What is Dementia?

A common misconception is that the words "dementia" and "Alzheimer’s disease" are interchangeable.

Dementia is a general term for a decline in mental ability and has variety of symptoms. It’s not inevitable, and it’s NOT a normal part of aging. It’s actually a catch-all word for a variety of symptoms that can be caused by many different medical conditions, Alzheimer’s only being the most common. In fact, there may be more than 400 causes of dementia. We list some of the most common ones below. 

Features Common to All Types of Dementia 

All dementia syndromes feature problems with memory, thinking, reasoning, concentration, or judgment. A few conditions, such as depression or short-term delirium, may look like dementia. These “pseudo-dementias” are reversible and acute (not long-lasting). 

True dementia syndromes are neither reversible nor acute. Instead, they are chronic and progressive. In other words, they don’t go away. They continue to get worse over time.  

Furthermore, while some slight decreases in memory and thinking are normal with aging, changes with dementia syndromes are more dramatic.  

In all cases, dementia syndromes represent a change in the person’s normal abilities that is caused by a problem with the brain’s functioning. These changes increasingly impair a person’s ability to live daily life. Additionally, in some types of dementia syndromes, changes in personality occur early in the process. 

Causes and Risk Factors 

According to the Mayo Clinic, here are some of the most common causes and risk factors of dementia: 

• Age(especially those over 65) 
• Family history 
• Down syndrome 
• Sub-par diet and exercise 
• Excessive alcohol consumption 
• Cardiovascular Issues (including high blood pressure (hypertension), high cholesterol, the buildup of fats in your artery walls (atherosclerosis) and obesity) 
• Depression
• Diabetes 
• Smoking
• Air pollution 
• Head trauma(Traumatic brain injury) 
• Sleep disturbances(sleep apnea, etc.) 
• Vitamin and nutritional deficiencies(including Low levels of vitamin D, vitamin B-6, vitamin B-12 and folate) 
• Medications(including over-the-counter sleep aids containing diphenhydramine, such as Advil PM and Aleve PM, and those used to treat urinary urgency, such as oxybutynin or Ditropan XL). 
• Sedatives and sleeping tablets

Some treatable medical conditions can cause dementia symptoms. To get a proper diagnosis, it is important to determine the cause with your doctor if you or a loved is experiencing memory problems or other symptoms. A doctor can also help come up with a plan for controlling some of the risk factors through lifestyle changes. 

Most Common Types of Dementia Syndromes 

The four most common dementia syndromes are Alzheimer’s disease (AD), Lewy body dementia (LBD), vascular dementia (VaD), and frontotemporal dementia (FTD). These four conditions cause up to 80% of all types of dementia syndromes. We will review each type of dementia syndrome, symptoms, how it differs from others, and how the condition is managed below. 

Alzheimer’s Disease 

Alzheimer’s Disease is the most common form of dementia. It accounts for about one half or more of all dementia syndromes.  It’s a progressive disease that gradually worsens over time, and a patient typically experiences symptoms over three stages:  early, middle, and late. 

Early Stage  

• Difficulty finding words 
• Forgetting something just read 
• Not remembering names of people recently met 
• Difficulty performing routine tasks at work or socially 
• Losing or misplacing objects 
• Trouble planning or organizing 

Middle Stage 

• Forgetting personal history and events 
• Noticeable personality or mood changes  
• Disorientation regarding date and time 
• Increased need for assistance with personal care 
• Incontinence  
• Wandering and getting lost 
• Changes in sleep patterns 
• Thinking disturbances, such as suspicion and delusions 

Late Stage 

• Changes in physical abilities, including the ability to walk, sit, and eventually, swallow 
• Needing around-the-clock support with personal care 
• Not knowing their surroundings or recalling recent experiences 
• Increased difficulty communicating 
• Vulnerability to infections, particularly pneumonia 

How Alzheimer’s Disease Is Different from Other Types of Dementia 

Alzheimer’s Disease primarily impacts people 65 and older.  Unlike some other forms of dementia, AD typically progresses more slowly.  The average Alzheimer’s patient lives between four to eight years past their diagnosis, but some patients have lived up to twenty years.   

Management of Alzheimer’s Disease 

Unfortunately, there’s no known cure for Alzheimer’s, nor any proven way to slow the disease from progressing.  Researchers behind a newly FDA-approved medication claim it effectively reduces protein plaques on the brain believed to be part of the root cause of the disease in its early stages.  A caregiver should exhibit patience and give their loved one grace as they help them navigate life with Alzheimer’s. 

Lewy Body Dementia 

Lewy body dementia (LBD) is caused by deposits of a protein in the brain. The protein is “alpha-synuclein” (AL-fa-SIGH-new-clee-in). These deposits are called Lewy bodies. 

LBD symptoms start slowly and worsen over time and affect many aspects of the person’s life, including:  

• Alertness 
• Movement 
• Regulation of the autonomic nervous system 
• Visual hallucinations 
• Ability to remember correctly 
• Problem solving 

LBD causes fluctuations in alertness and attention, so people with LBD may take long daytime naps, stare out into space for long periods, and also may be depressed and unmotivated.  It can slow movements, cause rigidity, include tremors on both sides of the body, and create difficulty walking, which can cause intermittent falling spells.  

Changes in the autonomic nervous system may make sufferers feel dizzy, cause blood pressure to drop when they stand, and make them sweat, drool, and be constipated. People with LBD may also have visual or other hallucinations – like “seeing” children or animals in scary situations–and may act out their dreams. 

LBD affects memory. Sufferers may “mis-remember” things, like believing a person tripped them – even though it did not happen. They may have trouble planning, solving problems, or making wise decisions. Speech and thinking be slowed they may have trouble recognizing familiar people or objects, show little facial expression, and/or speak in a soft voice.  

