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Dementia 101: Types of Dementia

Dementia, Alzheimer’s, senility, forgetfulness. All of these words point to an experience. But do they point to the same one? Are they different? Are they the same?

I often hear these words thrown around interchangeably. Here I hope to give some etymological clarity. Aging in America is confusing. By using clear language, I hope we can communicate more effectively about our experiences. Through sharing experiences we also share wisdom to age more playfully.

I work in the field of psychology, which uses the DSM as its diagnostic manual. It is based on this that I will share the different types of dementia, or as it is now clinically called, neurocognitive disorder.

This brings us to our first language issue — dementia or NCD are interchangeable and are overarching terms for all that will follow. Below are all types of dementia or subtypes of NCD.

After someone is determined to be experiencing dementia, a subtype allows the experience to be further defined according to the known or presumed cause as well as the main characteristics, timeline, and symptom set of the dementia.

Knowing a subtype can help give behaviors meaning and offer understanding, as well as offering a way to share best practices for living with dementia. There is a wealth of research on each of these. Below is a very basic overview meant to be used as a starting point of understanding.

2015-06-12-1434132834-8593985-typesofdementia.jpg

1. Alzheimer’s disease — Alzheimer’s is named for the doctor who found the pathologies believed to be the cause. Although the exact cause for the behaviors labeled as Alzheimer’s is still unknown, it is thought to be inherited genetically. Alzheimer’s varies from other dementias in that it’s progression is steady and gradual. For a diagnosis of probable Alzheimer’s (probable because the tangles from which its name is derived can only be verified during a postmortem brain autopsy) there must be a decline in memory, learning and one other domain.

2. Frontal Temporal Dementia (FTD) or Frontotemporal lobar degeneration — This dementia is named for the part of the brain it affects most — the frontal lobe. FTD seems to appear suddenly and then progresses gradually. There is a behavioral and language variant. The behavioral variant is marked by disinhibition and changes in social behavior. The language variant results in a dramatic change in language ranging from speech production to word comprehension.

3. Lewy Body Disease — This type is also named for its assumptive cause — lewy bodies in the brain. Those with Lewy Body disease experience fluctuating cognition levels. This disease is also marked by detailed visual hallucinations. These hallucinations are not psychosis. Unfortunately, antipsychotics are often given to treat these hallucinations. These drugs are contraindicated or not recommended for people with a Lewy Body diagnosis and can make symptoms worsen. Lewy Body also has features of parkinsonism. There are more physical changes associated with Lewy Body than other dementias.

The remaining types are named for their cause; their exact symptoms vary based on the area of the brain which was damaged and how extensive the damage is. 

4. NCD due to vascular disease — The onset usually coincides with a cerebrovascular event — a disruption of blood supply to the brain, such as a stoke.

5. NCD due to traumatic brain injury — There must be evidence of an injury to the brain such as an impact to the head, either at a single moment or repeated over time such as multiple concussions from playing a contact sport.

6. Substance or medication induced — Damage has been done to the brain through the use of substances or medication. The symptoms remain after usual duration of intoxication or withdrawal.

7. Due to HIV infection — There is evidence of HIV infection and the dementia is not better attributed to another type.

8. Due to Prion disease — There is evidence of prion disease as well as rapid progression of NCD symptoms.

9. Due to Parkinson’s Disease — Parkinson’s is present before the NCD.

10. Due to Huntington’s Disease — Huntington’s is diagnosed before NCD, or there is family history or genetic testing to support the diagnosis.

In addition to these 10 types there are also the diagnoses of “NCD due to another medical condition” as well as “NCD due to multiple etiologies,” meaning that more than one of these types are present at the same time.

Every person is unique and so is their experience of dementia.

Understanding these broad categories can help us to share experiences and find helpful resources. Only a medical doctor or licensed mental health professional can offer a diagnosis. These same people can be very helpful in connecting you to local resources such as support groups, therapeutics, educational programs and medical resources.

What is dementia? The signs, symptoms and causes of dementia

Dementia is a term used to describe various symptoms of cognitive decline such as forgetfulness, but is not a clinical diagnosis itself until an underlying disease or disorder has been identified.

Dementia is a collective term used to describe the problems that people with various underlying brain disorders or damage can have with their memory, language and thinking. Alzheimer’s disease is the best known and most common disorder under the umbrella of dementia.

What is dementia?

