Dementia describes a group of symptoms associated with a decline in memory, reasoning, or other thinking skills. There are different kinds of dementia, and it’s not just a normal part of getting older. It happens when the cells in the brain get damaged, and they can’t communicate properly. This can affect how a person thinks, behaves, and feels.
One common type of dementia is Alzheimer’s disease, which is responsible for most cases (60-80%). Mixed dementia is when a person has changes in the brain related to more than one type of dementia at the same time.
It’s important to know that dementia isn’t just a natural part of aging. It can be caused by various conditions. Globally, around 50 million people are currently dealing with Alzheimer’s and other types of dementia.
What happens as we get older? Well, there are some common changes that happen with age, and it’s important to know that not all of them mean someone has Alzheimer’s or dementia.
For instance, people might make occasional mistakes when handling money or paying bills. They could forget names or appointments sometimes but remember them later. They might need a little help using the microwave or setting up their TV recordings. Occasionally, they might get confused about what day it is but figure it out later.
There could also be changes in vision due to cataracts. Finding the right word might become a bit challenging at times. Making occasional bad decisions or mistakes, like forgetting to change the car’s oil, could happen.
Misplacing things every now and then and retracing steps to find them is common. Feeling uninterested in family or social events might happen from time to time. People might develop specific ways of doing things and become irritable if their routine is disrupted. These are all normal parts of aging.
Alzheimer’s disease is a brain disease that gets worse over time, and it’s the most common type of dementia. Dementia is not a specific sickness itself. It’s a word used to talk about a group of symptoms.
Vascular dementia often happens after a stroke when the blood supply to the brain is blocked, which can kill brain cells. This kind of dementia is not the same as Alzheimer’s because it’s caused by damage to the brain from problems with blood flow, while Alzheimer’s doesn’t have a clear cause. If someone has a history of vascular issues like blood clots or strokes, they’re at risk for vascular dementia, and the risk goes up with each vascular problem.
Lewy Body Dementia (LBD) is a type of dementia that gets worse over time and causes problems with thinking, reasoning, and doing things independently. This happens because of abnormal tiny deposits in the brain that damage it.
Alzheimer’s and dementia are terms often used interchangeably, but they have distinct differences. Dementia is an umbrella term for a set of symptoms, including memory loss and cognitive decline, that affect a person’s daily life. Alzheimer’s disease is a specific type of dementia and the most common cause of dementia. Other types of dementia include vascular dementia, Lewy body dementia, and frontotemporal dementia. While dementia is a general term for various cognitive impairments, Alzheimer’s specifically refers to a progressive brain disorder characterized by the buildup of abnormal protein deposits in the brain, leading to memory loss and cognitive decline. In simpler terms, dementia is like an overarching category, and Alzheimer’s is one particular kind of brain condition under that category.
Dementia isn’t just one illness; it’s like saying “heart disease,” covering various specific medical conditions, including Alzheimer’s disease. The term “dementia” includes disorders caused by unusual changes in the brain that lead to a decline in thinking skills (cognitive abilities). This decline is significant enough to affect daily life and independent function, and it also influences behavior, feelings, and relationships.
Alzheimer’s disease makes up 60-80% of dementia cases. Vascular dementia, the second most common cause, happens due to tiny bleeding and blockage of blood vessels in the brain. Mixed dementia occurs when someone has brain changes from multiple types of dementia simultaneously. Several other conditions can cause dementia-like symptoms, including some that can be reversed, like thyroid problems and vitamin deficiencies.
People often mistakenly call dementia “senility” or “senile dementia.” This comes from the old, incorrect belief that serious mental decline is a normal part of getting older.
Scientists think that Alzheimer’s disease doesn’t have just one cause. It probably happens because of different things like our genes, how we live, and where we live. Some things make the chance of getting Alzheimer’s higher. We can’t do anything about getting older, having family members with it, or the genes we’re born with. But there’s new evidence that shows we might be able to do something about other things.
- Getting Older
- Family History
- Genes
- Other things that might make it more likely, like hitting your head
- Forgetfulness that affects your daily life: You might forget events, repeat things, or need more reminders like notes to remember things.
- Difficulty in planning or solving problems: Struggling with tasks like paying bills or following familiar recipes.
- Trouble completing usual tasks at home, work, or for fun: Facing challenges in activities like cooking, driving, using a phone, or shopping.
- Confusion about time or place: Finding it hard to understand when things are happening or losing track of dates.
- Problems with visual images and spatial relations: Experiencing difficulty with balance, judging distance, and being more prone to tripping or dropping things.