How LBD Differs From Other Dementia Syndromes 

Lewy bodies may also cause dementia syndrome in people with Parkinson’s disease and Alzheimer’s disease (AD). Scientists are not sure if the three conditions are related or if people can have more than one type of dementia syndrome at the same time, and research is ongoing. 

Unlike LBD, visual hallucinations are uncommon in early Alzheimer’s disease. 

Management of LBD 

Early diagnosis and treatment with medicines called cholinesterase inhibitors (donepezil, rivastigmine) may help control cognitive and movement symptoms. Patients with rigidity also may do well with the medication levodopa. Avoid anti-hallucination (anti-neuroleptic) medicines, which may make other symptoms worse. Always consult with a physician about which medications may be the most appropriate. 

Emotional support, loving reassurance, reducing sources of stress, and a calm attitude are important for hallucination management, but agitation and aggression may make it necessary to call for outside help.  

Vascular Dementia 

Vascular dementia (VaD) is dementia caused by brain damage from a lack of blood flow to the brain, which causes oxygen and nutrient supply to slow or stop. 

VaD can sometimes occur fairly suddenly after a stroke, or r in someone who has diseased arteries in the brain. VaD can also occur over time from diabetes, high blood pressure, high cholesterol, or smoking— all risk factors for vascular disease. 

Symptoms for VaD vary and depend on which part of the brain and how much of it is affected, but may include: 

• Confusion 
• Trouble paying attention and concentrating 
• Problems with memory, judgment, and problem solving 
• Unsteady gait 
• Restlessness, agitation, and irritability  
• Depression, anxiety, or apathy 

Depression may also partly be caused by knowing that the VaD changes are causing problems in daily life. 

People with VaD may be more emotional, easily bursting into tears or giggling without knowing why. They may wander or get lost easily, have trouble managing money, or following instructions. In some cases, VaD may cause incontinence, hallucinations, or delusions. 

Weakness on one side of the body or trouble with balance and walking may be problems for those with VaD who have had a stroke. 

How VaD is Different From Other Types of Dementia 

Memory loss is milder in early VaD than in the early stages of Alzheimer’s disease (AD).  VaD can come on suddenly, while AD has a gradual onset. Mood swings are more common in VaD than in other types of dementia syndromes.  

Management of Vascular Dementia (VaD) 

Management of VaD can involve a combination of controlling risk factors, mental health treatment, medicines, brain-stimulating activities, and physical rehabilitation. 

Controlling risk factors 

Controlling cardiovascular symptoms to prevent further damage is critical. This includes managing diabetes and high blood pressure, preventing blood clots, reducing cholesterol, smoking cessation, exercise, eating well and maintaining a healthy weight. 

Mental health treatment 

A depressed or anxious person may benefit from prescribed medications and cognitive behavioral therapy can help coping with the diagnosis. Learning to break down complex tasks into smaller steps can be beneficial. Cooking dinner for example, would start with making a list of food ingredients, ensuring the ingredients are in the home, putting them on the counter, measuring them, and following a recipe step by step.  

Medications for memory problems, including donepezil, rivastigmine, galantamine, and memantine, may help with thinking and memory issues. Always consult with a physician about which medications may be the most appropriate. 

Maintaining activities and stimulating the brain 

A quiet environment can help with concentration, memory, and communication. Making a personal record of one’s life story may also be helpful in stimulating the brain and improving mood. 

Physical rehabilitation  

People with VaD who have had strokes may also need physical rehabilitation for strength, dexterity, and/or movement.  

Frontotemporal Dementia (FTD) 

Frontotemporal dementia is another catch-all term for a group of brain disorders that affect the frontal and/or temporal lobes, located behind the eyes and forehead on both sides of the brain. 

The frontal/temporal lobes help with the following: 

• Planning steps in a process  
• Knowing in which order to perform a sequence of steps 
• Prioritizing more important activities 
• Shifting from one activity to the next 
• Monitoring and correcting errors  

People with conditions that cause FTD may begin to behave in socially inappropriate ways – their ability to understand someone else’s feelings (empathy) vanishes and they become uninhibited and use poor judgment.  

The loss of inhibition may cause overeating, excessive alcohol consumption, and a craving for sweets or carbohydrates. They may also try to consume inedible objects, such as straws, paper products, Styrofoam cups, and plastic silverware. 

They may begin having trouble managing finances, neglect work or responsibilities, make offensive remarks, and have a decline in personal hygiene because FTD affects their lack of judgement. 

FTD may also cause speech and language problems.  Some may also have a flat facial expression while others inappropriately sing, dance, and recite phrases. 

How FTD Differs From Other Types of Dementia 

FTD tends to occur at a younger age than other types of dementia and can begin as early as age 40. 

Memory loss is not as prominent in early FTD as in AD, but behavior changes occur more quickly. Spatial problems like getting lost in a familiar place are rare in FTD but more common in AD and VaD.   

Hallucinations are rare in FTD even as the disease progresses but are common in LBD and advanced AD. Problems making sense of speech, talking, or reading are challenges for many people with FTD, but are not a hallmark of early AD or LBD—although word finding problems and sentence repetition may occur in AD. Language problems may occur in VaD, especially after a stroke. 

Management of FTD 

There is no cure or specific treatment for FTD, and the only medications for it are those used to treat symptoms of agitation, irritability, compulsive behaviors, sleep problems, and/or depression. Altering the environment can be helpful in managing behaviors, such as limiting access to food and alcohol for overeaters or compulsive drinkers.  Those with language issues may benefit from speech therapy. 

If you suspect your loved one may have dementia, getting an early, accurate diagnosis is important to coming up with a treatment plan specific to your loved one’s needs.  

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