Dementia is not a single disease in itself, but a general term to describe symptoms such as impairments to memory, communication and thinking.1

While the likelihood of having dementia increases with age, it is not a normal part of aging. Before we had today’s understanding of specific disorders, “going senile” used to be a common phrase for dementia (“senility”), which misunderstood it as a standard part of getting old. 1,2

Light cognitive impairments, by contrast, such as poorer short-term memory, can happen as a normal part of aging (we slowly start to lose brain cells as we age beyond our 20s3). This is known as age-related cognitive decline, not dementia, because it does not cause the person or the people around them any problems.1 Dementia describes two or more types of symptom that are severe enough to affect daily activities.

Symptoms that are classed as “mild cognitive impairment” – which, unlike cognitive decline, are not a normal part of aging – do not qualify as dementia either, since these symptoms are not severe enough.1 For some people though, this milder disease leads to dementia later on.4

A number of brain disorders with more severe symptoms are classified as dementias, with Alzheimer’s disease being the best known and most common.

An analysis of the most recent census estimates that 4.7 million people aged 65 years or older in the US were living with Alzheimer’s disease in 2010.5 The Alzheimer’s Association has used this analysis to number-crunch the extent of the disorder in its 2013 report. It estimates that:

  • Just over a tenth of people aged 65 years or more have Alzheimer’s disease
  • This proportion rises to about a third of people aged 85 and older.

The non-profit organization says Alzheimer’s accounts for between 60% and 80% of all cases of dementia, with vascular dementia caused by stroke being the second most common type.

What causes dementia?

All dementias are caused by brain cell death,1 and neurodegenerative disease – progressive brain cell death that happens over a course of time – is behind most dementias.4,6

brain neuron
Nerve cells (neurons) in the brain – loss or damage can cause dementia. Alzheimer’s disease is the leading cause.

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.6

Some of the causes are simpler to understand in terms of how they affect the brain and lead to dementia:1

  • Vascular dementia – this results 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 received by sports players – have been linked to certain dementias appearing later in life. Evidence is weak, however, that a single brain injury will raise the likelihood of having a degenerative dementia such as Alzheimer’s disease.7

Dementia can also be caused by:1,2,8

  • Prion diseases – from certain types of protein, as in CJD (Creutzfeldt-Jakob disease) and GSS (Gerstmann-Straussler-Scheinker syndrome).
  • HIV infection – when the problem is simply termed HIV-associated dementia. How the virus damages brain cells is not certain.
  • Reversible factors – some dementias can be treated by reversing the effects of underlying causes, including medication interactions, depressionvitamin deficiencies (for example, thiamine/B1, leading to Wernicke-Korsakoff syndrome, which is most often caused by alcohol misuse), and thyroid abnormalities.

Alzheimer’s dementia is caused by progressive brain cell death. Estimates range between 60% and 80% for the proportion of all cases of dementia being accounted for by Alzheimer’s disease.2 In the US, about 5.3 million people are thought to have the disorder among the estimated 6.8 million individuals who have some form of dementia.4

Alzheimer’s is thought to be caused by “plaques” between the dying cells in the brain and “tangles” within the cells (both are protein abnormalities: a build-up of “beta-amyloid” in plaques and the disintegration of “tau” protein in tangles).

These inclusions in the brain are always present with the disorder but whether they are themselves the cause, or if there is some other underlying process, is not known – and there is some overlap with other disorders that show similar changes in brain cells.1,9

The brain tissue in a person with Alzheimer’s has progressively fewer nerve cells and connections, and the total brain size shrinks.1,9

See the Medical News Today Alzheimer’s disease page for more detailed information about this specific type of dementia.

Dementia with Lewy bodies is also caused by neurodegeneration linked to abnormal structures in the brain. Here, the brain changes involve a protein called alpha-synuclein.10

Mixed dementia refers to a diagnosis of two or three types occurring together. A person may show both Alzheimer’s disease and vascular dementia at the same time. Or the combination could be Lewy bodies and Alzheimer’s. There can also be a combination of all three types.10

Parkinson’s disease is also marked by the presence of Lewy bodies. While the part of the brain affected means there are classic movement symptoms, people with Parkinson’s can also go on to develop dementia symptoms as the degenerative changes in the brain gradually spread.10

Huntington’s disease is similar to Parkinson’s in the respect of being classically marked by uncontrolled movements yet having dementia as a component. It results in mood changes, too. Huntington’s is an inherited condition caused by a single faulty gene. This can produce the disease at any age – as young at 2 years of age and as old as 80, but typically between the ages of 30 and 50 years.10

Other disorders leading to symptoms of dementia include:10

  • Frontotemporal dementia (also known as Pick’s disease)
  • Normal pressure hydrocephalus (when excess cerebrospinal fluid accumulates in the brain)
  • Posterior cortical atrophy (caused by the same tissue abnormalities seen in Alzheimer’s disease, but in a different part of the brain), and
  • Down syndrome (people born with this are more likely to develop young-onset Alzheimer’s).