- New issues with speaking or writing: Struggling to follow or join conversations, and having difficulty finding the right words.
- Misplacing things and inability to retrace steps: Putting items in unusual places and having trouble remembering where you put them.
- Decreased or poor judgment: Falling victim to scams, mismanaging money, neglecting hygiene, or having difficulty taking care of pets.
- Withdrawal from work or social activities: Avoiding usual activities and struggling to stay engaged in hobbies or social events.
- Changes in mood and personality: Becoming easily upset, fearful, or suspicious in regular situations.
There is no single test that can determine if a person is living with Alzheimer’s or another dementia. Physicians use diagnostic tools combined with medical history and other information, including neurological exams, cognitive and functional assessments, brain imaging (MRI, CT, PET) and blood tests to make an accurate diagnosis.
Medical history
During the medical assessment, the medical doctor will review the person’s medical history, including psychiatric history and history of cognitive and behavioral changes. He or she will want to know about any current and past medical problems and concerns, as well as any medications the person is taking. The doctor will also ask about key medical conditions affecting other family members, including whether they may have had Alzheimer’s disease or other dementias.
Physical exam and diagnostic tests
During a medical workup, the physician will likely:
- Lifestyle, including diet, nutrition and use of alcohol.
- Review all medications.
- Check blood pressure, temperature and pulse.
- Listen to the heart and lungs.
- Collect blood or urine samples for laboratory testing.
Information from a physical exam and laboratory tests can help identify health issues that can cause symptoms of dementia. Common causes of dementia-like symptoms are depression, untreated sleep apnea, delirium, side effects of medications, thyroid problems, certain vitamin deficiencies and excessive
alcohol consumption. Unlike Alzheimer’s and other dementias, these conditions often may be reversed with treatment.
Neurological exam
During a neurological exam, the physician will closely evaluate the person for problems that may signal brain disorders other than Alzheimer’s. The doctor will look for signs of stroke, Parkinson’s disease, brain tumors, buildup of fluid in the brain, and other conditions that may impair memory or thinking.
The physician will test:
- Reflexes.
- Coordination, muscle tone and strength.
- Eye movement.
- Speech.
- Sensation.
- may also include a brain imaging study.
If the evaluation does not indicate Alzheimer’s disease or another dementia, but the symptoms continue to get worse over time, your doctor may need to order more tests, or you may wish to get a second opinion.
Cognitive, functional and behavioral tests
Cognitive, functional and behavioral tests evaluate memory, thinking and simple problem-solving abilities, and may quickly assess changes in behaviors and symptoms. Some tests are brief, while others can be more time intensive and complex. More comprehensive cognitive, functional and behavioral tests are often given by a neuropsychologist to evaluate executive function, judgment, attention and language. Such tests may give an overall sense of whether a person is experiencing cognitive symptoms that affect activities of daily living and function and is aware of these symptoms; knows the date, time and where he or she is; and can remember a short list of words, follow instructions and perform simple calculations.
Examples of cognitive, functional and behavioral tests include:
- Ascertain Dementia 8 (AD8)
- Functional Activities Questionnaire (FAQ)
- Mini-Cog
- Mini-Mental State Exam (MMSE)
- Montreal Cognitive Assessment (MoCA)
- Neuropsychiatric Inventory Questionnaire (NPI-Q)
Depression screen and mood assessment
In addition to assessing mental status, the doctor will evaluate a person’s sense of well-being to detect depression or other mood disorders that can cause memory problems, loss of interest in life, and other symptoms that can overlap with dementia.
If you suspect that you or your loved one is becoming more forgetful and you believe it may be dementia, ask your family doctor to send you a referral to geriatric clinics in Toronto. Click the link below to learn more.
Lewy body dementia (LBD) is a progressive brain disorder that affects thinking, behavior, and movement. It is the third most common cause of dementia after Alzheimer’s disease and vascular dementia. LBD is characterized by the presence of abnormal protein deposits called Lewy bodies in the brain. These deposits disrupt normal brain function and lead to a range of symptoms.
Lewy bodies are also seen in other brain problems like Alzheimer’s disease and Parkinson’s disease dementia. Many people with Parkinson’s eventually develop problems with thinking and reasoning, and many people with Lewy body dementia experience movement symptoms, such as hunched posture, rigid muscles, a shuffling walk, and trouble initiating movement.
