Psychiatric Aspects of Dementia

Purpose of Review: The psychiatric aspects of dementia are increasingly recognized as significant contributors to distress, disability, and care burden, and, thus, are of increasing interest to practicing neurologists. This article examines how psychiatric disorders are entwined with dementia and describes the predictive, diagnostic, and therapeutic implications of the psychiatric symptoms of dementia.

Recent Findings: Psychiatric disorders, particularly depression and schizophrenia, are associated with higher risk for late-life dementia. Psychiatric phenomena also define phenotypes such as frontotemporal dementia and dementia with Lewy bodies, cause distress, and amplify dementia-related disabilities. Management requires a multidisciplinary team, a problem-solving stance, programs of care, and pharmacologic management. Recent innovations include model programs that provide structured problem-solving interventions and tailored in-home care.

Summary: There is new appreciation of the complexity of the relationship between psychiatric disorders and dementia as well as the significance of this relationship for treatment, community services, and research.

Address correspondence to Dr Chiadi U. Onyike, Johns Hopkins University, 600 N Wolfe St, Meyer 279, Baltimore, MD 21287, [email protected].

Relationship Disclosure: Dr Onyike has received personal compensation as special issue editor for the International Review of Psychiatry and the Psychiatric Clinics of North America and has given expert legal testimony for the Paley Rothman law firm on disabilities related to frontotemporal dementia. Dr Onyike receives research funding from the Jane Tanger Black Fund for Young-Onset Dementia Research, the National Institute of Neurological Disorders and Stroke, the National Institute on Aging, the National Institutes of Health, the Robert and Nancy Hall family, and Tau Therapeutics.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Onyike discusses the unlabeled/investigational indications and evidence for efficacy and risks of prescribing antidepressants, antipsychotics, and other psychotropic agents for treating psychiatric aspects of dementia, as well as the alternatives to making these prescriptions, which include behavioral interventions, care programs, caregiver support and training, environment modulation, and structured recreation.