Medical professionals and the public alike have long debated the question of whether Dementia is a mental illness or not. It is a complex issue with various interpretations and the potential for confusion. Let’s tackle this conundrum step by step. First, it’s important to understand what Dementia is and what exactly classifies as a mental illness.
Dementia is a term used to describe a group of symptoms that impact a person’s ability to think, communicate, and carry out daily activities. This progressive brain disorder (meaning that it gets worse over time) is characterized by memory loss, difficulty with basic tasks, and confusion, which can eventually lead to a decline in cognitive and physical abilities. Although Dementia can occur as early as the 40s or 50s, it is more commonly found in people over 65.
Many people confuse Alzheimer’s disease with Dementia, but they are not quite the same thing. Dementia is caused by a variety of diseases that affect the brain. These may include Alzheimer’s disease, vascular Dementia, Lewy body dementia, frontotemporal Dementia, and Huntington’s disease. But Alzheimer’s disease, in itself, is just one type of Dementia. It is like comparing headaches to migraines.
In other words, every case of Alzheimer’s disease is an example of Dementia, but not every type of Dementia is Alzheimer’s. However, it is interesting to note that Alzheimer’s disease is the most common form of Dementia, accounting for up to 70% of cases.
What Classifies as a Mental Illness?
According to the National Institute of Mental Health (NIMH), mental illness refers to a
“wide range of mental health conditions – disorders that affect your mood, thinking, behaviour, and overall functioning.”
In layman’s terms, a mental disorder is a behaviour that significantly impairs your ability to function normally in society every day. The problem with classifying mental illnesses in any given era has always been the subjective nature of what is considered normal, and by extension, abnormal, in that era.
For example, at a time when people were more physically active and less educated, conditions such as ADHD might not have been considered a disorder; because daily life consisted more of manual labour, and symptoms like ‘being unable to sit still’ or ‘difficulty focusing’ did not get in the way of leading a “normal” life.
Another key challenge in defining mental illnesses is that it is not always clear what causes them. A combination of genetic, environmental, and lifestyle factors can cause mental illnesses. This makes it difficult to determine the underlying cause of a mental illness and to develop effective treatments.
Despite the challenges, mental illnesses are still classified and diagnosed by mental health professionals using a standardized system known as the Diagnostic and Statistical Manual of Mental Disorders (DSM), also referred to as “psychiatry’s bible”.
According to this, a critical criterion for diagnosing a mental illness is that the symptoms are not due to a medical condition or substance abuse. For example, a person who experiences symptoms of depression may be misdiagnosed if their symptoms are actually caused by an underlying medical condition such as a thyroid disorder.
Some common examples of mental illness include depression, anxiety disorders, Schizophrenia, bipolar disorder, and obsessive-compulsive disorder (OCD).
Let’s read about some common symptoms of Dementia now, to find out how similar they are to those of mental health conditions.
- Memory loss: One of the most common and early symptoms of Dementia is memory loss, particularly for recent events.
- Difficulty with everyday tasks: People with Dementia may have trouble carrying out daily tasks, such as preparing meals, shopping, and managing their finances.
- Confusion: People with Dementia may become easily confused, especially in new or unfamiliar environments.
- Language problems: They may also need help with speaking or writing and understanding others.
- Disorientation: People with Dementia may become disoriented and lose track of time and place.
- Mood swings: They may experience mood swings and become easily agitated, irritable, or depressed.
- Decreased motivation: A loss of interest in daily activities and a decrease in motivation can also be a symptom of Dementia.
Comparison to Mental Illnesses
Memory loss is a common symptom of both Dementia and a common mental health condition: Depression. People with depression may experience forgetfulness and difficulty concentrating, similar to the memory problems experienced by people suffering from Dementia, therefore they might also face difficulty in maintaining healthy relationships with say, a family member or friend.
Additionally, both depression and Dementia tend to change a person’s mood and behaviour, making it difficult to differentiate between the two conditions.
Another mental disorder that has similar symptoms to Dementia is Schizophrenia. Schizophrenia is a mental health condition that affects a person’s ability to think clearly and can cause confusion, disorientation, and memory problems. These symptoms are very similar to those experienced by people with Dementia.
Also, both Dementia and Attention-Deficit/Hyperactivity Disorder (ADHD) can cause problems with attention and concentration. People with Dementia may have trouble focusing and retaining information, while people with ADHD may have difficulty paying attention and staying on task. Additionally, both conditions can cause impulsiveness and restlessness, which can be mistaken for each other.