The fact that these symptoms overlap and other evidence suggests that Lewy body dementia, Parkinson’s disease, and Parkinson’s disease dementia might be connected through the same issues in how the brain deals with the alpha-synuclein protein (major component of Lewy bodies). Many people with both Lewy body dementia and Parkinson’s dementia also have plaques and tangles in the brain, which are linked to Alzheimer’s disease.
Discovering the Signs of Lewy Body Dementia:
- Cognitive Shifts: Experience changes in thinking and reasoning.
- Dynamic Alertness: Encounter fluctuations in confusion and alertness, noticeable at different times of the day or from one day to the next.
- Movement Mysteries: Witness slowness, gait imbalance, and other parkinsonian movement features.
- Vivid Hallucinations: Engage with well-formed visual hallucinations, adding a surreal element to perception.
- Unveiling Delusions: Navigate through episodes of delusions, providing insight into the complexity of the condition.
- Visual Puzzle: Encounter difficulty in interpreting visual information, contributing to the intricate nature of the symptoms.
- Sleep Struggles: Battle sleep disturbances that disrupt the regular sleep cycle.
- Autonomic Challenges: Experience malfunctions in the “automatic” (autonomic) nervous system, further complicating the landscape of symptoms.
- Memory Mosaic: Encounter memory loss that, while significant, takes a distinct form compared to the more pronounced memory challenges seen in Alzheimer’s.
Similar to various forms of dementia, Lewy body dementia cannot be definitively diagnosed with a single test. Presently, the diagnosis of Lewy body dementia relies on clinical assessment, reflecting a healthcare professional’s informed judgment regarding the underlying cause of an individual’s symptoms. As is the case with numerous dementia types, the sole method to confirm a Lewy body dementia diagnosis conclusively is through a postmortem autopsy.
- Early in Lewy body dementia, movement symptoms are more significant contributor to disability compared to Alzheimer’s, although moderate and severe stageAlzheimer’s can lead to problems with walking, balance, and mobility
- REM sleep disorder is more noticeable in Lewy body dementia compared to Alzheimer’s.
- In the initial stages of Alzheimer’s, memory loss is typically more pronounced than in early Lewy body dementia, although advanced stages of Lewy body dementia may exhibit memory problems along with its usual effects on judgment, planning, and visual perception.
- In the Lewy body dementia, hallucinations, delusions, and misidentification of familiar individuals are more prevalent than in Alzheimer’s.
- The disruption of the autonomic nervous system, resulting in a drop in blood pressure upon standing, dizziness, falls, and urinary incontinence, is much more frequent in early Lewy body dementia than in Alzheimer’s.
Given that Lewy bodies often coexist with Alzheimer’s brain changes, distinguishing between Lewy body dementia and Alzheimer’s disease, especially in the early stages, can be challenging. Similar to various forms of dementia, Lewy body dementia cannot be definitively diagnosed with a single test. Presently, the diagnosis of Lewy body dementia relies on clinical assessment, reflecting a healthcare professional’s informed judgment regarding the underlying cause of an individual’s symptoms. As is the case with numerous dementia types, the sole method to confirm a Lewy body dementia diagnosis conclusively is through a postmortem autopsy.
Lewy Body dementia is diagnosed under the following conditions:
- The initial symptoms are consistent with dementia associated with Lewy bodies.
- Both dementia and movement symptoms are present at the time of diagnosis.
- Dementia symptoms emerge within one year after the onset of movement symptoms.
On the other hand, Parkinson’s disease dementia is diagnosed when a person is initially diagnosed with Parkinson’s based on movement symptoms, and dementia symptoms become apparent a year or more later.
Many experts now consider Lewy Body dementia and Parkinson’s disease dementia as different manifestations of the same underlying issues related to the brain’s processing of the protein alpha-synuclein. However, despite this perspective, most experts still recommend maintaining separate diagnoses for Lewy Body dementia and Parkinson’s dementia.
Vascular dementia often develops following a stroke, which occurs when blood supply to the brain is disrupted, leading to the death of brain cells. Unlike Alzheimer’s disease, which has a mostly unknown cause, vascular dementia is a result of brain damage caused by compromised blood flow. Individuals with a history of vascular complications, such as blood clots and strokes, face an increased risk of developing vascular dementia, and this risk amplifies with each occurrence of vascular episodes.
The broader category known as Vascular Contributions to Cognitive Impairment and Dementia (VCID) includes conditions arising from stroke and other vascular brain injuries that bring about substantial alterations in memory, thinking, and behavior. The impact on cognition and brain function is influenced by factors like the size, location, and number of brain injuries.
