Exploring the Link Between Dementia and OCD
You just turned 60 and have begun to have memory lapses. You have never had problems with your memory before, but now you cannot remember anything! You cannot remember names, faces, or if you washed your hands, took your medications, or locked your door. So, what do you do? You repeat them over and over again until your hands crack and bleed and you are late for work and doctors’ appointments.
You do not understand what is happening to you, so what is happening to you is frightening. You never used to be like this. You feel like you are going crazy and losing control of your life, and it is making you cranky – very cranky. Where is the “old you” – the “you” that was positive, upbeat, and generally happy. Where is the “you” that could remember anything? What is going on and how can you make it stop?
Dementia and obsessive-compulsive disorder (OCD) are two increasingly prevalent conditions that can have a profound effect on an individual’s life. While the two conditions have distinct symptoms, there is evidence that they may be linked in some cases. In this article, we will explore the connection between dementia and OCD and the implications for diagnosis and treatment.
What is Dementia?
Dementia is a neurodegenerative condition that affects a person’s thought processes, memory, and ability to perform everyday activities. It affects approximately 50 million people worldwide. It typically presents around the age of 50, however, it can manifest earlier or later than this time. It is a progressive brain disorder caused by a variety of factors, such as one’s age, an injury, illness, or disease.
Dementia symptoms may include an inability to accurately remember recent events, an inability to speak, speak clearly, or understand language, and/or changes in one’s mood or behavior. Memory loss is the most common symptom of dementia. A person suffering from dementia typically experiences short-term memory, attention, problem-solving, language, and executive functioning issues.
There are different “types” of dementia, such as Alzheimer’s disease, mild cognitive impairment, vascular dementia, and Lewy body dementia. The most common “type” of dementia is Alzheimer’s disease, while the second most common “type” is Lewy body dementia. Lewy body dementia is characterized by thinking, movement, behavior, and sleep issues. The main difference between Alzheimer’s disease and Lewy body dementia is that Alzheimer’s disease mostly affects a person’s memory, while Lewy body dementia primarily impacts a person’s thought processes and movements.
Possible causes of this neurodegenerative condition include environmental factors, such as exposure to certain chemicals or toxins, or the APOE gene and family histories. For instance, parents or siblings who have the APOE gene are more likely to develop dementia.
Exercise and diet also appear to contribute to the development of dementia. Researchers recently found that people who adopt a healthy diet and get plenty of exercise have a lower risk of developing this disorder. But, keep in mind, however, that even with exercise and a healthy diet, a person may still develop dementia. Dementia is usually treated with a combination of therapy, medication(s), nutrition, and self-care.
What is OCD?
Obsessive-compulsive disorder (OCD) is a common anxiety condition that affects millions of people around the world. This mental health condition is characterized by recurrent and intrusive thoughts, images, fears, or urges (obsessions) that cause emotional distress (i.e., stress and anxiety), and repetitive behaviors (compulsions) that are aimed at reducing this distress.
Common OCD symptoms include irrational thoughts about being clean or orderly, repeated hand-washing or cleaning, or avoidance due to irrational fears. Similar to dementia, a variety of factors appear to cause or contribute to the development and progression of OCD.
These factors appear to be genetic, biological, or environmental. Researchers have found that people who have at least one close relative with a mental health condition, such as anxiety, depression, or OCD have a higher risk of also developing the condition. OCD treatment typically involves a combination of therapy, medication(s), and/or self-help tools.
Exploring the Link Between Dementia and OCD
A recent study suggests that people with dementia have a high risk of also developing OCD – higher than people who do not suffer from dementia. This suggests that there is a link between dementia and OCD. Conversely, another study found that people with OCD have a 3x higher risk, as opposed to people who do not have the condition, to develop dementia later in life. Researchers also found that OCD sufferers who develop dementia tend to experience worsening OCD symptoms, along with dementia symptoms, which can make either condition hard to diagnose. The researchers also discovered that the risk of developing dementia was highest in people with late-onset OCD (50+), primarily because late-onset OCD tends to be a sign of underlying and possibly undiagnosed neurodegenerative disease, such as dementia. They also found that people with certain “types” of OCD like checking or hoarding have the highest risk of developing dementia.