But does that mean that they are one and the same? Or that Dementia can be classified as a mental illness? Not so soon. The differences between these conditions cannot be ignored either. Dementia, for instance, is a decline in cognitive function that affects a person’s ability to perform daily activities, while ADHD is a neuro-developmental disorder that affects a person’s ability to control their behaviour and pay attention.
However, one thing is certain: Several common symptoms are shared among patients with mental health conditions and Dementia and all of them impact a person’s self-esteem aggressively.
Stages of Dementia
The stages of Dementia vary in different individuals, they range between severe and moderate stages, but they typically follow a similar pattern
- Early stage: In the early stage of Dementia, a person may experience mild memory loss and difficulty with basic tasks. They may also become more forgetful, but can still carry out most activities independently in their daily life.
- Middle stage: In the middle stage of Dementia, a person’s symptoms become more pronounced, and their ability to function normally decreases. They may start having trouble recognizing their friends and family members and may require more help with everyday activities.
- Late stage: In the later stage of Dementia, a person’s cognitive and physical abilities decline significantly and it becomes extremely challenging for them to tend to their own needs. By this stage, the symptoms of all types of Dementia become very similar. They may require full-time care and assistance with basic tasks, such as eating, bathing, and dressing. This is also the shortest stage of Dementia, which may last up to two years.
Related Disease and Causes of Dementia
Some of the most closely related diseases and causes of Dementia also happen to be mental health conditions. Let’s read about these disorders and how they are related to this major neurocognitive disorder that has been baffling us for so long. The most common mental disorder to cause dementia is Alzheimer’s disease
1. Alzheimer’s Disease
A type of Dementia, a general term used to describe a decline in cognitive function, including memory and reasoning. Alzheimer’s disease is the most common cause of Dementia, accounting for 60-80% of cases in dementia patients.
The onset of Alzheimer’s disease typically occurs in the middle or the later stages of life. The disease progresses over time, leading to increased memory loss and difficulty with other cognitive functions such as driving or cooking.
The exact cause of Alzheimer’s disease is still not fully known, but it is believed to involve a combination of genetic, environmental, and lifestyle factors. As the disease grows over time, brain cells are damaged further and may die, resulting in impaired cognitive function. The brain also undergoes physical changes during this time, including the formation of plaques and tangles, which are thought to contribute to the damage of brain cells.
It is important to note that not all individuals with Dementia have Alzheimer’s disease and that the progression and Dementia symptoms can vary greatly between individuals depending on factors such as whether or not they suffer from late-onset schizophrenia.
2. Vascular Dementia
It is a type of Dementia that is caused due to insufficient blood supply to the brain, which damages and eventually kills the brain cells. This disease ranks a close second to Alzheimer’s in causing dementia.
This can happen due to a variety of factors, such as stroke, high blood pressure, heart disease, or diabetes. People who have had a stroke in the past are considered to be at an increased risk of developing vascular Dementia because a stroke can cause brain damage, resulting in Dementia.
The symptoms of vascular Dementia can vary depending on the severity and location of the brain damage, but they typically include difficulty with memory and thinking, episodes of confusion, and problems with coordination and balance.
The progression of vascular Dementia can be slow or rapid, and the symptoms may appear suddenly after a stroke or develop gradually over time. In some cases, the symptoms may improve with treatment for the underlying cause, such as high blood pressure or diabetes. In other cases, the symptoms may progress, leading to a decline in cognitive and physical abilities.
3. Lewy Body Dementia
(LBD) is a progressive brain disorder that affects a person’s ability to think, move, and control emotions. It is the second most common type of progressive Dementia after Alzheimer’s disease, affecting an estimated 1.4 million people in the United States only.
LBD is characterized by the presence of abnormal protein deposits called Lewy bodies in the brain, which can impact various functions such as memory, attention, and movement. The symptoms of LBD can vary from person to person and may include changes in sleep patterns, visual hallucinations, and fluctuations in attention and alertness.
LBD can also cause symptoms that are similar to Parkinson’s disease, such as tremors, slow movement, and stiffness in the limbs. As the condition progresses, people with LBD may experience changes in mood, behaviour, and cognitive abilities, and may eventually require full-time care.
