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Types of Dementias

Introduction

This article discusses Alzheimer’s Disease, Frontotemporal Dementias, Lewy Body Dementia, and Vascular Dementia. It compares and contrasts their symptoms, risk factors, how these diseases progress, and their prognoses. Included are a few helpful strategies for care partners as well as ways to potentially lower risk of developing these types of dementia. The information is for educational purposes and is not meant to diagnose. Consult with your primary doctor and preferably a neurologist who specializes in dementia if you think yourself or a loved one is showing early warning signs or symptoms of these dementias.


Alzheimer's Disease

Alzheimer’s disease is the most common type of dementia impacting more than 6 million Americans and estimated to be 40 to 50 percent of dementia cases. Although rare, some develop the disease as early as 30 years old, which is known as Early Onset Alzheimer’s, and could live for decades. In most cases Alzheimer’s occurs in people 65 and older. Alzheimer’s.gov states potential causes to be a combination of “Age-related changes in the brain, like shrinking, inflammation, blood vessel damage, and breakdown of energy within cells, which may harm neurons and affect other brain cells.” Uncontrollable risk factors include family history, age, and gender. Other risk factors , many of which are controllable, include high blood pressure, smoking, heart disease, diabetes, obesity, physical inactivity, social isolation, depression, poor diet, excessive alcohol consumption, low levels of cognitive engagement, traumatic brain energy, and hearing loss.


Impaired memory, especially short-term memory, to the point of it affecting your daily life, ability to complete tasks, and learn new information can be an early warning sign for Alzheimer’s. This forgetfulness is more than what you would see in normal aging, such the occasional difficulty finding the correct word or remembering where you placed your keys. Also, some people are naturally absent minded and don’t process information quickly. So, it is important to know what your baseline is. Alzheimer’s can also cause difficulties with spatial awareness causing people to get lost in familiar settings. An additional symptom is changes in vision including loss of peripheral and a narrowing of focus kind of like tunnel vision which can cause issues with balance and driving. Manual dexterity and fine motor skills tend to decrease in the later stages of the disease. Due to confusion brought on by Alzheimer’s people may become irritable, assume malicious intent of others, and lose interest participating in once enjoyable activities. In the later stages, risk of falling, difficulty eating indecently, and inability to control bladder and bowels will make round the clock care necessary.


Frontotemporal Dementias

There are multiple types of Frontotemporal dementia which occur in roughly 50,000 to 60,000 45-to-65-year old’s in America. FTD may also be diagnosed as early as 20 or late into the 80s. It is caused by damaged nerve cells in the frontal and temporal lobes of the brain. According to Onyike and Diehl-Schmid, 2013, FTD is hereditary and there are 5 genetic loci for causal mutations. Their study is linked below. Head trauma and thyroid disease showed a slightly increased risk for developing FTD. However, the sample size was small and results have yet to be replicated. Characteristics of FTD include extreme personality changes, communication difficulties, executive dysfunction, and dietary changes. It is not until advanced FTD that memory impairment may become noticeable. It progresses faster than Alzheimer’s and has a prognosis of 3-14 years.


FTD is divided into two categories: Behavioral Variant and Primary Progressive Aphasia. It is possible for someone to have symptoms from both variants. FTD Behavioral Variant (bvFTD) makes up 60% of cases. Someone with this phenotype may lose impulse control and judgement of what is socially appropriate resulting in behavioral changes like swearing, stealing, increased interest in sex, and lack of suitable personal hygiene. Additional symptoms include apathy, lack of empathy, emotional and social withdrawal, and decreased self-awareness. Following instructions in correct sequence is also impacted by bvFTD because of changes to the prefrontal cortex. It can be difficult to get a diagnosis due to symptoms being the same as some psychiatric disorders. Also, some people have blunt personalities and do not abide by social norms. This doesn’t necessarily mean they have something wrong with them. Examining all symptoms and comparing them to baseline personality is crucial to avoid misdiagnosis.


FTD Primary Progressive Aphasia is divided into three subtypes each affecting ability to comprehend language and conversations. Some have semantic variant which cause reduced ability to remember meanings of words, follow along a conversation, and speak using words that make sense in the given context. Someone with logopenic variant knows what the words mean but they can’t mentally find them. Nonfluent-agrammatic variant causes problems using and understand correct complex grammar and forming the words.