Ultimately, however, the exact link between the two conditions is not fully understood at this time. However, several theories have been proposed to explain this relationship. One theory is that the OCD symptoms stem from a dementia-related cognitive decline. Another theory is that the OCD symptoms increase the risk of developing dementia. Understand that most people display OCD symptoms before officially being diagnosed with dementia, however, in some cases a person with dementia is diagnosed with this condition before exhibiting OCD-like symptoms.
When a person develops OCD symptoms first, this tends to resemble obsessive thoughts, and/or compulsive hand-washing, checking, or counting, followed by memory issues. For instance, if an OCD sufferer used to check the door three times exactly, once they develop dementia this may increase to 15 times, due to memory issues. These symptoms typically worsen over time.
Examples of people with OCD who later developed dementia include – an elderly woman OCD sufferer, who previously developed an obsession with contamination, and who compulsively washed her hands to ease the stress and anxiety associated with started experiencing delusions that people were stealing from her, and as a result would hide her belongings.
Similarly, an older man with OCD later developed Lewy body dementia in which he became fixated on symmetry, and as result, began to compulsively arrange and rearrange his living room furniture. Like the woman in the previous example, this individual started experiencing delusions that people were following him, and hiding his belongings.
Ultimately, more data is needed to fully determine the exact link between the two conditions.
Symptoms of Dementia and OCD
Dementia and OCD symptoms can overlap in some cases. Common dementia symptoms typically include inability to interpret language, memory issues, and/or changes in behavior. While common OCD symptoms typically involve obsessive thoughts and compulsive behaviors (rituals or routines). Both conditions appear to involve a dopamine imbalance in the brain. Dopamine is a hormone/neurotransmitter that is responsible for regulating movement, emotion, and motivation. It also contributes to a person’s ability to remember things, retain information, and learn new skills.
Both conditions also appear to involve a serotonin imbalance or deficiency in the brain. Serotonin is also a hormone/neurotransmitter responsible for regulating a person’s mood, appetite, and sleep. Serotonin, like dopamine, also appears to contribute to memory and learning. Moreover, a recent study found that people who have OCD are more likely to have abnormalities in the parts of the brain that control emotions and memory.
Researchers have also found that OCD symptoms, such as repetitive thoughts and compulsions, may resemble those found in people with dementia, which can make diagnosing OCD in older adults challenging. Keep in mind, however, that OCD symptoms can be a sign of early dementia. For example, a person with dementia may develop obsessive thoughts about cleanliness or orderliness, or may begin to compulsively wash their hands.
Risk Factors for Dementia and OCD
The risk factors for dementia and OCD are similar. Some of the most common risk factors include a person’s age, genetics, and environmental factors. Age is the most significant risk factor for both conditions, as the risk of developing dementia or OCD increases as a person ages. Genetics can also play a role in both conditions, as people who have a family history of dementia or OCD are more likely to develop either or both conditions.
Environmental factors, such as stress and trauma, can also increase the risk of developing one or both conditions. Environmental factors that can elevate one’s risk of developing OCD and dementia include a poor diet (junk foods, salty or sugary foods, and processed foods can increase inflammation in the brain and body triggering or worsening OCD and dementia symptoms), a sedentary lifestyle, smoking, chronic alcohol use, social isolation, exposure to toxins, etc.
Diagnosing Dementia and OCD
Diagnosing dementia and OCD can be challenging, as the two conditions share many of the same symptoms. For this reason, it is important for doctors to conduct a thorough evaluation to ensure an accurate diagnosis. During the evaluation, doctors will typically ask questions about the person’s medical history, family history, and lifestyle. They may also order laboratory tests and imaging studies to rule out other potential causes of the symptoms.
Specifically, diagnosing OCD symptoms typically involves checking for the presence of certain symptoms. While diagnosing dementia usually involves “ruling out” other possible causes for the cognitive decline. Keep in mind, however, that there are different “types” of dementia each with its own set of symptoms, which can make properly diagnosing it tricky. For instance, memory loss is a common Alzheimer’s disease and Lewy body dementia symptom. However, memory loss can also be a symptom of another mental health condition like depression or anxiety.
Also, understand that there are no “official” tests for OCD or dementia. There are psychological assessments (Yale-Brown Obsessive Compulsive Scale (Y-BOCS) or the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)) that can be used to diagnose OCD, while no such assessment exists for dementia. Also, while OCD is clearly defined in the DSM-5, there is no such distinction in the manual for dementia.
