Neurological condition may be interpreted as psychiatric disease or age–related psychosis

Shobha (65) was forgetful, irritable, sad and had disturbed sleep. A medical examination did not reveal any significant neuro–psychological impairment and she was treated with anti–depressants.

She had a relapse after some time and her memory worsened. Brain imaging revealed degeneration (cerebral atrophy) with clogged blood vessels. A chronic patient of diabetes and hypertension, her cognitive impairment needed medication and lifestyle modifications.

Mental health in the elderly may be affected by neurological conditions. This may falsely be interpreted as psychiatric disease or age–related psychosis compromising quality of life.

Prevention consists of managing hypertension, diabetes, dyslipidemia, heart disease and correcting any micronutrient related deficiencies and lifestyle changes like healthy diet, regular exercise and stress management. Engaging in mentally stimulating tasks like reading, puzzles, crosswords and chess also help.

With age, blood vessels get clogged and this may cause memory loss, imbalance, confusion, abnormal behaviour, apathy and social withdrawal among the elderly, say experts.

"The brain's blood vessels also build plaque with age and risk factors like diabetes, high blood pressure, high lipid levels and liver or kidney disease further leads to choking thereby reducing blood supply to the brain. More the risk factors, more severe will be the brain damage. People living in India, Pakistan and Bangladesh are more prone," said neurologist Rajas Deshpande, director of the neurology department in Ruby Hall Clinic.

Increased pressure in the fluid compartment (ventricles containing cerebrospinal fluid) in the brain may also cause memory problems, speech problems, imbalance, stiffness in legs/falls, and urine incontinence, he added.

" Neuropsychiatry–related illness can be due to an increased susceptibility of the aging brain. Disorders range from abrupt and acute onset of confusion or delirious states to gradual progressive mild cognitive impairment and dementia," said psychiatrist Jyoti Shetty, head of the department of psychiatry in Bharati Hospital.

"Besides Alzheimer's, vascular dementia is the second most frequent illness among the elderly. Cognitive changes related to vascular (brain blood vessels) events are preventable and benefit from early diagnosis," Shetty said, adding, "In addition, deficiency of vitamin B12 may also contribute to neuropsychiatric changes."

"Along with neurocognitive change, changes in mood, personality, behaviour and sleep is common. Late stages can result in the patient having incontinence and being almost in a vegetative state,"Shetty said.

Evaluation is by the history, neurocognitive/neuropsychological assessments, various laboratory investigations and brain imaging (MRI).

"Vascular (blockage of small or large blood vessels) and subcortical dementia are difficult to treat, but modification and exclusion of risk factors arrests their progression. Increased fluid pressure (hydrocephalous) can be treated by repeated removal of small amounts of the cerebrospinal fluid over three monthly intervals," Deshpande said.

"While planning for any major surgeries, it is advisable to do a complete neurological assessment and necessary tests to exclude the risk of stroke /brain related problems in the elderly. ," he advises.

This year, the theme of World Mental Health Day is 'mental health and older adults'.

WHAT AFFECTS THEM

• BRAIN DEGENERATION: Causing Alzheimer’s disease, Parkinson’s
• BRAIN TUMORS: Either primary or secondary
• LACK OF BLOOD SUPPLY: As with the heart, brain’s blood vessels also get clogged with age and this may cause memory loss, imbalance, confusion, abnormal behaviour, apathy and social withdrawal
• DEFICIENCIES: Inadequate diet or absorption may predispose to deficiencies of Vitamin B12 and E which may contribute to worsening of brain function. Low levels of thyroid hormone may also cause dementia
• DRUGS: Elderly population is usually on many medicines that may affect normal thinking, problem–solving, sleep etc and impair memory, cause confusion or sometimes frank abnormal behaviour. These may also cause imbalance, Parkinson’s symptoms like rigidity and tremors and incontinence. Convulsions are also common in the elderly due to long–term drug use
• DEPRESSION: Loss of spouse, caretaker, friends, family etc and feeling of loneliness, fear, dejection may predispose or worsen depression in the elderly. Depression may itself cause or worsen dementia or abnormal behaviour. Also, medical problems especially a disability may worsen depression. Poststroke depression is established and common, but treatable

OTHER CAUSES

• Major surgeries like cardiac, knee/ hip replacement, spinal surgery
• Radiation for cancer treatment may also cause brain degeneration
• Brain infections like tuberculosis/ meningitis / encephalitis may cause permanent memory and hearing loss in the elderly
• Other systemic illnesses like fever, urinary tract infections, pneumonia may temporarily worsen memory loss and neurological function within hours, but it may take weeks – months for recovery
• After a bout of vomiting/loose motions, the elderly are prone to lapse into confusion/ unconsciousness or even coma due to sudden lowering of blood sodium levels. These have to be carefully treated with calculated amounts of sodium, as even rapid correction may cause paralysis/coma again