What Is Dementia?
Types of Dementia
Vascular Dementia
If a relative or friend of yours gets this type of dementia, it’s usually because he’s had a major stroke, or one or more “silent” strokes, which can happen without him realizing it.
The symptoms depend on which part of his brain was affected by the stroke.
While Alzheimer’s usually begins with memory problems, vascular dementia more often begins with poor judgment or trouble planning, organizing, and making decisions.
Other symptoms may include:
- Memory problems that disrupt your loved one’s daily life
- Trouble speaking or understanding speech
- Problems recognizing sights and sounds that used to be familiar
- Being confused or agitated
- Changes in personality and mood
- Problems walking and having frequent falls
Dementia With Lewy Bodies (DLB)
Lewy bodies are microscopic deposits of a protein that form in some people’s brains. They’re named after the scientist who discovered them.
If someone you know gets DLB, it’s because these deposits have formed in the part of the brain called the cortex.
The symptoms include:
- Problems thinking clearly, making decisions, or paying attention
- Memory trouble
- Seeing things that aren’t there, known as visual hallucinations
- Unusual sleepiness during the day
- Periods of “blanking out” or staring
- Problems with movement, including trembling, slowness, and trouble walking
- Dreams where you act out physically, including, talking, walking, and kicking
Parkinson’s Disease Dementia
People with the nervous system disorder Parkinson’s disease get this type of dementia about 50% to 80% of the time. On average, the symptoms of dementia develop about 10 years after a person first gets Parkinson’s.
This type is very similar to DLB. They have the same symptoms, and people with both conditions have signs of Lewy bodies in their brains.
Mixed Dementia
This is a combination of two types of dementia. The most common combination is Alzheimer’s disease and vascular dementia.
Frontotemporal Dementia (FTD)
If your loved one has an FTD, he’s developed cell damage in areas of the brain that control planning, judgment, emotions, speech, and movement.
Someone with FTD may have:
- Personality and behavior changes
- Sudden lack of inhibitions in personal and social situations
- Problems coming up with the right words for things when speaking
- Movement problems, such as shakiness, balance problems, and muscle spasms
Dementia symptoms
A person with dementia may show any of the symptoms listed below, mostly due to memory loss.
Some symptoms they may notice themselves, others may only be noticed by caregivers or healthcare workers.
The signs used to compile this list are published by the American Academy of Family Physicians (AAFP) in the journal American Family Physician.
Possible symptoms of dementia:
- Recent memory loss – a sign of this might be asking the same question repeatedly.
- Difficulty completing familiar tasks – for example, making a drink or cooking a meal.
- Problems communicating – difficulty with language; forgetting simple words or using the wrong ones.
- Disorientation – getting lost on a previously familiar street, for example.
- Problems with abstract thinking – for instance, dealing with money.
- Misplacing things – forgetting the location of everyday items such as keys, or wallets, for example.
- Mood changes – sudden and unexplained changes in outlook or disposition.
- Personality changes – perhaps becoming irritable, suspicious or fearful.
- Loss of initiative – showing less interest in starting something or going somewhere.
As the patient ages, late-stage dementia symptoms tend to worsen.
Dementia stages
Sometimes, dementia is roughly split into four stages:
Mild cognitive impairment: characterized by general forgetfulness. This affects many people as they age but it only progresses to dementia for some.
Mild dementia: people with mild dementia will experience cognitive impairments that occasionally impact their daily life. Symptoms include memory loss, confusion, personality changes, getting lost, and difficulty in planning and carrying out tasks.
Moderate dementia: daily life becomes more challenging, and the individual may need more help. Symptoms are similar to mild dementia but increased. Individuals may need help getting dressed and combing their hair. They may also show significant changes in personality; for instance, becoming suspicious or agitated for no reason. There are also likely to be sleep disturbances.
Severe dementia: at this stage, symptoms have worsened considerably. There may be a loss of ability to communicate, and the individual might need full-time care. Simple tasks, such as sitting and holding one’s head up become impossible. Bladder control may be lost.
Early signs
Early signs of dementia can include:
- Changes in short-term memory.
- Changes in mood.
- Trouble finding the right words.
- Apathy.
- Confusion.
- Being repetitive.
- Finds it hard to follow a storyline.
- Trouble completing everyday tasks.
- Poor sense of direction.
- Difficulty adapting to changes.
Dementia causes
Dementias can be caused by brain cell death, and neurodegenerative disease – progressive brain cell death that happens over time – is associated with most dementias.
However it is not known if the dementia causes the brain cell death, or the brain cell death causes the dementia.
But, as well as progressive brain cell death, like that seen in Alzheimer’s disease, dementia can be caused by a head injury, a stroke, or a brain tumor, among other causes.
