Exploring OCD and Dementia’s Comorbidity OCD dementia comorbidity

OCD Statistics

October marks the beginning of OCD Awareness Month, which was set by the International OCD Foundation in 2009. Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by a person experiencing obsessive thoughts, resulting in compulsive behaviors. Anatomically speaking, OCD is believed to be caused by abnormalities in the brain’s basal ganglia, which is involved in motor control. Common symptoms associated with OCD include fear of contamination, repetitive checking, need for symmetry, rigid mental routines, counting, and/or sexually intrusive thoughts. OCD first emerges between ages 7-12 and late teenhood through early adulthood (i.e., early 20s). In the US, one in 40 adults and one in 100 children will develop OCD in their lifetime. Globally, OCD affects 1%-3% of the population. The condition is more common in females than males and arises from a combination of genetic and environmental factors. Patients typically wait 2.5 years before seeing a mental health professional. After that, it may take another 1.5 years between being diagnosed and receiving actual treatment for their OCD. To be diagnosed with OCD by a medical provider, one needs to meet the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders. There, it says that the person must experience either obsessions or compulsions and that their symptoms have to be time-consuming (i.e., take up more than one hour per day) and severely disrupt their life.

Living with OCD

It is important to note that the obsessions that accompany OCD are recurrent, uncontrollable, pervasive, and generally bring a lot of stress to the person experiencing them. They can also be illogical and lack a clear purpose. As mentioned earlier, the obsessions and compulsions are often time-consuming, meaning they interfere with the person’s quality of life, daily activities, relationships, and school/employment. They are also generally NOT what the person with OCD wants to be thinking of or doing. Simply put, the compulsions and obsessions of people with OCD are usually not pleasurable nor gratifying. For that reason, these obsessive thoughts bring forth intense feelings of fear, anxiety, disgust, and uncertainty. This should be emphasized, as people without OCD tend to use the term very loosely without fully understanding the gravity of the condition. This is very dangerous to do, as it trivializes the condition, which can make people undermine its complexity and/or be confused about what the true definition of it is. It could also generate further misconceptions about OCD, such as that it is only characterized by being “very clean or organized.” Such a generalization can make the condition seem desirable to those who do not have it, and it does not encompass the entire condition, as the severity and types of obsessions and compulsions differ from person to person. Additionally, some people may not even experience both obsessions and compulsions; instead, they may just experience one or the other. For example, people who just report feeling obsessions are categorized as “Pure O,” meaning they typically do not act on their thoughts.

These maladaptive thoughts persist until the person feels everything is “just right,” typically achieved through compulsive acts intended to reduce anxiety (i.e., neutralize the obsession). It could also include the person avoiding situations that trigger their unwanted thoughts. Once the compulsion is enacted, that does not mean the obsessive thoughts and further compulsions go away. Instead, they will repeat themselves over and over again in a continuous cycle, which can be very exhausting for the person to experience. Conditions commonly associated with OCD that involve repetitive intrusive thoughts and compulsions include trichotillomania (i.e., hair pulling), excoriation (i.e., skin picking), hoarding disorder, and body dysmorphic disorder. Due to the stigma and lack of awareness associated with these conditions and OCD, it is possible that people underreport when they are experiencing these conditions. With that being said, one disease that is not talked about much in relation to OCD but has been seen to be comorbid with it is dementia.

Dementia and OCD Relationship

Dementia is a neurodegenerative disorder that generally emerges with advanced aging. Its hallmarks are gradual cognitive decline and memory difficulties. Over time, researchers have investigated how OCD is related to dementia, as they are both believed to be caused by genetic and environmental factors. Furthermore, anxiety and depression are common conditions associated with both, which may cause a person with dementia to exhibit certain obsessions and compulsions. But is that enough to say that OCD is a risk factor for this neurodegenerative disease? The answer is that scientists do not yet understand the relationship between OCD and dementia. Nevertheless, some of the research literature suggests there is a link between the two conditions. For example, some studies propose that those who have a family history of hoarding and rechecking obsessions (e.g., constantly checking that the front door is locked) may have a higher chance of developing dementia as they age. This is because some researchers infer that constantly checking something over and over again may be an indicator of memory issues in the future. Additionally, hoarding is a common action in both conditions. In dementia, individuals may frequently misplace their items because they forget where they initially put them. As a result, the person can feel distressed and start to hoard their items as a way to give them a semblance of control over the situation.

