Q: Bipolar Disorder & Alzheimer's|
Hi there, Dr. Phelps,
I am wondering what the research says about a connection between bipolar
disorder and Alzheimer's Disease. My fraternal aunt was diagnosed bipolar about
forty years ago, she is now in her eighties. My dad had her committed, thirty
years ago. It was too emotionally, and financially, draining for him so it
expired. She has not received treated since. Recently, Elder Services took her
to a doctor, who admitted her to a hospital, which led to a psychiatric
evaluation, an AD diagnosis, and an assisted living placement. Unfortunately,
they are not able to manage her behaviors, or her medications. It is very
difficult to separate out what symptoms/behaviors are due to what diagnosis. It
seems like important information to have, though, as we must find her an
appropriate placement. Please send any helpful information or advice, it is
Dear Maria --
When elders are having difficulty controlling their behaviors such that they can
not manage in an assisted living facility, this sense of being difficult for
nearly everyone, including relatives like you who are trying to help. You're
asking an important question.
First of all, one could reason that if your mother's behaviors are actually due
to bipolar disorder, rather than Alzheimer's, at least in part, that this is
good news, and that the bipolar disorder symptoms might therefore be amenable to
treatment and have the potential to improve substantially. By comparison, the
symptoms of Alzheimer's can be damp down somewhat, but so far, we do not know of
treatments which can really stop the progression of the illness, let alone
reverse some of the symptoms toward normal, as we believe some of the treatments
for bipolar disorder can do.
Therefore, in my view, in general terms, when Alzheimer's and bipolar disorder
might both be present, I think it is worth it aggressively treating the bipolar
component to see how much improvement can be obtained. This includes, for
example, uses some medications which can potentially shorten the patient's life
by increasing the risk of a cardiovascular problems such as a heart attack.
These medications include most of the currently used "antipsychotics".
However, often overlooked in this setting our medications which are not "antipsychotics"
but which have known benefit in bipolar disorder. Although we generally try to
avoid using lithium in the elderly, I still keep in reserve; but a medication
with significant potential for benefit, even at low dose, if there is indeed a
"bipolar component", is Depakote. Whereas we usually use 1000 mg and up in
younger people, as little as 500 mg, and sometimes even less, can be useful in
the elderly if they are having problems with aggression, irritability,
disorganized behavior, and irregular sleep patterns.
One could also reason as follows: suppose there is no "bipolar component"; is
there any reason to think that something like Depakote, or perhaps even the
antipsychotic family (which probably represents a greater risk, and which many
patients more strongly dislike, in my experience), might help anyway? Indeed,
this is rather commonly tried "empirically", a jargon term used in medicine
meaning use of a medication when there is no clear indication for it but just a
suspicion that it might be helpful, a sort of "let's try it and see" approach.
As you already may understand from your question, the history of bipolar
disorder in your family increases the need to think along these lines even if in
her lifetime there was little indication of bipolar disorder in terms of mood
symptoms. I hope this possibility you are raising proves to be of some use.
Published September, 2007