- Vascular dementia (also called multi-infarct dementia) – resulting from brain cell death caused by conditions such as cerebrovascular disease, for example, stroke. This prevents normal blood flow, depriving brain cells of oxygen.
- Injury – post-traumatic dementia is directly related to brain cell death caused by injury.
Some types of traumatic brain injury – particularly if repetitive, such as those received by sports players – have been linked to certain dementias appearing later in life. Evidence is weak, however, that a single brain injury raises the likelihood of having a degenerative dementia such as Alzheimer’s disease.
Dementia can also be caused by:
- Prion diseases – for instance, CJD (Creutzfeldt-Jakob disease).
- HIV infection – how the virus damages brain cells is not certain, but it is known to occur.
- Reversible factors – some dementias can be treated by reversing the effects of underlying causes, including medication interactions, depression, vitamin deficiencies, and thyroid abnormalities.
Diagnosing dementia
The first step in testing memory performance and cognitive health involves standard questions and tasks.
Research has shown that dementia cannot be reliably diagnosed without using the standard tests below, completing them fully, and recording all the answers; however, diagnosis also takes account of other factors.
Cognitive dementia tests
Today’s cognitive dementia tests are widely used and have been verified as a reliable way of indicating dementia. They have changed little since being established in the early 1970s. The abbreviated mental test score has ten questions, which include:
- What is your age?
- What is the time, to the nearest hour?
- What is the year?
- What is your date of birth?
Each correct answer gets one point; scoring six points or fewer suggests cognitive impairment.
The General Practitioner Assessment of Cognition (GPCOG) test includes an added element for recording the observations of relatives and caregivers.
Designed for doctors, this sort of test may be the first formal assessment of a person’s mental ability.
The second part of the test probes someone close to the patient and includes six questions to find out whether the patient has:
- become less able to remember recent events or conversations
- begun struggling to find the right words or using inappropriate ones
- found difficulty managing money or medications
- needed more help with transport (without the reason being, for example, injury)
If the test does suggest memory loss, standard investigations are then recommended, including routine blood tests and a CT brain scan.
Clinical tests will identify, or rule out, treatable causes of memory loss and help to narrow down potential causes, such as Alzheimer’s disease.
The mini-mental state examination (MMSE) is a cognitive test which measures:
- orientation to time and place
- word recall
- language abilities
- attention and calculation
- visuospatial skills
The MMSE is used to help diagnose dementia caused by Alzheimer’s disease and also to rate its severity and whether drug treatment is needed.
Dementia treatments
Brain cell death cannot be reversed, so there is no known cure for degenerative dementia.
Management of disorders such as Alzheimer’s disease is instead focused on providing care and treating symptoms rather than their underlying cause.
If dementia symptoms are due to a reversible, non-degenerative cause, however, treatment may be possible to prevent or halt further brain tissue damage.
Examples include injury, medication effects, and vitamin deficiency.
Symptoms of Alzheimer’s disease can be reduced by some medications. There are four drugs, called cholinesterase inhibitors, approved for use in the U.S.:
- donepezil (brand name Aricept)
- galantamine (Reminyl)
- rivastigmine (Exelon)
- tacrine (Cognex)
A different kind of drug, memantine (Namenda), an NMDA receptor antagonist, may also be used, alone or in combination with a cholinesterase inhibitor.
Cholinesterase inhibitors can also help with the behavioral elements of Parkinson’s disease.
Other quality-of-life care
“Brain training” may help improve cognitive functioning and help deal with forgetfulness in the early stages of Alzheimer’s. This might involve the use of mnemonics and other memory aids such as computerized recall devices.
Dementia risk and prevention
the risk of cognitive decline and dementia.
Frequently Asked Questions
What is dementia?
Dementia is a collective name for progressive brain syndromes which affect memory, thinking, behaviour and emotion. The most well-known form of dementia is Alzheimer’s disease, which accounts for 50-60% of all cases. Other forms of dementia include vascular dementia, dementia with Lewy bodies and fronto-temporal dementia.
I think my partner has dementia. How do I convince them to see our doctor?
Remember, many conditions have symptoms similar to dementia. It is important not to assume that someone has dementia just because some of the symptoms are present. Strokes, depression, alcoholism, infections, hormone disorders, nutritional deficiencies, and brain tumours can all cause dementia-like symptoms. Many of these conditions can be treated.
Can I reduce my risk of getting dementia?
Yes you can! There are ways to reduce the risk of getting dementia and although we can’t guarantee that you won’t get dementia even if you ‘do everything right’, studies of large groups of people do show that those who adopt ‘brain-healthy’ lifestyles have a reduced risk of developing dementia.