, hallucinations and depression. However, it’s important to note that not every person with dementia experiences these extreme behavioral changes.
Treating behavioral symptoms in someone with dementia would not necessarily take the same course as treating someone with mental illnesses. In fact, Day reports that some psychotropic drugs should not be administered to those with dementia because they could do more harm than good.
There are several strategies that have been proven to work better that pharmacological intervention in dementia cases. For instance, Day says, “Those with dementia are going to be reactive to certain things in their environment, so changing the stimuli or changing the environment may be the best way to calm the individual.”
For those concerned about the behavioral symptoms of dementia, Day recommends calling the Alzheimer’s Association 24-hour hotline for advice at (800) 272-3900.