Dementia isn’t a singular noun. Part 2: Types of dementia

dementia 1 fall 2021aIn the previous post, I wrote about what dementia isn’t, and how dementia differs from natural aging.

Now let’s talk about what dementia is – and what it is, is an umbrella term for nine different neurodegenerative diseases that result when brain cells or neurons die or are damaged.

Alzheimer’s Disease accounts for as much as 80% of all dementia cases. More than 10% of Americans over 65 suffer from it, as do more than one-third of those over 85. It progressively and irreversibly destroys brain cells, impairing memory, thinking skills, judgment, and reasoning. Testing can identify other causes of similar symptoms, but only an autopsy can diagnose Alzheimer’s with 100% certainty. While there’s no cure yet, there are treatments to slow down its destructive symptoms and improve quality of life – not only for patients, but also for family caregivers.

As its name implies, Vascular Dementia has to do with blood flow. When a blockage, stroke, high cholesterol, or diabetes reduces blood flow to the brain, that starves it of oxygen and nutrients. The resulting brain damage can lead to confusion, trouble speaking or concentrating, vision loss, bladder and bowel control problems, and hallucinations, among other symptoms. Unlike Alzheimer’s and other forms of dementia, symptoms come on suddenly, not gradually over time. A heart-healthy lifestyle – exercise, low-fat diet, blood pressure and cholesterol management – can slow or sometimes even halt its progression. Individually tailored treatment plans – including medication, mental exercises and caregiver assistance – can maximize a patient’s remaining cognitive abilities.

When a form of protein called Lewy bodies build up in the brain, they can cause Lewy Body Dementia, second only to Alzheimer’s disease in prevalence. Its symptoms include shaking, slow and rigid movements, balance problems, fainting, fluctuating personality and mood changes, memory loss and confusion, and visual hallucinations. Some medications can treat some symptoms, but different people react to them in different ways; some can actually make symptoms worse. Nondrug options include exercise (physical therapy, weight training, cardiovascular training, stretching and balancing exercises) for motor control and music therapy for mood improvement.

Even though age is one of the biggest predictors of Parkinson’s Disease, even adults younger than 50 can get it. Parkinson’s is more a precursor to dementia than dementia itself. Over time – ten years or so – an estimated 50-80% of Parkinson’s patients will develop mild dementia, and 20% severe dementia. Neurons in the brain produce dopamine, which helps control muscle movement. When those neurons die, the resulting decrease in dopamine produces tremors, slowed movement, writing and speech changes, impaired posture and balance, and loss of automatic movement. There can also be psychological changes, such as depression, irritability, disorientation, and hallucinations. These symptoms can develop so slowly and gradually that they’re too mild to be noticed. Medications can control dopamine levels and help reduce tremors. A surgical procedure called Deep Brain Stimulation can also help. So can regular exercise and physical and speech therapy.

Frontotemporal Dementia (also known as Pick’s Disease) is more like three different dementias with the same cause – degeneration of the brain’s frontal lobe. One form produces lethargy, with some patients staying in bed all day – or extreme lack of inhibition, producing behaviors from sexually charged language to outright crimes. With a second form patients can understand speech but not reply coherently. A third form is the opposite; patients can speak clearly but not understand a word they hear. Average survival is seven years from first symptoms. With the right support, some of the behavioral issues can be managed.

Huntington’s Disease can start showing symptoms anytime from age two to old age. Huntington’s progresses at different speed for different people, so patients live from ten to 30 years. A “genetic stutter” in one of the 23 chromosomes in the human gene code makes the brain lose nerve cells. This physical change produces behavioral changes, from irritability to hallucinations or psychosis; abnormal arm, leg, head, and face movements; speech, memory, and judgment problems; and depression. Medication, psychotherapy, and occupational therapy can help these conditions, while individually tailored caregiving can help patients manage their symptoms.

When incorrectly folded proteins spread through the brain, they make brain tissues spongy. This leads to Creutzfeldt-Jakob Disease. This dementia progresses very quickly. Like other dementias, it leads to memory loss, personality changes, and sometimes hallucinations. Unlike other dementias, its symptoms include speech impairment, jerky muscle contractions, balance and coordination difficulties, seizures, rigid posture, and changes in gait. Sadly, there’s no known cure or treatment, but, as dementia.org advises, “by understanding the scope of the condition, you can better support the condition in a loved one.”

Unlike other dementias, Normal Pressure Hydrocephalus is treatable and, to a certain extent, reversible. When cerebrospinal fluid builds up in and bloats the brain’s ventricles, they press against, and damage, the surrounding tissue. Its main symptoms include slowed thinking, unsteady walking and leg weakness, and loss of bladder control later on. Surgically inserting a tube and draining the excess fluid can reduce many of the symptoms, and medication can help control them.

Wernicke-Korsakoff Syndrome is a one-two punch. Punch number one is Wernicke encephalopathy, most often caused by alcohol abuse. Excessive drinking creates permanent brain damage by starving the brain of vitamin B1. (So can HIV/AIDs, bariatric weight-loss surgery, long-term dialysis, extreme nausea and vomiting during pregnancy, and long periods of IV therapy without B1 supplements.) Vitamin B1 injections can improve its symptoms: confusion, delirium, vision difficulty, and lack of muscle coordination. As those symptoms ease, punch number two, Korsakoff Psychosis, caused by permanent damage to the brain’s memory centers, kicks in. Its symptoms include mild to severe memory loss, difficulty forming new memories, making up words or stories to compensate for memory loss, and hallucinations. Permanent brain damage is, well, permanent. But abstinence from alcohol and maintaining a healthy, balanced nutritional diet can slow the progression.

Different types of dementia affect different people differently, with different pacing. So caregiving needs to be anything but a check-off-the-box affair. That’s why we get to know our clients and their families with a thorough three-part needs assessment, covering everything from physical, psychological and mental status to mobility issues and nutritional needs and legal wishes. Why we custom-design a holistic, coordinated care plan based on each client’s individual needs. And why our monthly nursing assessments involve not just checking vital signs, but carefully tracking changes and updating the caregiving plan accordingly.

Whether for dementia or regular aging, please contact us to see the difference that kind of individual approach can make.

Next: Part 3 – Stages of Dementia