4. Frontotemporal Dementia
(FTD) is a type of progressive Dementia that affects the frontal and temporal lobes of the brain. These regions are responsible for what is known as ‘Executive Functions’. These are mental processes that enable us to plan, focus attention effectively, remember instructions, and help in decision-making. When these are affected by FTD, it may lead to changes in behaviour, language, and memory.
FTD typically affects people between the ages of 45 and 65 and is often misdiagnosed in its early stages because it’s another type of Dementia that has symptoms that resemble those of other mental health conditions, such as depression or bipolar disorder. Common symptoms of FTD include changes in behaviour, such as impulsiveness, disinhibition, and apathy, as well as changes in language, such as difficulty speaking, writing, and understanding language.
As FTD progresses, individuals may experience worsening memory and cognitive difficulties, as well as physical symptoms such as difficulty swallowing and muscle weakness.
5. Huntington’s Disease
It is caused by a genetic mutation in the HTT gene, which is a Protein Coding gene that helps produce the huntingtin protein. This protein is essential for normal brain function. This mutation in the HTT gene results in the production of an abnormal form of huntingtin, which accumulates in the brain and damages nerve cells over time.
The symptoms of Huntington’s disease typically appear in people between the ages of 30 and 50 and lead to a significant deterioration in physical and mental abilities over time.
6. Parkinson’s Disease
It is a health condition that affects the way a person moves. It happens when certain nerve cells in the brain stop working properly. These cells are responsible for making a chemical called dopamine, which helps control the human body’s movement. When these cells die or don’t work well, there is not enough dopamine in the brain, which results in stiffness and slowed movement.
The exact relationship between Parkinson’s disease and Dementia is still not fully understood. Still, researchers suggest that both conditions may share common underlying causes, such as changes in the brain’s structure and functions. The onset of Dementia in individuals with Parkinson’s disease typically occurs several years after the movement disorder diagnosis.
Changes in memory and attention often characterize Dementia in Parkinson’s, and executive function, although some individuals may also experience changes in language and visual-spatial abilities.
Parkinson’s disease and Dementia have a complex relationship, with up to 80% of individuals with Parkinson’s disease developing some form of Dementia.
Treatment Options for Dementia
The most common treatments for Dementia focus on the patient’s cognitive symptoms, such as memory loss, confusion, and difficulty communicating, but it is pertinent to find appropriate treatment for each patient. Medications are often prescribed to manage these symptoms and may include cholinesterase inhibitors and antipsychotic drugs.
In addition to medication, changes in lifestyle can help slow down the progression of Dementia. These may include changing the patient’s diet and nutrition, physical activity, and social activities. Participating in social activities, such as going for walks, attending classes, and engaging in leisure activities, can help reduce symptoms of isolation and depression.
Therapies can also prove to be beneficial for people suffering from Dementia. These therapies include cognitive stimulation therapy, reminiscence therapy, and music therapy. Cognitive stimulation therapy involves activities that focus on improving memory, attention, language skills, and problem-solving.
Reminiscence therapy is a type of therapy that focuses on helping the person recall memories and encourages them to talk about their past experiences. Music therapy can help people with Dementia recall memories, improve communication skills, and reduce anxiety.
Finally, environmental modifications can make home and community settings safer for people with Dementia. These modifications may include adding grab bars in bathrooms, removing throw rugs, and ensuring minimal distractions when communicating.
While Dementia cannot be cured, there are treatments available that can help manage the symptoms and slow the progression of the condition.
Dementia as a Mental Illness
So, is Dementia a mental illness? It is still far from easy to provide a straightforward and satisfactory answer to that. Based on what we have discussed thus far, some might argue that it is not a mental illness because it is primarily caused by physical changes in the brain, such as the death of brain cells, and not by psychological factors. They might also argue that Dementia is not a psychiatric condition and does not involve direct changes in a person’s personality or mood.
However, others might argue that Dementia is a mental illness because it affects a person’s behaviour and mental processes. For example, a person with Dementia may have mood swings, become agitated and confused, or have difficulty communicating. And these changes can very well have a significant impact on a person’s mental well-being and functioning in everyday life.
In conclusion, whether or not Dementia is considered a mental illness is a matter of perspective. But what is essential is that we recognize how Dementia can affect mental health and well-being and provide the necessary support and resources required for them to cope with the challenges they face because of it.
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