Mental Illness, Alzheimer's, Dementia, Older Adults

Behavioral health services support persons with serious mental illness, care givers, and people with dementia by developing knowledge and skills in clinicians and others who provide care for them.

Serious mental illnesses, such as Schizophrenia, Bi-Polar Disorder or Major Depression often develop earlier in life; even so, symptoms and episodes may re-appear or persist. Adults with serious mental illnesses and Intellectual (developmental disabilities) are also at risk of developing dementing illnesses. Serious mental illness may also develop in adults with dementia and can include dementia with hallucinations or delusions, dementia with depressed mood, and dementia with behavioral disturbance.

Dementing illnesses, such as Alzheimer’s Disease, Lewy Body Dementia or Vascular Dementia most often appear later in life; in general, the risks of developing dementia increase with age for everyone. Delirium related to illness becomes more common with age. Substance use, misuse, or dependency and non-intentional prescription drug misuse are also common concerns. Medication interactions, age related changes in physical and mental functioning, brain trauma, and increasing isolation all may mask as psychiatric conditions.

A common concern relates to memory changes. Frequently primary care doctors are approached about memory and behavioral changes, often by someone other than the older adult.  Adult children, spouses, neighbors and friends might notice troubling changes over time and help the older adult obtain needed assistance. There are many reasons for forgetfulness and/or memory loss and early identification is important for treatment and future planning.

Memory loss also occurs for reasons other than Alzheimer's or dementia; some possible causes include: medication interactions, work problems, depression, anxiety, infections, sleep loss, being overwhelmed or having other illnesses, chronic conditions or diseases. Accurate assessments lead to appropriate treatment and depending upon diagnosis, reversing symptoms is sometimes possible. While no cure exists for non-reversible dementias, there are programs and services (such as Adult Day Programs and in-home respite) and medications that can extend the quality of life and the time the person with dementia lives at home or in the community.

Many times, sorting through psychiatric symptoms, delirium, physical and sensory deficits and medication problems is challenging.   Accurate assessments are essential to determine the cause of symptoms and guide treatment. There are specific protocols to rule out other causes of symptoms.

Family caregivers of isolated older adults with mental illness or progressive disabling medical conditions are also the focus of interventions designed to improve coping skills, mental health needs, reduction of stress, burden, depression and family conflicts.  Family caregivers are at greatly increased risk of depression and other physical problems.  

In general, older adults use fewer public behavioral health services than younger adults; the reasons include stigma, denial, inadequate outreach services, lack of transportation, lack of education about the services and mental illness, and lack of staff trained in geriatrics. 

Access to services can be confusing; people may have private insurance, Medicare or Medicaid, but generally primary care physicians, the local Community Mental Health Service Program or Area  Agency on Aging can assist.

The Michigan Mental Health Code does not include required treatment of dementia unless the dementia occurs in conjunction with another diagnosable serious mental illness.

For more information, please contact Alyson Rush, Program Specialist at rusha@michigan.gov or 517-335-0250

Glossary

Dementia is characterized by loss of or decline in memory and other cognitive abilities. It is caused by various diseases and conditions that result in damaged brain cells. There are many causes and types of dementia.

Alzheimer’s is the most common cause of dementia; problems with memory, thinking and behavior continually progress over time and have named stages. Some medications may help slow progression.

Lewy Body Dementia, although only recently named, is the third common type of dementia. Confusion and alertness vary significantly; seeing things other people don’t see and delusions are common as are malfunctions in the autonomic nervous system. Accurate assessment of Lewy Body Dementia is critical for appropriate use of antipsychotic medications.

Vascular Dementia is often considered the second most common cause of dementia, and is characterized by reduced or blocked blood flow in the brain that causes a series of strokes that frequently result in a step-wise pattern of decreased function. Symptoms vary depending on where in the brain the damage occurs and medication is often prescribed.

Schizophrenia is a serious mental illness that is characterized by symptoms that are often disabling such as confused thinking, hearing voices other people don’t hear, delusions such as believing other people are reading their mind or guiding thoughts are often very scary. Schizophrenia is most often managed with support and antipsychotic medication.

Bi-Polar Disorder is generally characterized by periods of depression with other periods of feeling really good and elated. Sometimes Bi-Polar Disorder is referred to as Manic Depression. Bi-Polar illnesses are often managed with a combination of medication and cognitive therapy.

Major Depressive Disorder is a mood disorder where people feel a loss of interest in things and sadness. It affects thinking and behavior and is much severe than having the ‘blues’. Treatment to manage major depressive disorder is often a combination of medication and cognitive therapy.

(Intellectual) Developmental Disability, formerly known as mental retardation, is generally characterized as low IQ and impaired intellectual functioning.