Recent developments on causes of dementia from MNT news

Link found between dementia and vitamin D deficiency – In what is regarded as the first large, population-based study of its kind, a team of researchers has found a link between vitamin D consumption and the risk of developing dementia. Older people who do not get enough vitamin D could double their risk of developing the condition.

Traumatic brain injury in older adults linked to increased dementia risk – A study published in JAMA Neurologysuggests that for adults aged 55 years and older, traumatic brain injury may be linked to an increased risk of dementia.

Does poor sleep increase risk of dementia? – While sleep protects both physical and mental health, some people experience better sleep than others. Now, new research has associated poor sleep with an increased risk of dementia as a result of changes that occur within the brain.

Signs and symptoms

mature lady looking confused
Memory loss in dementia can be serious enough for the person to forget where they are, even on their home street.

The symptoms of dementia experienced by patients, or noticed by people close to them, are exactly the same signs that healthcare professionals look for. Therefore, detailed information on these is given in the next section about tests and diagnosis.

A person with dementia may show any of the following problems, mostly due to memory loss – some of which they may notice (or become frustrated with) themselves, while others may only be picked up by carers or healthcare workers as a cause for concern. The signs used to compile this list are published by the American Academy of Family Physicians (AAFP) in the journal American Family Physician:6

  • Recent memory loss – a sign of this might be asking the same question repeatedly, forgetting about already asking it.
  • Difficulty completing familiar tasks – for example, making a drink or cooking a meal, but forgetting and leaving it.
  • Problems communicating – difficulty with language by forgetting simple words or using the wrong ones.
  • Disorientation – with time and place, getting lost on a previously familiar street close to home, for example, and forgetting how they got there or would get home again.
  • Poor judgment – the AAFP says: “Even a well person might get distracted and forget to watch a child for a little while. People with dementia, however, might forget all about the child and just leave the house for the day.”
  • Problems with abstract thinking – for example, dealing with money.
  • Misplacing things – including putting them in the wrong places and forgetting about doing this.
  • Mood changes – unlike those we all have, swinging quickly through a set of moods.
  • Personality changes – becoming irritable, suspicious or fearful, for example.
  • Loss of initiative – showing less interest in starting something or going somewhere.

The Alzheimer’s Association has put together Know the 10 signs – a PDF document listing real-life examples of how this type of dementia can affect people.

What causes dementia

All dementias are caused by brain cell death,1 and neurodegenerative disease – progressive brain cell death that happens over a course of time – is behind most dementias.4,6

brain neuron
Nerve cells (neurons) in the brain – loss or damage can cause dementia. Alzheimer’s disease is the leading cause.

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.6

Some of the causes are simpler to understand in terms of how they affect the brain and lead to dementia:1

  • Vascular dementia – this results 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 received by sports players – have been linked to certain dementias appearing later in life. Evidence is weak, however, that a single brain injury will raise the likelihood of having a degenerative dementia such as Alzheimer’s disease.7

Dementia can also be caused by:1,2,8

  • Prion diseases – from certain types of protein, as in CJD (Creutzfeldt-Jakob disease) and GSS (Gerstmann-Straussler-Scheinker syndrome).
  • HIV infection – when the problem is simply termed HIV-associated dementia. How the virus damages brain cells is not certain.
  • Reversible factors – some dementias can be treated by reversing the effects of underlying causes, including medication interactions, depressionvitamin deficiencies (for example, thiamine/B1, leading to Wernicke-Korsakoff syndrome, which is most often caused by alcohol misuse), and thyroid abnormalities.

Alzheimer’s dementia is caused by progressive brain cell death. Estimates range between 60% and 80% for the proportion of all cases of dementia being accounted for by Alzheimer’s disease.2 In the US, about 5.3 million people are thought to have the disorder among the estimated 6.8 million individuals who have some form of dementia.4

Alzheimer’s is thought to be caused by “plaques” between the dying cells in the brain and “tangles” within the cells (both are protein abnormalities: a build-up of “beta-amyloid” in plaques and the disintegration of “tau” protein in tangles).

