I was recently invited to be part of a Q&A panel at an evening discussing mental health at my church – Lansdowne Church, Bournemouth (to watch a video of the full event, click here).
The questions for me primarily focused around the issue of mental health and dementia – a very under-researched, under-diagnosed and misunderstood topic! I did my best, within my knowledge and understanding, to answer the questions that came my way, but it inspired me to look a bit further into the issue and share a blog post about it… I hope you find my musings helpful!
Mental health and dementia – what is happening in the brain?
Firstly lets take a look at what is happening in the brain for people with either dementia or living with mental health problems. For a simple and visual summary of how the brain works see the following image:
I’m not a neuro-psychiatrist (as much as I’d love to be!) and do not claim to have extensive knowledge of the brain and its workings! But two things I’d like to clarify about mental health and dementia before I start:
Mental illnesses are disorders of the brain, dementia is a disorder of the brain: it is inevitable that they will overlap.
Mental illness and dementia are NOT the same thing.
What is dementia? Most simply put, it is a change in the physical structure of the brain through death of nerve cells, and the breaking down or disruption of connections between nerve cells. There are many reasons for this depending on the type of dementia diagnosed e.g. reduced blood supply or bleeds, or clusters of unwanted protein matter damaging the cells. There are different types of dementia, and if you want to know more about this I highly recommend the set of YouTube videos produced by the Alzheimer’s Society on different types of dementia.
What is mental illness? I’m not even going to attempt to define mental health problems!
Regan (2016) (link below) summarises mental health as “a positive experience of self, individual resources including self-esteem and optimism, the ability to sustain relationships and resilience”.
There are a huge range of issues which disrupt this ‘healthy’ mental state: from mild anxiety or depression to severe cases of psychosis, schizophrenia and bi-polar. Some mental health problems can be addressed without medication, through re-training the brain – to manage emotional regulation, and to combat thought and behavioural patterns – and by making changes to live a more healthy life style. On the other hand, some problems need medication to manage physical changes in the brain and chemical imbalances.
Ultimately, in either case, the brain is not functioning in a way to keep our thought processes healthy – in turn this impacts our emotions and our behaviours.
Whatever the cause or cure, living with mental health difficulties can feel like a daily battle, taking up a lot of emotional, physical and mental strength, and can have a real impact on our ability to function.
So combine this with a disease that is already impacting the ability to function on a cognitive, physical or emotional level and you can see where the complications start!
Dementia and mental ill-health
Developing dementia when already living with mental health problems can be very difficult to manage and understand, both from the person experiencing it and those caring for and supporting them. On the other side of the coin, the physicality of what is happening in the brain in dementia can also be a cause of mental health problems.
Think about it: if parts of the brain that manage emotional regulation are disrupted by dementia, then managing distress and anxiety will be much harder: possibly leading to aggression or withdrawal. If the part of the brain that manages visual processing is disrupted, the brain may create sounds, sights or smells that aren’t really there (also known as hallucinations). Psychotic symptoms (delusions, hallucinations, apathy, aggression etc.) are surprisingly common in dementia:
41% of people living with Alzheimer’s disease present with psychotic symptoms at some point!
20% of people over 65 develop psychotic symptoms by the age of 85!
Symptoms of mental ill-health in dementia are very hard to treat in the way it would normally be treated; anti-psychotic medications have been proven to have many negative effects on the functioning, and quality of life for people with dementia; talking therapies are not effective when a person is beyond being able to articulate and process conversations.
In the later stages of dementia a person may present with symptoms and this could be as much as we can manage.
How to help
The problem with such a lack of understanding and focus on this area results in carers (and people supporting those with dementia and mental ill-health) feeling lost and under-equipped to manage presentation and symptoms.
I’ll use the summary of mental health used earlier to shape some simple advice and tips for helping those for whom mental health and dementia are issues:
- “A positive experience of health… self-esteem… positivity”
Enable the person to engage in activities that are meaningful to them – something that is familiar and will build their sense of self.
This could look like supporting people with domestic tasks, e.g. putting clothes in to a washing machine. Even if they don’t remember (or can’t work out) how to use it, they may still be able to physically put the washing in and take it out. Or it could be looking at photos of family or of life events where they take their identity.
- “Sustain relationships and resilience”
Help tackle social isolation – loneliness is horribly common among older people, and inevitably leads to depression and cognitive decline.
Find ways of increasing interaction, whether that’s visiting more often, or arranging a befriending scheme.
Isolation can happen in a busy environment – if you work in a health or care setting, make the effort to have a chat! Even short, passing conversations can help to avoid loneliness. Try talking about something meaningful to them whilst assisting with personal care tasks.
- Expression of self is another key to having a healthy mental state.
Try different sensory approaches – communication isn’t just talking! Use music or art, textures and touch/pressure to allow expression of feelings or frustrations. Or use pictures or sounds to reminisce.
The first thing to ALWAYS remember when managing symptoms of dementia and mental ill-health is to know the PERSON and to ensure they are at the centre of all we do.
You can read my blog about the Enriched Model of Dementia Care for a more detailed reminder.
For anyone wanting to know more about this topic, I’d encourage you to read this recent review (where I got a lot of my information for the first part of this blog post!): The interface between dementia and mental health.
Please do scroll back through my other blog posts and/or get in touch for more details and advice about living with dementia, and for caring for people with dementia.