Coping with Obsessive-Compulsive (OCD) Behavior and Dementia

Obsessive Compulsive Behavior in Dementia
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What Is Obsessive-Compulsive Disorder (OCD)?

OCD is a disorder characterized by obsessive thoughts and compulsive behaviors. It's not uncommon to see this challenging behavior in certain types of dementias such as frontotemporal dementia, Huntington's disease, and progressive supranuclear palsy

With obsessive and/or compulsive behaviors, a loved one may have the need to repeat actions or behaviors multiple times.

For example, your father might check the locks 12 times instead of once, repeatedly wash his hands until they're so dry that the skin cracks and bleeds, or constantly want to go to the bathroom.

Is OCD a Predictor of Dementia?

Some research has indicated that later life development of obsessive-compulsive behaviors (as opposed to a life-long tendency) could be connected to the early stages of dementia and should be evaluated by a knowledgeable physician. For example, research presented at the American Academy of Neurology 2016 annual meeting reported that OCD symptoms could be an early sign of frontotemporal dementia. 

Another study found that those who had a history of hoarding and checking obsessions (for example, an urge to repetitively check and recheck that the faucet is turned all the way off) had a higher risk of developing Alzheimer's disease later in life.

A third study found that obsessive compulsive symptoms developed prior to the onset of Huntington's disease in some of its participants.

 

While obsessions and compulsions, which are indicators of anxiety, are not uncommon in dementia, more research needs to be conducted before OCD symptoms are conclusively tied to an increased risk of dementia. 

How to Respond to Obsessions and Compulsions in Dementia

If you're a caregiver for someone with these types of behaviors in dementia, it's not unusual to feel stressed, frustrated or unsure of what you should do.

The key to responding in these situations is to determine whether the behaviors are simply a nuisance and harmless, or whether they present a danger to the person or those around him. If they're just harmless quirks, you're better off taking a deep breath, accepting those characteristics and focusing your energy on other things.

Additionally, try to keep in mind that repetition in dementia, while perhaps related to some obsessions or compulsions, is often triggered simply by a poor short-term memory or general anxiety in dementia. Maintaining routines can be reassuring to people who are feeling disoriented or uncertain. For example, some people become very rigid about the order in which things are done, or they require something that doesn't make sense to us, such as wanting four forks at each meal they eat. This might be very frustrating because it doesn't make sense to us, but to the person with dementia, that obsession or insistence may help them remember their tasks or feel a little more in control. And, in dementia, control is something that is often slipping away.

However, if the obsessions and compulsions interfere with safety or are causing the person emotional distress, they should be addressed and reported to the physician.

Sometimes, verbal reassurances or distractions are helpful to people. Other people benefit from treatment with SSRIs, a class of antidepressants with fewer side effects that seems to be beneficial and provide some relief from OCD. 

Sources:

American Academy of Neurology 2016 Annual Meeting. Frontotemporal Dementia (FTD) with Late-Onset Obsessive-Compulsive Symptoms (OCs): An Individual-Patient Data Meta-Analysis. April 21, 2016. http://www.abstractsonline.com/pp8/#!/4046/presentation/5541​

Dementia and Geriatric Cognitive Disorders. Obsessive-compulsive behavior as a symptom of dementia in progressive supranuclear palsy. http://www.ncbi.nlm.nih.gov/pubmed/20798538

The Journal of Neuropsychiatry and Clinical Neurosciences, VOL. 12, No. 2. Late-Life Obsessive-Compulsive Disorder and Huntington's Disease. http://neuro.psychiatryonline.org/doi/full/10.1176/jnp.12.2.288

The Primary Care Companion for CNS Disorders.2011; 13(3). Late-Onset Cinephilia and Compulsive Behaviors: Harbingers of Frontotemporal Dementia. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184557/

Psychiatry Res. 2015 Feb 28;225(3):381-6. Is obsessive-compulsive symptomatology a risk factor for Alzheimer-type dementia? http://www.ncbi.nlm.nih.gov/pubmed/25576369

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