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Emotions and Alzheimer's disease...obsessive-compulsive disorder...cadasil-related dementia.

Q My grandmother is confined to a nursing home with AD. She no longer seems to remember my visits, so is there any point in my visiting her every week as I have been doing?

A Your grandmother may not show signs of remembering that you spent time with her, but your visits very likely have a positive emotional impact. A recent small study of AD patients who were shown a selection of happy and sad movies revealed that although the participants' recollection of the actual films quickly faded, the emotional aftereffects lasted as long as half an hour. This suggests that although AD patients may not remember events, they may remember emotions associated with them. Since their emotional life can be influenced by their environment, actions by caregivers that promote positive feelings are likely to improve the patient's quality of life and wellbeing.

Q My husband has obsessive-compulsive disorder that involves constant washing of his hands to eliminate germs. He seems to be getting worse and has become very depressed about it. Can this disorder be treated?

A Obsessive-compulsive disorder (OCD) involves intrusive and disturbing thoughts or apprehensions that drive individuals to engage in irrational ritualistic behavior to relieve their anxieties. Excessive hand-washing is a common manifestation of this psychiatric disorder, which affects up to three percent of people and can become disabling if left untreated. Most people with OCD are aware that their behavior is irrational, but cannot control it. The condition appears to have a genetic component, and although it is poorly understood, research suggests that it is often accompanied by brain-structure abnormalities and the inability to change behavior in response to new information. Fortunately, there are a number of effective therapies, including cognitive behavioral therapy (CBT), perhaps the most effective treatment. CBT addresses OCD by gradually exposing individuals to situations or objects that provoke fear and helping them avoid the usual behavioral response until the connection between stimuli and reactions is dramatically weakened. Antidepressant medications may also be effective, and for a small percentage of patients with especially difficult cases, deep brain stimulation with electrical current has also proven effective. With proper treatment, as many as 85 percent of patients show significant improvement.

Q Can you please tell me about a form of dementia called CADASIL? My brother has this condition. What is his prognosis?

A CADASIL is a hereditary disorder in which a thickening of the walls of blood vessels in the brain's white matter restricts blood flow to certain brain regions and causes stroke and tissue death. Symptoms of CADASIL (which stands for Cerebral Autosomal Dominant Arteriopathy with Sub-cortical Infarcts and Leukoencephalopathy) include migraine headaches and multiple strokes, eventually progressing to dementia. It is often misdiagnosed as Alzheimer's disease (AD), multiple sclerosis, or another neurodegenerative disease. Other indications of CADASIL may include vision problems, seizures, cognitive decline, and psychiatric problems, such as severe depression and significant changes in personality and behavior. Unfortunately, there is no treatment for CADASIL. After onset of the disease, most often occurring in the individual's mid-30s, patients are usually given supportive care, such as medications for migraine, aspirin and antihypertensive medications to reduce risk of stroke and heart attack, and drug therapy for depression. Risk factors such as high cholesterol and diabetes should also be addressed. The disease usually progresses slowly, but by the age of 65 most people with CADASIL have signs of cognitive decline and dementia, and some may be unable to care for themselves because of multiple strokes. MMM


MD Executive Vice Chair Department of Psychiatry Director, Clinical Research Program Massachusetts General Hospital Slater Family Professor of Psychiatry Harvard Medical School
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Title Annotation:ASK THE DOCTOR
Author:Fava, Maurizio
Publication:Mind, Mood & Memory
Article Type:Column
Geographic Code:1USA
Date:May 1, 2015
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