These inclusions in the brain are always present with the disorder but whether they are themselves the cause, or if there is some other underlying process, is not known – and there is some overlap with other disorders that show similar changes in brain cells.1,9

The brain tissue in a person with Alzheimer’s has progressively fewer nerve cells and connections, and the total brain size shrinks.1,9

See the Medical News Today Alzheimer’s disease page for more detailed information about this specific type of dementia.

Dementia with Lewy bodies is also caused by neurodegeneration linked to abnormal structures in the brain. Here, the brain changes involve a protein called alpha-synuclein.10

Mixed dementia refers to a diagnosis of two or three types occurring together. A person may show both Alzheimer’s disease and vascular dementia at the same time. Or the combination could be Lewy bodies and Alzheimer’s. There can also be a combination of all three types.10

Parkinson’s disease is also marked by the presence of Lewy bodies. While the part of the brain affected means there are classic movement symptoms, people with Parkinson’s can also go on to develop dementia symptoms as the degenerative changes in the brain gradually spread.10

Huntington’s disease is similar to Parkinson’s in the respect of being classically marked by uncontrolled movements yet having dementia as a component. It results in mood changes, too. Huntington’s is an inherited condition caused by a single faulty gene. This can produce the disease at any age – as young at 2 years of age and as old as 80, but typically between the ages of 30 and 50 years.10

Other disorders leading to symptoms of dementia include:10

  • Frontotemporal dementia (also known as Pick’s disease)
  • Normal pressure hydrocephalus (when excess cerebrospinal fluid accumulates in the brain)
  • Posterior cortical atrophy (caused by the same tissue abnormalities seen in Alzheimer’s disease, but in a different part of the brain), and
  • Down syndrome (people born with this are more likely to develop young-onset Alzheimer’s).

Recent developments on causes of dementia from MNT news

Link found between dementia and vitamin D deficiency – In what is regarded as the first large, population-based study of its kind, a team of researchers has found a link between vitamin D consumption and the risk of developing dementia. Older people who do not get enough vitamin D could double their risk of developing the condition.

Traumatic brain injury in older adults linked to increased dementia risk – A study published in JAMA Neurologysuggests that for adults aged 55 years and older, traumatic brain injury may be linked to an increased risk of dementia.

Does poor sleep increase risk of dementia? – While sleep protects both physical and mental health, some people experience better sleep than others. Now, new research has associated poor sleep with an increased risk of dementia as a result of changes that occur within the brain.

Signs and symptoms

mature lady looking confused
Memory loss in dementia can be serious enough for the person to forget where they are, even on their home street.

The symptoms of dementia experienced by patients, or noticed by people close to them, are exactly the same signs that healthcare professionals look for. Therefore, detailed information on these is given in the next section about tests and diagnosis.

A person with dementia may show any of the following problems, mostly due to memory loss – some of which they may notice (or become frustrated with) themselves, while others may only be picked up by carers or healthcare workers as a cause for concern. The signs used to compile this list are published by the American Academy of Family Physicians (AAFP) in the journal American Family Physician:6

  • Recent memory loss – a sign of this might be asking the same question repeatedly, forgetting about already asking it.
  • Difficulty completing familiar tasks – for example, making a drink or cooking a meal, but forgetting and leaving it.
  • Problems communicating – difficulty with language by forgetting simple words or using the wrong ones.
  • Disorientation – with time and place, getting lost on a previously familiar street close to home, for example, and forgetting how they got there or would get home again.
  • Poor judgment – the AAFP says: “Even a well person might get distracted and forget to watch a child for a little while. People with dementia, however, might forget all about the child and just leave the house for the day.”
  • Problems with abstract thinking – for example, dealing with money.
  • Misplacing things – including putting them in the wrong places and forgetting about doing this.
  • Mood changes – unlike those we all have, swinging quickly through a set of moods.
  • Personality changes – becoming irritable, suspicious or fearful, for example.
  • Loss of initiative – showing less interest in starting something or going somewhere.

The Alzheimer’s Association has put together Know the 10 signs – a PDF document listing real-life examples of how this type of dementia can affect people.

Adult Day Centers

Adult day centers offer people with Alzheimer’s and other dementias the opportunity to be social and to participate in activities in a safe environment.

Benefits of day centers

Adult day centers offer benefits to both caregivers and people with dementia.

If you are a full-time caregiver, adult day centers can provide a much needed break. While the person with Alzheimer’s is at the center, you’ll have time to rest, run errands or finish other tasks. If you find yourself feeling guilty, ask yourself this, “If I wear myself out to the point of total exhaustion, what good will I be to the person with dementia?”