In one particular study, researchers tested working memory on 55 participants who had OCD versus 55 participants who did not (i.e., healthy controls). The memory tests they were given included the digit span test (DST), the visual space memory test (VSMT), the 2-back task, and the Stroop color word test (SCWT). On all tests, participants with OCD performed significantly worse compared to the healthy controls. In another study, researchers investigated the relationship between late-onset OCD and dementia. There, they recruited two participants who started to display OCD symptoms after age 50, which is atypical. Both participants ended up developing dementia, which made researchers recommend that clinicians test for this neurodegenerative condition if patients report late-onset OCD. In a third nationwide longitudinal study, researchers used the Taiwan National Health Insurance Research Database to compare participants’ memories with and without OCD. Again, participants who had OCD reported a higher risk of developing dementia compared to the healthy controls and were able to be diagnosed six years in advance with the neurological condition. With all that being said, this data is still not enough to claim that OCD is a risk factor for dementia, as more studies need to be conducted. Nevertheless, it is still important to note, especially as the onset of OCD tends to occur first before dementia.

Treatment Options

Although both conditions are currently incurable, there are still several treatments available to make the symptoms more manageable and to increase one’s quality of life.

**Disclaimer: the following treatments described should NOT be taken as medical advice, and we are NOT medical professionals. Please consult with a medical professional if you or your loved ones are considering treatment**

In a pharmaceutical sense, patients can be prescribed Selective Serotonin Reuptake Inhibitors (SSRIs), such as Prozac or Zoloft. SSRIs work by increasing serotonin levels in the brain, which is a neurotransmitter known for making us feel good. With regard to OCD, it can reduce symptoms by regulating the anxiety associated with it. Patients may also be prescribed clomipramine, a tricyclic antidepressant, especially if the SSRIs do not work for them. If opting for this route, it is always best to consult with a psychiatrist to see which medication suits you.

Psychologically speaking, there are several forms of therapy available to patients. The first one is cognitive behavioral therapy (CBT), where patients get to challenge their cognitive distortions with their therapist. Another intervention method is dialectical behavioral therapy (DBT), which can help OCD patients regulate their emotions when faced with stressful or difficult situations, relationships, and emotions. Although DBT is commonly associated with borderline personality disorder, it is still useful for other mental health conditions. Other forms of therapy include exposure and response prevention (ERP), which involves patients gradually being exposed to situations that trigger their obsessive thoughts and compulsions. Acceptance and commitment therapy (ACT) is another form of psychotherapy clinicians use. ACT allows patients to change how they view their compulsions and obsessions and the feelings that arise when they experience them. ACT seeks to view the thinking patterns and actions associated with OCD as fluid and adaptable and how they can be addressed in the moment.

If medication and psychotherapy do not work, practitioners can resort to other forms of treatment. This involves psychiatric neurosurgery, such as deep brain stimulation (DBS), for patients who experience extreme OCD and are resistant to other forms of treatment. A non-invasive treatment option for patients is transcranial magnetic stimulation (TMS); this uses magnetic fields to regulate brain regions associated with OCD. Like DBS, TMS is used for severe cases of OCD when no other forms of treatment have worked.

Although OCD is a chronic condition, managing its symptoms can produce great benefits for the person and enhance their lives. Such rewards could transcend if and when a person also develops dementia in the future, especially when considering their shared similarities and times of diagnosis. In addition, because dementia is known to worsen OCD symptoms and can even cause more obsessions and compulsions to arise, learning how to mitigate its negative effects early on could be very advantageous for patients.

Sources: