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COMMON PROBLEMS IN MULTI-INFARCT DEMENTIA: EMOTIONS AND INCONTINENCE
Emotions
We try to control our emotions and expression of them both consciously (one tries not to laugh at someone in the same room who is wearing a hideous hat) and unconsciously (I always cry during the last few minutes of the film The Color Purple even though I’m trying not to). A stroke can effectively bring one’s emotions nearer the surface, lessening any control so that some sufferers cry or more rarely laugh at inappropriate times. The control system seems to be damaged. This is known as emotional lability and ranges from the person crying when a certain subject is mentioned to bursting into tears whenever they try to speak. In its severe form it is obviously very disabling both in terms of rehabilitation and socially. There is good evidence that one of the anti-depressants – amitryptiline – in a dose too low for it to be having an anti-depressant effect is helpful. I have used it many times with good success.
Incontinence
Incontinence of urine (more rarely of faeces) can occur after a single stroke but is more common as multiple strokes lead to a confused state. The condition is often associated with more marked physical disability, making toileting difficult, and also because the nervous control of the bladder may be damaged making the achievement of continence difficult. Though one tries to avoid them, one may have to use some form of incontinent pad or consider the use of a urinary catheter when both the physical and mental results of multiple strokes are advanced.
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