Treatment Options for Dementia and OCD
The treatment options for dementia and OCD can vary depending on the severity of one or both conditions. For both conditions, it is important to develop a treatment plan tailored to the individual’s needs. Treatment for people with dementia may include medication(s), lifestyle changes, and psychotherapy. Medications, like cholinesterase inhibitors, may be prescribed to slow down or delay the progression of dementia.
Lifestyle changes like adopting a healthy diet and exercising more may also help improve a person’s cognitive function. Psychotherapy is beneficial for people suffering from dementia. Psychotherapies like cognitive-behavioral therapy (CBT) can help people with dementia address their emotional and behavioral symptoms. Treatments for people with OCD may also include medication(s), psychotherapies like CBT and exposure response and prevention (ERP) therapy.
Medications like selective-serotonin reuptake inhibitors (SSRIs) may also be prescribed to reduce an OCD sufferer’s intrusive thoughts and ritualistic behaviors. CBT is the go-to treatment for both conditions because it helps the individual identify and modify dysfunctional thoughts and behaviors. ERP therapy is also a good therapy for both conditions because it is designed to reduce a person’s OCD-related and dementia-related stress, fears, and anxiety.
Although most comorbid health conditions are treated concurrently, in this case it is best to treat the conditions separately. Thus, the goal of most OCD therapists is to treat the primary condition first, which in this case is OCD. OCD should be treated separately from dementia, so the OCD sufferer can fully absorb the treatment. Once the OCD is under control, the therapist will likely refer the person to a neurologist to address the dementia.
Social Implications of Dementia and OCD
The social implications of dementia and OCD can be significant. Both conditions can affect an individual’s ability to interact with others and complete daily tasks. People with dementia may have a hard time communicating with others, while people with OCD may be reluctant to engage in social activities due to a fear of embarrassment or judgment. Therefore, it is important to be aware of these social implications because they can, and often do have a significant impact on the sufferer’s quality of life.
It is also important to provide support and understanding to those struggling with both dementia and OCD, because they will need you to effectively manage them. The best thing you can do for a loved one or friend with OCD and dementia is to be there for them. In other words, there is a shoulder to cry on, a listening ear, a cheerleader when they accomplish a goal, and a person that cares unconditionally.
Research on the Link Between Dementia and OCD
Research on the link between dementia and OCD is still in its early stages. However, there have been some promising findings that suggest that the two conditions may be linked in some cases. For example, a recent study found that people with dementia were more likely to develop OCD symptoms than those without. As studies exploring the link between dementia and OCD continue, it is important to understand the potential implications for the diagnosis and treatment of both conditions, especially when evaluating and treating people with OCD or dementia.
Prevention of Dementia and OCD
Currently, there is no way to prevent dementia or OCD, however, there are steps that a person can take to lower the risk of developing either or both conditions.
If you are predisposed to developing one or both conditions, it is important to be physically active, consume healthy foods, practice stress-management techniques like mindfulness meditation, and/or self-help tools like journaling, writing, reading, and/or joining an online OCD recovery treatment program, like Impulse Therapy, if you are struggling with OCD symptoms.
It is also important to get plenty of sleep and rest, and develop a strong support system. Getting control of your stress and anxiety is also important for preventing OCD and dementia. Lastly, it is important to stay socially-connected to others, while engaging in activities that promote cognitive health.
Research suggests that dementia and OCD are intertwined in some cases. Thus, it is imperative that people learn and understand the potential personal and social implications for diagnosis and treatment of not just one, but both conditions. Although there is no way to prevent dementia or OCD at this time, there are steps a person can take to reduce the risk of developing one or both conditions.
Understanding these implications is crucial for OCD therapists who are treating people with OCD or an OCD/dementia comorbidity. Understanding the link between dementia and OCD, can help doctors better diagnose and treat the two conditions. It is also important to be supportive of and show empathy towards people who are struggling with both dementia and OCD, because they will need your help to cope with these conditions.
If you or someone you know is experiencing symptoms of dementia and/or OCD, it is important to seek help or encourage your loved one to seek help from a qualified medical doctor or therapist. With the right treatment and support, it is possible to successfully manage both conditions.
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