If you are a caregiver that works during the day, an adult day center can be very helpful as you try to balance a job with caregiving duties. Hours of service vary at each center, but some are open from seven to 10 hours per day. Some also may offer weekend and evening hours, and transportation and meals are often provided.

For people with Alzheimer’s and dementia, adult day centers provide a chance to be social and to participate in staffed activities such as music and exercise programs. Keep in mind that the person with dementia will need time to adjust to the experience of going to the center. Some people may resist going at first, but they often look forward to the visit after several weeks of attending, meeting people and joining in activities.

Services

The services provided vary depending upon the center. Common types of services are listed below, as well as questions that may help you determine whether a specific day program fits your family’s needs. (Keep in mind that few adult day programs offer all of the services described, and not all of the services are necessary for a program to be of high quality.)
  • Counseling: The center may provide support services for people with dementia and their families. For example, they may offer guidance on outside resources and arrange for supportive care in the home.
  • Health services: If the person with Alzheimer’s requires medical services (i.e., insulin shots, help with medication, etc.) be sure to ask if staff provides medical assistance. Some centers also may provide blood pressure checks and physical, dental, foot, eye or ear examinations.
  • Nutrition: Does the center provide nutritious meals and snacks? Sample a meal to find out. If needed, ask if the center can accommodate a special diet or provide a culturally specific menu. Some centers also offer nutritional education programs.
  • Personal care: Centers may provide help with hairstyling, toileting, eating, showering and other personal care tasks.
  • Activities: Daily activities may include music, art, recreation, discussion and support groups. Ask what activities are offered for people with dementia.
  • Behavior management: Find out if the center is prepared to deal with behaviors associated with dementia. These many include wandering, incontinence, hallucinations, sexually inappropriate behavior or speech difficulties.
  • Therapy: Some centers help arrange for needed physical, occupational or speech therapy. They may have therapists onsite or on-call.
  • Special needs: Make sure the center can accommodate any special needs. For example, is the center equipped to deal with someone who uses a wheelchair, who is hearing or visually impaired, or who is handicapped in another way? Knowing about any service restrictions before using a center may help prevent problems.

Selecting a center

  • Learn about your options.
    Talk to your local Alzheimer’s Association about adult day centers in your area, ask other caregivers about their experiences, and call your local senior center or area agency on aging. You can also use our Community Resource Finder to find an adult day program near you.
  • Consider your needs.
    Adult day centers can vary. Consider which center offers the services that you and the person with dementia need.
  • Give the day center a chance.
    Consider using its services at least twice a week for a month before making a final decision. Occasional use won’t give you an accurate picture of how the center operates.
  • Re-evaluate care needs.
    At some point the person with Alzheimer’s may need more care than the center can provide. Center staff and support groups can help evaluate your needs for future care.

Alzheimer’s Care Schaumburg IL

Alzheimer’s Care Schaumburg IL

Alzheimer’s Car in Fort Myers FLIt’s not easy to witness a loved one going through some of the more significant symptoms and signs of Alzheimer’s disease. Going over to visit an aging parent who was diagnosed with Alzheimer’s more than five years ago, he or she not recognizing you, or even talking about people who have been deceased for many years can be emotionally traumatizing for many individuals.

When loved ones begin talking about people who haven’t been around in many years, mentioning that they want to give them a call, it can be a difficult situation. They may have a disconnection with the current time and have no concept that their loved one has passed away a long time ago.

This creates a difficult situation for them as well as any caregiver working with them on a regular basis. What happens when the senior is picking up the phone and trying to dial a specific number? What happens when they are convinced that they absolutely must talk to this person before much time goes by?

Some people may try to lie and tell the individual that the person is away on a vacation. They might attempt to assuage the senior with Alzheimer’s and hope that they will forget this little episode before long.

So what happens when they pick up the phone to dial the number? If they happen to remember the phone number, this might require some quick thinking on the part of you or some other family member or caregiver who happens to be with them at that moment.

You’re confronted with a delicate situation to handle. Telling them the truth can cause confusion, anxiety, and potentially even a verbal or physical outburst. The path of least resistance is often the most tempting one to travel. What happens as the senior completes the dialing of that phone and receives a recording message that the number is no longer in service or somebody picks up on the other end and has never heard of that person?  That can lead to even more confusion, stress and anxiety.

The best way to deal with this particular type of situation is with honesty and tact. Focusing on redirection can also help, as long as there is a plan in place for redirecting the individual at that time.

Dealing with somebody with Alzheimer’s is a delicate situation at times and that’s why it’s beneficial to rely on the services of an experienced Alzheimer’s care provider.