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Friday, January 07, 2011

Can Bipolar Disorder Cause Dementia?

We normally think of bipolar disorder as a treatable for most patients.  My experience is that if the patient is compliant with treatment (and that is a big "if"), then symptoms can be mostly controlled. 

Unfortunately, there is some evidence that some persons with bipolar disorder may eventually develop more enduring memory problems and other cognitive deficits.  I frequently have bipolar patients referred to me for assessment of memory problems or evaluation for possible dementia, and usually I do find mild to moderate problems. 

Most of the patients referred to me in this situation are in their fifties, not in their sixties, seventies, and eighties, as usually occurs when I am testing patients for dementia.  This suggests to me that there is something very different about this process than Alzheimers.  It seems to develop earlier in life, causing problems in one's job.  In addition, the patient seems to have more insight that they are having problems, whereas many of the patients with Alzheimers are brought by their family members and do not have insight that they are having cognitive problems.  However, if there is such a thing as a bipolar dementia, we do not as yet have a clear picture of what t would look like in terms of specific symptoms like to differentiate it from Alzheimers, ischemic dementia, and so on.

In a situation of testing a person with bipolar disorder, it is always possible that their memory problems are actually due to their depression.  Depression causes a generalized decrease in brain function and interferes with memory.  And so, part of the evaluation always has to be looking at the current severity of depression.  But the cognitive deficits associated with bipolar disorder do not appear to be linked to whether the person is currently depressed or not.  There seems to be something else going on.  It is possible for example that the excessive cortisol release caused by depression and mania over the lifespan have damaged the hippocampus, so that even after depression improves, there is a memory problem.

Three factors tend to make the problem worse: older age, having an onset at a younger age, and having a more severe illness overall.  There is some evidence that the more episodes of depression and mania, the greater the cognitive deficits may be.  Thus, the cognitive deficits in later life may be preventable if persons take management of their illness seriously and treat it conscientiously.

Problems occur in other aspects of brain functioning besides just memory.  These include problems with executive functioning, concentration, and visuospatial skills.

The cognitive problems appear to be persistent and sometimes severe, so that sometimes a diagnosis of dementia may be appropriate.  Usually, I do not diagnose dementia with these patients because the symptoms are not quite severe enough.  I use the milder DSM-IV diagnosis of Cognitive Disorder Not Otherwise Specified. Until we have more information about the reversible or irreversible nature of this illnes and how it responds to treatment, I prefer to use the less serious diagnosis.

10 comments:

Ronine said...

very interesting perspective and it certainly sounds likely that we could have a new classification of diagnosis under the dementias. I will be interested in your work.

Geffrey said...

I have a severe case of Bipolar11 disorder and ADHD. My memory gradually gets worse. Appointments, names,promises I make, birthdays, and places I was supposed to be hours ago. I'm an artist who's creative gift is disappearing, my previous ability to speak and write eloquently, my friendships and my desires ate all fading. My grandmother died recently and had Dimentia I am terrified I will gradually become such as her. I take a series of meds that seems to have worked better than anything I have ever taken. I would be curious about participating in your study

Nicola said...

My dad is 75 with bi-polar probably all his life, mostly untreated as he refused to take medication. His manic and depressive episodes were very regular, every 6 months. He may have had some form of dementia for the past couple of years - difficult to tell whether it was dementia or bi-polar as he had a very long manic phase. He began to show definate signs of dementia 2 weeks ago and has deteriorated rapidly. I think he is not at stage 6 - only partly aware of what's going on, sometimes not knowing his us. Talking constantly but not really making sense even though there is some understandable train of thought. I can't find any stories about anyone declining this fast. We are still trying to get him an urgent appointment with a consultant to shed some light on the speed of decline.

Nicola said...

Sorry - made a few mistakes in that - he is at stage 6. He sometimes doesn't know us.

Kaylees Kloset said...

I just found this blog post after searching to see if dementia type symptoms can be found in someone with Bipolar Disorder. My husband has been deployed and in combat in the Army infantry in the past few years - and is being treated for PTSD for some strange behaviors and symptoms. Insomnia and confusion/flashbacks/hallucinating type behavior. He will have a week or two that he is his normal self, the man that I married 5 years ago, then he will have a day or two of insomnia and confusion, and then today he had a rare day of being overly excited and goofy and loud - just acting absolutely obnoxious. And it hit me - he has all these behaviors in cycles! I wonder if he is bipolar, and his confused episodes are part of his depressive state, and these obnoxious loud episodes are his manic states. I am definitely going to be calling the doctor he see's for his supposed PTSD (which I do believe he has as well, and maybe set off his Bipolar Disorder?).

Joseph said...

I experienced my first ever manic phase last December. It lasted until the first week of February. I then went into my first bout of major depression that got significantly worse. I did not got to the doctor until to get on proper medications until June. The depression has gotten lessoned somewhat but is still pretty bad.



I was dianosed with BP II in late June. I recently turned 49 and have no history of phyciatric disorders in my past.

My executive functioning and memory are severely diminished. Both are necessary for the profession I am in. I have lost a job that I had recently started because of severe anxiety and panic attacks. My libido is gone. My wife has been supportive but I suspect that she is having an affair. To be honest I wouldn't blame her. This may or may not be true because of my irrational thinking.

My personality has changed.

This disease which I have only recently learned about has devasted me and my family's lives.

After doing some research on the subject I am not optomistic that my mental functioning will return after the depression has cleared.
I hope and pray that I am wrong.

God Bless.

Michael Chellew said...

I am bipolar-manic type. My is memory is pudding.
My cognitive skills and thinking are all but gone. Dementia runs rampant in mothers side of the family.
I believe that I am genetically gifted with dementia.
I am scared. I will not endure undergoing a slow death.
Whatever it takes.

mchellew

Pip said...

I found this blog entry after searching for bipolar and memory loss/dementia. I was diagnosed with bipolar in my thirties after several cycles of hypomania, mania and depression. Currently I am more than two years into a severe depression that leaves me barely able to function, and which is a clear interruption of my "normal" cycle.

I've always had memory problems when depressed. This time, though, it is much worse. As well as the usual concentration and short-term memory issues, I'm having a lot of long-term, semantic and procedural memory loss which I have never experienced before in any depression.

I've told my psychiatrist it feels like brain damage and they keep giving me little memory tests to do. By turns these memory issues terrify and upset me. It's next to impossible to explain to someone who has known me well that I'm sorry I don't remember them at all (not even a little bit), especially when to them, I've been ignorant, and to me, I'm trying to explain and apologise to a complete stranger.

David Tal said...

A lot of people around the world are having Memory Disorder, for family members who are experiencing this illness it's have been nice to this article.

Memory Disorder Clinic

Elle Pepper said...

I wish there was more news, m grandfather, we believe is bipolar two, but he has never sought treatment, his depressive episodes last months at a time, and his manic phase is short, but this time when he flipped, something went wrong, and he quickly cycled from mania to a sort of paranoid/delusional form of psychosis.

as the psychosis continues unabated, we are now unsure that he will ever recover even if we get him into treatment,

He confuses his daughter and his grandaughter, he is belligerent, and foul-mouthed when he never has been (though in recent years that has started changing) And he has such a persistant delusion that is scares us.

In less than two weeks he has gone from depressed and functional to psychotic and irrational with memory loss and belligerent outbursts, we suspect that his last bipolar swing was just too much, and short of drugging him at night, we are having a difficult time controlling him. We fear we might have to send him to a home because we can't watch him every moment of every day and the persistent delusion is becoming cumbersome.