There are two types of VCID, namely vascular dementia and vascular cognitive impairment (VCI). These conditions are linked to common risk factors that elevate the likelihood of cerebrovascular disease (stroke). These risk factors include atrial fibrillation (a heart rhythm issue), high blood pressure, diabetes, and elevated cholesterol levels.
Gradual changes in thinking and behavior can occur due to multiple small strokes, where each stroke damages smaller vessels, leading to an increasing number of blockages in the brain. The primary warning sign of vascular dementia is memory loss, especially after experiencing a vascular event like a stroke or blood clot. It is crucial to monitor and work on maintaining cognitive function in such situations.
Specific symptoms of vascular dementia are more pronounced immediately after a stroke and include:
- Disorientation, confusion, and difficulty concentrating.
- Speech difficulties, such as trouble finding the right words or pronouncing them.
- Vision loss and changes in senses like smell and taste.
- Classic stroke symptoms like a droopy face, body numbness, or paralysis.
- Uncontrollable emotional behavior, such as laughing or crying.
- Involuntary body movements like hand grabbing or hitting.
Similar to Alzheimer’s disease and other forms of dementia, these symptoms can be mistaken for other issues, so it’s crucial to consult with a healthcare professional for a proper diagnosis. Through blood tests, heart scans, and brain scans, doctors can determine the cause of memory loss and other dementia.
Symptoms of Vascular Cognitive Impairment and Dementia (VCID) may appear suddenly and fluctuate over one’s lifetime. VCID can coexist with Alzheimer’s disease.People with VCID almost always have abnormalities in the brain on magnetic resonance imaging scans. These abnormalities include evidence of prior strokes, often small and asymptomatic, as well as diffuse changes in the brain’s “white matter”—the intricate network of neural pathways crucial for transmitting messages between different brain regions. Microscopic brain examination shows thickening of blood vessel walls called arteriosclerosis and the thinning or absence of elements in the white matter, adding another layer of complexity to our understanding.
Vascular dementia is a condition where memory and cognitive functions gradually decline due to damage or disease in the brain’s blood vessels. Sometimes, the symptoms of vascular dementia can be challenging to differentiate from Alzheimer’s disease. Unlike Alzheimer’s, vascular dementia (VCID) is characterized by more prominent issues with organization, attention, slowed thinking, and problem-solving, while Alzheimer’s is primarily associated with memory loss.
Vascular cognitive impairment refers to noticeable changes in language, attention, thinking, reasoning, and memory that do not significantly impact daily life. These changes, resulting from vascular injury or disease in the brain, progress slowly over time.
Post-stroke dementia can develop months after a major stroke. While not everyone who has had a major stroke will develop vascular dementia, the risk is notably higher in those who have experienced a stroke.
Multi-infarct dementia occurs due to numerous small strokes (infarcts) and mini-strokes. Impairments in language or other functions depend on the affected region of the brain. The risk of dementia is significantly elevated in individuals who have had a stroke, especially when strokes affect both sides of the brain. Even strokes without noticeable symptoms can increase the dementia risk.
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an extremely rare inherited disorder causing thickening of blood vessel walls, reducing blood flow to the brain. CADASIL is associated with multi-infarct dementia, stroke, and other disorders, with symptoms potentially confused with multiple sclerosis. Many with CADASIL remain undiagnosed.
Subcortical vascular dementia, previously Binswanger’s disease, involves extensive microscopic damage to small blood vessels and nerve fibers in the brain’s white matter. Cognitive changes include issues with short-term memory, organization, attention, decision-making, and behavior. Symptoms typically begin after age 60 and progress gradually. Individuals with subcortical vascular disease often have high blood pressure, a history of stroke, or evidence of disease in large blood vessels in the neck or heart valves.
Cerebral amyloid angiopathy is characterized by the accumulation of amyloid plaques in blood vessel walls in the brain. Diagnosis often occurs when multiple small bleeds in the brain are detected through magnetic resonance imaging.
Vascular dementia is thought to affect in the same way as other forms of dementia. For this reason, AChE inhibitors (donepezil, rivastigmine and galantamine) are among the most common ways to treat dementia symptoms associated with this disorder. To prevent further damage, people at risk of strokes that lead to vascular dementia are often prescribed blood pressure, atrial fibrillation management regimes.
How is VCID Treated?
Vascular contributions to cognitive impairment and dementia (VCID) are often managed with drugs to prevent strokes or reduce the risk of additional brain damage. Some studies suggest that drugs that improve memory in Alzheimer’s might benefit people with early vascular dementia. Treating the modifiable risk factors, such as high blood pressure, can help prevent additional stroke.
