Dementia is not a single disease, but instead a group of diseases or, in some cases, injury, that can cause a change in a person’s intellect, thinking skills, such as memory or language, personality or social behavior. People will often equate dementia with Alzheimer’s Disease, but Alzheimer’s is just one type of dementia. The onset and course of dementia is dependent upon the type of disease causing the symptoms. Some dementias are progressive and primarily managed by changes to the environment; others can be medically treated and reversed.
Dementia symptoms vary, depending on the type, but can include:
- Memory loss
- Changes in language, such as difficulty finding the right word
- Changes in judgment or reasoning abilities
- Difficulty with organization and planning
- Personality changes
- Changes in motor skills or walking
- Changes in behavior
- Paranoia or suspiciousness
Some changes in thinking are normal as a person ages. However, if you or a family member is experiencing a significant change in thinking and can no longer perform daily activities, such as managing medications, paying bills, cooking or driving, talk to your doctor. Your doctor will check for common dementia symptoms, but there are a number of other issues to first consider that may contribute to changes, including:
- Medication effects
- Alcohol/drug use
- Poor nutrition
- Lack of exercise
- Sleep Disorders
- Metabolic Abnormalities
- B-12 Deficiency
- Thyroid Irregularities
Your doctor can screen for these through interview, examination and/or blood work and address the issue.
In some cases, where dementia symptoms are experienced, your physician may refer you for a further follow-up, including:
- Neuropsychological Evaluation: A formal evaluation of your thinking abilities
- Neurological Evaluation
- Lab Work Up
- Radiologic work-up: MRI or CT of the brain
- Age: This is the largest risk factor for development for most dementias, with risk increasing with greater age
- Gender: Depending on the type of dementia, there can be a greater prevalence in men or women. For example, women are at greater risk for Alzheimer’s Disease than men.
- Race: Certain racial groups carry a higher risk, depending on dementia type. For example, African-Americans and Latinos have a higher risk for vascular disease and therefore vascular dementia.
- Family history: There is no specific gene that determines if a person will develop dementia, but there is greater risk when it runs in a family.
- History of head injury: A history of a moderate to severe head injury or multiple head injuries when younger can increase dementia risk.
- Heart risk factors: If it is bad for your heart (e.g. high blood pressure, high cholesterol, diabetes, smoking), then it is bad for your brain and increases dementia risk.
- Alcohol and drug use.
Common Types of Dementia
- Alzheimer’s Disease: Alzheimer’s disease typically has on onset later in life, and it's one of the most common types of dementia. The main presenting symptom is memory loss, specifically a type of memory loss called rapid forgetting, in which new memories are not formed well. Alzheimer’s disease is a slow, progressive dementia, with the course ranging from three to 15-plus years. Alzheimer’s disease is due to the presence of two co-occurring disease pathologies, plaques and tangles. Plaques are an accumulation of a specific protein between the cells. Tangles are a breakdown of the structure within the cells, also due to a protein. Alzheimer’s disease cannot be cured, but there are medications to slow the rate of progression.
- Lewy Body Dementia: Lewy Body Dementia is also a dementia of later life. This type of dementia can look similar to Alzheimer’s disease, but is accompanied by changes in the person’s gait and posture, similar to those seen with Parkinson’s disease, as well as visual hallucinations. There also tends to be variability in the person’s presentation from day to day with periods of lucidity and periods of confusion. Lewy Body Dementia cannot be cured, but some of these dementia symptoms can be managed.
- Vascular Dementia: Vascular Dementia is due to changes in the blood vessels in the brain. Changes in thinking or behavior occur as a result of a large stroke, a bleed in the brain or the build-up of small mini-strokes over time. Vascular Dementia symptoms are typically managed by addressing the underlying vascular risk factors, such as high blood pressure or high cholesterol. A dementia medication, similar to what is prescribed for Alzheimer’s disease, may also be used.
- Frontotemporal Dementia: Frontal dementia tends to occur between the ages of 40 and 70 and has two main presentations, a change in language or a change in personality. The subtype associated with a change in language is referred to as a Primary Progressive Aphasia (PPA). In PPA, the person’s ability to verbally express themselves declines with time. A change in personality occurs in the other subtype, a Frontal Dementia. The person may become more disinhibited or apathetic. Neither PPA or Frontal Dementia can be cured, but the symptoms can, at least partially, be treated with medication or special therapies.
- Normal Pressure Hydrocephalus (NPH): NPH is due to a build-up of excess fluid in the brain. The presenting symptoms are a change in gait (difficulty walking), incontinence and changes in thinking. When this triad of dementia symptoms is present and an MRI of the brain shows excess fluid, NPH may be considered. NPH can be treated, with significant symptom improvement in some patients, with a shunt, which redirects the excess fluid elsewhere in the body.
Dementia Treatment Options
For most dementias, there is not a cure, but there are dementia treatments available to help slow the progression of disease. Changes to the patient’s environment are essential in the management of depression. Maintenance of a healthy active lifestyle is also important.
For More Information
For more information or to schedule an appointment, please call 847.425.6400.