Distinguishing Between Dementias: Not Everyone Has Alzheimer’s

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Dementia. Alzheimer’s. These words can strike fear in us when we don’t understand what causes them. Anyone more than 40 years of age has probably at least momentarily thought about the possibility of having to deal with these disease processes, and most of the population has probably come in contact with someone who has some form of dementia. Why do some people get dementia at an early age and others live well into their 90s (or more), remaining as sharp and aware as a healthy 20 year old? As with anything in life, knowledge is power. Knowing what differentiates between types of dementias and a diagnosis of Alzheimer’s disease is only the beginning.

First of all, Alzheimer’s disease (named after the Alois Alzheimer, who in 1907 gave the first known description of the disease) is a form of Dementia. Alzheimer’s disease accounts for 60 to 80 percent of all dementias. This rate increases with age and is the most common type of dementia. It does not discriminate between men and women or economic backgrounds. IQ does not come into play either. Highly intelligent people who have lead successful lives doing highly skilled jobs get Alzheimer’s just as persons with low or varying levels of intelligence. Unfortunately, the gold standard of diagnosing Alzheimer’s is upon examination of the brain at autopsy, to reveal neurofibrillary tangles and plaques that are characteristic of the disease. Tests performed by the physician for diagnosis of the patient while they are alive are based on a series of exams related to deterioration of cognitive function, memory decline, lack of ability to learn new things, personality changes, paranoia, irritability, inability to socialize, lack of hygiene, weight loss due to forgetting to eat or prepare meals or other activities of daily living. In the later stages of the disease, a person will not be able to recognize a simple object, may wander aimlessly and usually becomes incontinent. Swallowing can become impaired and the person may lose the ability to walk. Unfortunately, Alzheimer’s is a progressive disease.

Dementia affects different areas of the brain. The frontal lobe (forehead region) controls behaviors and judgement. When this area is impaired, a person who was normally calm and refined their whole life may start to exhibit rude language or aggressive behaviors. Not being able to identify risks – such as wandering into unsafe areas – may occur. The temporal lobe (area behind the temples) controls memory. Obviously if this area is impaired the memory and ability to recall information suffer. The parietal lobe (above and behind where the ears are located) is the language center of the brain. Inability to speak or speaking in ways that don’t make sense may occur when damage is here.

Below are just a few types of the most common dementias. There are many, and some are rarer and not seen as often because they are associated with an underlying disease. Research shows that genetics, alcohol abuse and addiction, or environmental factors can play a role in developing a form of dementia. A very important note is that these dementias can accompany Alzheimer’s disease.

Vascular dementia Hypertension and high cholesterol levels related to cardiovascular disease and stroke have shown to contribute to vascular dementia. In the old days, this was referred to as “hardening of the arteries.” After a stroke or series of strokes, or because of long term effects of the above mentioned conditions, oxygen deprivation can cause brain cells to die, affecting various areas of the brain resulting in dementia.

Frontotemporal dementia As the name suggests, this type of dementia affects the front part of the brain resulting behavioral changes and personality changes. People will often say “That’s NOT my Mom,” when referring to witnessing a behavior that is very out of character for that person. Impaired judgment and decline in social skills are often the first signs of this dementia.

Lewy bodies Proteins in the brain cells in the brain stem, that interfere with the cell, causing tremors much like Parkinson’s Disease, along with hallucinations are typical with this type of dementia (named after the discoverer Frederic Lewy in 1912).

Mixed dementia This is a form of a mixture of more than one type of dementia. Vascular dementia and Alzheimer’s are usually found together most often, but other combinations are also possible.

Denial is common with all forms of dementia. Often, family members or friends will comment that the person is “usually not like this,” or “is just having one of those days.” The problem with denial is that although the caregiver has the best intentions, the person with the dementia suffers because they may not be getting the care that they need. Often times, household hazards exist such as access to stoves and other cooking devices, or something like confusing the hot water with the cold. Medications may not be given correctly or on schedule, and many times hygiene suffers.

Denial also spills over to the care giver.  Loved ones who care for family or friends with dementias often experience care giver stress related anxiety. The stress of caring for someone with Alzheimer’s and Dementia can also result in physical illness. Lack of sleep and general neglect of one’s own health due to the fact that there just isn’t enough time in the day to make for yourself if your attention is constantly focused on the person with dementia is a common complaint.

Finding a physician that specializes in diagnosing dementias is the first step toward practical treatment. Various mental evaluation tests that can be performed by the physician are usually the first step in order to identify if dementia is present. PET scans, MRI’s and CT scans are all valuable medical diagnostic tools that physicians use to determine if the patient has any lesions or tumors and also to see if the brain shows any sign of shrinkage which is a characteristic of Alzheimer’s. Contacting a physician who specializes in geriatrics or the Alzheimer’s Association are both good resources for anyone who needs assistance in dealing with the possibility of a diagnosis of dementia.

Article by Sandra Van Zandt, Sunset Home director of nursing services.

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