Psychiatric Complications in Dementia

Abstract

Psychiatric complications are very common in all dementias, which are best conceptualized as neuropsychiatric diseases. The most common complications involve disturbances in emotions (depression, anxiety, apathy, affective lability, irritability, and euphoria), psychosis (delusions and hallucinations), and behavior (restlessness and aggression). These complications are quite heterogeneous and can be difficult to categorize because of fluctuations in symptoms over time and the frequent occurrence of subsyndromal symptoms. Psychiatric co-morbidity is very common in dementia, and most of these symptoms or syndromes are associated with excess functional disability. In addition, psychiatric disturbances in the context of dementia are associated with poorer outcomes, decreased quality of life, increased institutionalization, and caregiver distress. Our understanding of the etiology and pathophysiology of behavioral and psychological signs and symptoms in dementia is limited. Screening instruments are available to assist in clinical evaluation and there are a variety of treatment options, both psychopharmacological and psychosocial. This chapter covers the neurobehavioral complications of common dementias not covered elsewhere in this book, specifically Alzheimer's disease (AD), vascular dementia (VaD), and frontotemporal dementia (FTD).