Living in the moment
Reimagining mental health care for patients with dementia
When memories of the past begin to fade, patients with Alzheimer’s disease and other types of dementia often experience life changes that can bring heavy emotional tolls. From the shock of receiving a diagnosis to the anticipation of further memory loss, patients and caregivers alike encounter challenges that have a lasting impact.
"Although many people think of dementia as mainly a cognitive condition that affects memory and decision-making, the most difficult problems for patients and their families often relate to their behavior and mental health,” says Antonio L. Teixeira, MD, PhD.
Nearly 40% of people with Alzheimer’s disease suffer from anxiety or depression, and most experience behavioral shifts— like paranoia, agitation, and apathy—that can disrupt their daily lives.
While neurologists focus on addressing the cognitive impairments associated with Alzheimer’s disease, psychiatrists like Teixeira and his team strive to address behavioral changes and improve the mental health of both patients and their caregivers.
"Many of my patients with dementia no longer understand how their actions affect the people around them,” Teixeira says. “We see that behavioral health problems can have a greater impact on families than cognitive decline alone.”
Most mental health conditions fluctuate in severity for people with Alzheimer’s disease over days, months, and even years. In particular, the late afternoon can be a difficult time for patients due to sundowning.
"Sundowning can be especially difficult for caregivers. It’s a time when most people are getting ready for bed, yet people with Alzheimer’s disease can experience heightened restlessness and agitation, which makes it difficult to sleep,” Teixeira says.
In addition to providing behavioral care to reduce the impact of sundowning and ease symptoms of depression and anxiety, Teixeira and his team conduct research to develop new treatment options to improve the mental health for people with dementia. Collaborating with Holly M. Holmes, MD, Teixeira is testing a noninvasive therapy to help patients with cognitive impairment who experience apathy.
Robbing people of their motivation and interest in life, apathy differs from conditions like depression and anxiety in patients with dementia because it gets progressively worse over time.
"Unfortunately, apathy does not seem to respond to standard interventions or medications,” Teixeira says. “To help our patients, we had to think outside the box.”
Using transcranial direct current stimulation—a noninvasive device that sends tiny, pain-free electrical charges to the brain—Holmes and Teixeira hope to help people with Alzheimer’s disease and other dementias overcome apathy. Patients can use the cap-like device from the comfort and convenience of home, making it available to people with limited mobility and other health challenges.
Based on promising preliminary results, Teixeira and Holmes are now expanding this project to evaluate if transcranial direct current stimulation can also help improve anxiety, depression, and other behavioral disorders in people with dementia.
"Behavioral symptoms often come in clusters, so we are trying to maximize our impact and improve multiple symptoms at once,” Teixeira says.
As the incidence of conditions like Alzheimer’s disease, depression, and anxiety continue to rise across the nation, philanthropic support to the Many Faces. One Mission. campaign can help to develop more effective, accessible therapies to improve brain and behavioral health.
"Federal grants don't allow much space for curiosity or creativity. Philanthropy gives us the freedom to explore exciting new frontiers in dementia research so we can deliver better treatments to even more patients,” Teixeira says.
“Philanthropic support empowers us to pursue bold solutions to the toughest brain and behavioral health challenges facing our communities," says Holly M. Holmes, MD, Joan and Stanford Alexander Chair in Gerontology. "With age-related conditions like Alzheimer’s disease and other dementias on the rise, research funds act as a catalyst to accelerate discovery and help deliver life-changing treatments to patient bedsides.”