Manage the Emotional Challenges 
Associated with Memory Loss

A diagnosis of dementia immediately triggers thoughts about memory loss, trouble concentrating, poor judgment, and difficulty with communication. But there is also an emotional aspect of dementia that can be just as challenging as many of those cognitive changes. The emotional consequences are felt by individuals who are still able to process a future of declining cognition, as well as by those in the later stages of dementia, who experience uncontrolled mood swings, personality changes, and emotional upheavals simply as a result of the changes going on in the brain.

Psychiatrist Felipe Jain, MD, director of Healthy Aging Studies at the Depression Clinical and Research Program at Massachusetts General Hospital, explains that anxiety is a common response when someone is formally diagnosed with mild cognitive impairment (MCI), a stage between normal, age-related thinking skills changes and more serious changes associated with dementia. MCI can be a permanent state, or it can be a precursor to full-blown dementia.

Providing calm reassurance and support can help ease the anxiety and agitation experienced by those struggling with memory loss.

“In the early stages, someone diagnosed with MCI often experiences anxiety,” Dr. Jain explains. “Their future is unknown. They could stay at that stage for the rest of their life, or could progress to dementia in a relatively short-term timeframe. Worrying about what is going to happen to them, where they might end up, and about the impact of the decline on their family is common. Reactions to being diagnosed with dementia range from grief to anger to outright denial.”

Emotions and Brain Changes

There are several different types and causes of dementia, including Alzheimer’s disease (AD), Parkinson’s disease (PD), frontotemporal dementia, and others. These all stem from harmful changes to the structure of the brain and the health of brain cells (neurons). And while some of the more obvious changes include forgetfulness and confusion, serious mood disorders can develop from the same conditions injuring brain tissue.

“The brain damage causing dementia can result in many symptoms, including depression and extreme anxiety,” Dr. Jain says.  “The person can become confused and focus on these emotions, and even try to hide their memory loss from family members and even from health-care providers. Sometimes health-care providers only diagnose depression or anxiety and believe that this is the major problem due to the patient minimizing their other symptoms. It is very important to look out for uncharacteristic or prolonged depression or anxiety in someone with memory problems, or for a person with these lifelong symptoms who develop memory problems, and to have them evaluated by a specialist.”

The particular type of dementia often determines the emotional changes that occur, both in the early and late stages. For example, frontotemporal dementia often starts out with behavioral and emotional changes due to the regions in the brain that are first affected by the disease, Dr. Jain explains. “Some patients have variants of dementia that cause early problems with word finding, and they often have difficulty expressing their feelings,” he adds. “Alzheimer’s begins with memory loss, and basic emotional function is preserved until very late in the illness. However, as dementias progress, it is common that patients develop an inability to express their emotional distress and may become agitated, irritated, or more confused due to pain, other physical symptoms they cannot explain, or anxiety.  When dementia reaches this stage, it can be useful to suggest to the patient something they might be feeling or needing and ask if that is correct.”

For instance, an individual may be feeling overwhelmed by visitors or want to take a nap, but be unable to express those thoughts. Gently asking a few questions may provide answers and may calm the person before an outburst occurs.

Strategies That Can Help

While each individual’s emotional needs are unique and likely to change as their dementia and health change, there are some generally accepted approaches that are often helpful.

One of the most important strategies is to create a stress-free environment that makes the person feel comfortable, whether they‘re living at home, a skilled nursing facility, or other setting. “It is important to help the person with cognitive decline return to familiar emotional ground with music, pictures, memories, or stories,” Dr. Jain says.

Also helpful is remaining calm when a loved one becomes upset, even if that person acts in a way that is hurtful. “In some situations, when the person becomes confused and angry or irritated, it is helpful not to confront them or become defensive and better to distract them and try to engage in a different activity,” Dr. Jain says. “It is no longer about who is ‘right,’ but about how to build a bridge with someone whose mind is trapped in a different world. They cannot be ‘made’ to see what is right—even about basic things, such as the death of a family member. Forcing them to confront the truth can do more harm than good. Despite the confusion, they are still the same person in many important ways, but may have trouble refocusing their attention in ways that are life promoting and on things they can understand.” MMM

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Associated with Memory Loss appeared first on University Health News.

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