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Psychologie & NeuroPsychiatrie du vieillissement

Bipolar disorders and dementia: fortuitous association or filiation? A case-report and review of the literature Volume 5, issue 1, Mars 2007

  • Author(s): Pascal Menecier, Olivier Rouaud, Céline Arezes, Dany Nasr, Laure Menecier-Ossia, Amélie Charvet-Blanc, Louis Ploton , Consultation mémoire du mâconnais, RDAS, Mâcon, CMRR de Dijon, Hôpital général de Dijon, Service de chirurgie, Centre hospitalier de Mâcon, Service de gériatrie, Hôpital Bouchacourt, Saint Laurent-sur-Saône, Cabinet d’orthophonie, Mâcon, Laboratoire “Psychologie de la santé et du développement” (EA 3729), Institut de psychologie, Université Lyon-2
  • Key words: bipolar disorders, cognitive disorders, dementia, iatrogenic effects, apathy, comorbidity
  • Page(s) : 23-34
  • DOI : 10.1684/pnv.2007.0035
  • Published in: 2007

The prevalence of bipolar disorders is about 4% of the population. Among the patients the emergence of cognitive disorders has been identified. These disorders can sometimes result in authentic dementia-like syndromes. The neuropsychological characteristics of the cognitive impairment include disorders of the steady attention, executive functions, memory and language. This group of cognitive disorders leads to a subcorticofrontal syndrome. Different neuroanatomical bases have been suggested. The most common etiopathogenic hypothesis retains a cumulative neurological toxicity of the thymic episodes (depression or mania). The role of psychoactive treatments must be taken into account. The secondary cognitive effects of psychoactive drugs usually used in bipolar disorder (lithium, antiepileptics, antidepressants, antipsychotics or tranquillizers) are similar to the cognitive impairment associated with the disease. Differentiation between cognitive disorders related to the pathology and those related to its treatment is difficult. The optimal use of the therapeutic drug classes, preferring antipsychotics of second generation and avoiding products with anticholinergic effect, is essential. There is no specific pharmacological treatment for this dementia syndrome. Psychological approaches offer an alternative way of care, which remains to be investigated and validated. Prevention of iatrogenic effects of drugs constitutes, presently, the main therapeutic intervention.