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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.


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.


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.

lianties said...

South Africa. I'm diagnosed with bipolar 1 for over 6 years. Every year I got ECT's for 3 years in a row. My last one was about 2 years ago and since then I can not remember. Small things. My short term memory is not all there... I get lost in conversations, it's it my brain just switch of for a split second. The same when I'm walking or just standing, I loose my balance just for a split second then I'm ok again. Now I'm having problem seeing. The one day I can see perfectly, even read a book with NO problem, the next day it all blurry as if I clearly need a glasses. Yes I did test my eyes and they are fine, but they were tested on those good days. I even did blood test, sugar, etc. No one can tell me what's wrong. So now I'm not only starting to loose my memory, but also my balance and eyesight. I just came out of clinic, knowing I stand a very good chance of alzimers and just 43

Diana's #1 Fan! said...

I was diagnosed in 2010 when I turned 40. I had a manic episode induced by St. John's Wart. I had obsessive thought patterns for a year straight and used it to study Bipolar disorder. I'm replying to your post to give you hope. Not to say it's easy but to say that it can and will change. That is the one constant I a have learned. One of the key things I try to implement daily is self monitoring by asking why I'm thinking what im thinking. Does the intensity of my feelings match my reality? Moods affect your thought patterns and I've worked hard to always check my thinking before I react or speak. That is no easy task especially during agitated mania. And is impossible at times. But those times I can at least recognize it was my crazy head and apologize and explain afterwards. I also try to recognize my triggers and my symptoms that say you are getting too close to being unwell. So you need to back it up and let go of something's and take a break. Get some rest and deligate so you can reduce stress. This too shall pass. While your in it, it might feel like it will never end but it does, it always changes. Hormones also play a roll in changing your thinking patterns. So many things matter in how we think and relation to our chemistry. The food you eat has a huge bearing on the effects of our bodies and brains, hormones etc. many of the common connections I found while researching is inflamation in the brain. If you research histamine intolerances you can learn about how a healthy gut affects our brains. Knowing what foods our bodies have reactions too can help us to reduce inflamation which will also help our symptoms. So many studies connected with bipolar and schizophrenia are connected to things that cause inflamation in the part of the brain that both those illness are based from. Stress produces cortisol and cortisol produces inflammation. So stressing your body physically or mentally can be a trigger. Lack of sleep, lack of food or drink all induce stress. First and foremost you have to learn to take care of your basic needs. God has been my salvation through all of this. There is also scientific study of brain monitoring that when you pray or meditate it actually lights up the area of the brain that reduces all those stress symptoms. So science has proven its good for your mind and body to pray. We are not here on this earth to be alone. God made us to need each other. This illness tells us we are alone or that we can do it all alone. When we implement the things that help us to stay stable we have to trust others, rely on others and need others. The world teaches us differently. A cognitive behavior therapist could be a God send for helping with your marriage. Communication goes out the window with this illness and both parties are left feeling alone. They can help immensely in this area. Which can save further hurts and ultimately the marriage. Their is so much more I could share. Just know that their is hope. Lean on God and use the tools he provides through his people to help your family through this.

God Bless you and your family.

(I created my google ID on a friend of mines blog during a contest she was having. Hence the name. lol!)

Unknown said...

I was diagnosed with manic depression in my late 30s. It has been a adventure. My life is a screwed up mess. I'm 63 now. And wow, having all kinds of problems with memory, and doing things my body just can't take anylonger. I also suffer extreme anxiety disorder, and Im breaking out in sweats. Chest and other pain. I'm in hospital right now for chest pain... but I'm sure it's just this mental illness and after all these years I hate this crap.... wish I could stop my brain from thinking. I'm scared!!!!

Debra Schlef said...

I cry so easy to. Been told I have dementia, don't know what to believe. ......just wish this all would just end. That is my statement before this. Just wanted to ad

Debra Schlef said...

I cry so easy to. Been told I have dementia, don't know what to believe. ......just wish this all would just end. That is my statement before this. Just wanted to ad