Have you ever wondered if the words “dementia” and “Alzheimer’s disease” were interchangeable? If not, what exactly is dementia?
Dementia is not a disease. It’s also not inevitable, and it’s NOT a normal part of aging. It’s actually a catch-all word for a variety of symptoms. These symptoms are caused by many different medical conditions. In fact, there may be more than 400 causes of dementia.
Some causes of dementia include:
- Alzheimer’s disease (AD)
- Lewy body dementia (LBD)
- Vascular dementia (VaD)
- Frontotemporal dementia (FTD)
- Parkinson’s disease
- Syndromes caused by long-term alcohol or drug abuse
- “Mad cow” disease and associated conditions
- Huntington’s disease
- Mixed dementia (more than one cause)
Features Common to All Types of Dementia
All dementia syndromes feature problems with memory, thinking, reasoning, concentration, and/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, and 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.
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 condition cause up to 80% of all types of dementia syndromes.
AD is the most common. It accounts for about one half or more of all dementia syndromes. In Normal Aging of the Brain vs Alzheimer’s Disease, [link to eBook] we thoroughly describe patterns seen in AD.
In this eGuide, we discuss the three remaining most common causes of dementia syndromes:
- Lewy body dementia
- Vascular dementia
- Frontotemporal dementia
For each type of dementia, we’ll review symptoms, how it’s different from others, and how the condition is managed.
Lewy Body Dementia
Symptoms of 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:
- Regulation of the autonomic nervous system
- Visual hallucinations
- Ability to remember correctly
- Problem solving
LBD causes fluctuations in alertness and attention. As a result, people with LBD may take long naps during the day or stare out into space for long periods of time. They may also be depressed and unmotivated.
Furthermore, LBD slows movements, causes rigidity, can include tremors on both sides of the body, and create difficulty walking. People with LBD may experience intermittent falling spells.
As a result of the changes in the autonomic nervous system, they may feel dizzy. They may also sweat, drool, and be constipated. Their blood pressure may drop when they stand.
People with LBD may also have visual or other hallucinations. For example, they may “see” children or animals in scary situations. They may act out their dreams.
LBD affects memory. Furthermore, they may “mis-remember” things. For example, a person with LBD may believe a person tripped them—even though it did not happen.
Additionally, people with LBD may have trouble planning, solving problems, or making wise decisions. Their speech and thinking be slowed, too. At the same time, they may show little facial expression and speak in a soft voice.
People with LBD may have trouble recognizing familiar people or objects.
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). Research is still being done in this area. 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.
Unlike LBD, visual hallucinations are not common in early Alzheimer’s disease.
Management of LBD
Early diagnosis and treatment with medicines called cholinesterase inhibitors (donepezil, rivastigmine) may help control symptoms related to thinking abilities in people with LBD. These medicines may also help with some of the movement problems.
Some patients with rigidity also do well with the medication levodopa. Anti-hallucination (anti-neuroleptic) medicines may make other symptoms worse, so they are avoided.
Emotional support, loving reassurance, reducing the source of stress, and a calm attitude are important for management of hallucinations. However, agitation and aggression may make it necessary to call family or friends for immediate help. It may be necessary to leave the room or home if in danger, and/or call 911.
Symptoms of Vascular Dementia
Vascular dementia (VaD) is dementia caused by brain damage from a lack of blood flow to the brain. (Vascular means having to do with blood vessels.) The blood vessels bring important oxygen and nutrients to our brains. When this flow either slows gradually or suddenly stops, VaD can result.
For example, VaD can sometimes occur fairly suddenly after a stroke. It can also occur in someone who has diseased arteries in the brain (similar to those seen in the heart with heart disease). VaD can occur over time from diabetes, high blood pressure, high cholesterol, or smoking—risk factors for vascular disease.
The symptoms for VaD vary. They depend on what part of the brain is affected and how much of the brain is affected.