Lewy Body Dementia

Lewy body dementia is the third most common type of dementia. It is an umbrella term that encompasses dementia with Lewy bodies and Parkinson’s disease dementia. Both types are associated with Lewy bodies in the brain. Whether a person has DLB or PDD depends on the location of Lewy bodies. It is associated with abnormal deposits of alpha-synuclein protein in the brain. Besides this, little is known about what causes this type of dementia. It is a progressive disease typically starting in adults age 50 and older. On average people can live five to eight years. Some live up to 20 years after diagnosis. Common symptoms include lack of reasoning, trouble paying attention, acting out dreams, and vivid visual hallucinations. Hallucinations are most often visual and non-threatening. Animals, people, and children are commonly seen. However, it is possible to experience frightening hallucinations where they fear for their safety and the safety of others. They may have paranoid delusions such as believing the nurse is trying to poison them or their partner is cheating on them. Something new I learned is the term Capgras Syndrome which is the belief a familiar person has been replaced by an imposter. Treating the psychotic features of LBD can be difficult because most current anti-psychotics block dopamine receptors and worsen motor function.


If they have parkinsonism dementia, they may develop tremors, slow movements, rigidity, and stiffness. Eighty percent of people diagnosed with Parkinson’s prior to having dementia symptoms will develop dementia at some point in their life.


Vascular Dementia

There are several types of vascular dementia all resulting in problems with blood supply to the brain. For example, blockage, shrinkage, and inflammation of blood vessels. Often a major stroke, serious of smaller strokes, or smaller vessel disease cause vascular dementia. Symptoms appear suddenly and depending on the exact type of vascular dementia, symptoms may include issues with problems solving, completing tasks, concentrating, coordination, and continence. Depression, apathy, mood swings, uncontrollable laughter and crying, irritability, and sleep problems such as excessive daytime sleepiness and acting out dreams are common. Progression of the disease follows a stair step pattern meaning the person declines then levels out for a while and then continues to get worse. Life expectancy ranges from 3-5 years after symptoms first occur making it shorter than other types of dementia.


There are several modifiable risk factors that can help reduce likelihood of getting vascular dementia such as keeping blood pressure under control, eating a healthy diet, managing diabetes, engaging in physical exercise, and not smoking or drinking alcohol. Being under stress, limited time to exercise and cook healthy meals, living in a place where driving is the dominant form of transportation, working a desk job, socializing with other’s who promote a culture of unwinding by smoking or going to happy hour, and being low -income can make it challenging to be kind to our brain and body. Helpful treatment to improve quality of life in people with vascular dementia include physical therapy, occupational therapy, speech therapy, and music therapy.


Advice for Care Partners

In the early stages it is important for family and friends to help their loved one remain as independent as possible. Focus on the strengths that remain and offer assistance as needed. As the disease progresses keep a simple routine and make sure their environment is clean and organized. Offer visual cues when given verbal instructions. Speak low and calm and make sure you are standing in their field of view. Form bonds through music, poetry, and prayer. As your caregiving duties increase it is important to find time for respite. This can include hiring a paid caregiver for a few hours, sending your loved one to an adult day center, using memory care for respite or doing something relaxing while your loved one is taking a nap.


Learn as much about the type of dementia(s) your loved one has. Join a support group. Redirect person to another location, minimize shadows and noise if hallucinations are present, validate the feeling the person is having instead of arguing about the facts. Your loved one’s brain is not working as it once was. They do not mean to cause frustration or act in socially unacceptable ways. Both of you are doing the best you can with the knowledge and tools you have. For more ways on managing behavior related symptoms check out the videos linked below.


Resources

Articles









Videos

A Positive Approach to Care to FTD = Frontotemporal Dementia


Vascular Dementia, Stroke & Depression How they Affect the Brain


Behavior and mood symptoms in Lewy body dementia


ABC’s of Vascular Dementia w/ Tam Cummings, PhD April 7


The ABC’s of Alzheimer’s w/ Tam Cummings, PhD May 5



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