Managing Psychological Symptoms of Dementia (Podcast)

A medical school epiphany propelled Dylan Wint, MD, toward his career in brain health.

“In my neurology and psychiatry training, I saw folks who had healthy bodies, and yet if their brains were diseased, they had pretty miserable lives,” says Dr. Wint. “And conversely, I saw people who had really devastated physical statuses, but if they didn't have depression and they were cognitively intact, they were quite happy and content. So I thought the best way to approach healing was from the head down.”

In a recent episode of Cleveland Clinic's Neuro Pathways podcast, Dr. Wint discussed complex psychological symptoms associated with dementia and the best strategies for managing them. Dr. Wint is Medical Director of Cleveland Clinic Nevada and has extensive experience in treating neuropsychiatric symptoms in patients with dementia. His approach integrates medical, educational and behavioral strategies to support better quality of life for patients and their caregivers.

Dementia affects millions worldwide and brings with it a host of neuropsychiatric symptoms that profoundly affect patients and their caregivers, from depression and irritability to agitation, delusions and hallucinations. Among especially difficult symptoms is Capgras syndrome, a form of misidentification syndrome in which the person thinks that a loved one has been replaced by an imposter, says Dr. Wint.

“It is one of the most devastating things that happens for a caregiver when their spouse or their parent or their child no longer recognizes who they are, or disconnects who they are from the emotional relationship that they've had over the years,” says Dr. Wint.

Click the podcast player above to listen to the xx-minute episode now, or read on for a short, edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Excerpt from the podcast

Podcast host Glen Stevens, DO, PhD: What are the most common neuropsychiatric symptoms associated with dementia?

Dylan Wint, MD: In people with relatively mild dementia, the most common symptoms we see are depression, apathy and irritability. Sometimes anxiety. As dementia progresses, we tend to see more severe symptoms like agitation, aggression, hallucinations and delusions. This varies somewhat depending on the specific type of dementia. So for example, dementia with Lewy bodies is notorious for – and in fact, one of the diagnostic criteria is – visual hallucinations, which can occur very early. They can even be the very first symptom. So there's this broad description of which symptoms occur early and late, but it does depend on the specific type of dementia.

Dr. Stevens: This may be a difficult question to answer, but what is the underlying etiology of these neuropsychiatric symptoms?

Dr. Wint: The most straightforward answer I can give is that because behavior originates in the brain, a degenerating brain is likely to produce abnormal behaviors. But there are also some meta effects of the cognitive component. So for example, if you are highly forgetful and your spouse tells you that they are going out, and you forget that they were going out and they come back three hours later, you in the meantime have been wondering where they are. You can be pretty agitated and irritable by the time that loved one gets home. And so I believe that the cognitive dysfunction can sometimes contribute to the behavioral symptoms, perhaps as much as the actual physical degeneration and neurochemical degeneration of the brain itself.

Dr. Stevens: What about paranoia? How common is it to see problems related to it?

Dr. Wint: We do see this quite commonly. Sometimes it's a relatively subtle refusal to take medications. If someone is not paranoid and their spouse tells them ‘These are the medicines the doctor suggested you take,’ typically they'll go along with it. But a subtle paranoia can be exhibited by that refusal. And then there can be more intense paranoia, literally saying that a loved one or a caregiver is out to kill them or to harm them purposely. I don't know the specific percentage, but it is a frequent occurrence.