They may include:
- Trouble paying attention and concentrating
- Problems with memory, judgment, and problem solving
- Unsteady gait
- Restlessness, agitation, and irritability,
- Depression, anxiety, or apathy
In part, the depression may be caused by knowing that the VaD changes are causing problems in daily life.
What’s more, people may be more emotional. They may burst into tears or begin giggling and not know why. Furthermore, they may wander or get lost in familiar surroundings. They may have trouble managing money or following instructions. In some people with VaD, incontinence, hallucinations, or delusions may occur.
For those with VaD who have had a stroke, weakness on one side of the body or trouble with balance and walking may be problems.
How VaD is Different From Other Types of Dementia
Memory loss is common in the early stages of Alzheimer’s disease (AD), but is milder in early VaD. AD has a gradual onset, but VaD can sometimes come on suddenly. Mood swings are not as common in other types of dementia syndromes as they are in VaD.
Management of Vascular Dementia (VaD)
Much is known about managing vascular disease. Management of VaD may involve controlling risk factors, mental health treatment, medicines, brain-stimulating activities, and physical rehabilitation.
Controlling risk factors
First and most important, controlling cardiovascular symptoms and preventing further damage is a must. Risk factors to control include diabetes, high blood pressure, cholesterol, and smoking. Furthermore, exercise, eating a healthy diet, maintaining a moderate weight, and preventing blood clots may help prevent further damage.
Mental health treatment
Second, a depressed or anxious person may benefit from prescribed medications and cognitive behavioral therapy. Help coping with the diagnosis is also important. Likewise, learning to break down complex tasks into smaller steps can be beneficial. For example, cooking dinner could involve making a list of the food needed, ensuring that all ingredients are in the home, placing all the ingredients on the counter, measuring ingredients, and following the recipe step by step.
Medications for memory problems
Certain medications may help with thinking and memory problems. These might include: donepezil, rivastigmine, galantamine, and memantine.
Maintaining activities and stimulating the brain
A quiet environment can also help with concentration. Keeping mentally active can help with memory and communication. Making a personal record of one’s life story may also be helpful in stimulating the brain and improving mood.
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 of the brain. These lobes are located behind the eyes and forehead on both sides of the brain.
These parts of the brain help with the following activities:
- 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. The ability to understand someone else’s feelings (empathy) vanishes. What’s more, they become uninhibited and use poor judgment.
With this loss of inhibition, they may begin overeating, excessively drinking alcohol, and craving sweets or carbohydrates. They may try to consume inedible objects, such as straws, paper products, Styrofoam cups, and plastic silverware.
Because they lack good judgment, they may begin having trouble managing finances. Additionally, they may neglect work or responsibilities. They may make offensive remarks—remarks that they would never have made previously. They may also have a decline in personal hygiene.
In some people, FTD may cause speech and language problems.
Additionally, some people may have a flat facial expression while others may 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. For example, it may begin as early as age 40.
Memory loss isn’t as prominent in early FTD as in AD. Additionally, behavior changes occur quickly in FTD but are more gradual in AD. Spatial problems such as 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—although they are common in LBD and advanced AD. Problems with making sense of speech, talking, or reading are challenges for many people with FTD. These types of language problems 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
Unfortunately, there’s no cure or specific treatment for FTD. The only medications for FTD 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. For example, limiting access to food and not having inedible objects on the plate can help with people who are overeating or putting nonfood items in their mouths. Those with speech involvement may benefit from speech therapy.
In summary, dementia is a catch-all word that refers to a variety of symptoms. Hundreds of conditions can cause dementia. But the four most common types are Alzheimer’s disease, Lewy body dementia (LBD), vascular dementia (VaD), and frontal temporal dementia (FTD). Although symptoms sometimes overlap, healthcare professionals who are experts in the field of dementia are able to assess individuals and identify groups of characteristics to make an accurate diagnosis. Accurate diagnosis can allow proper treatment.
If you suspect you or a loved one may have dementia, an early, comprehensive evaluation is key to proper diagnosis and treatment. A brief screening tool is not adequate. If you’re not sure where to find an expert, reach out to Homethrive. We can help.