Many of us may from time to time,
forget our neighbour's name or the items to purchase at the
grocery store, and we wonder if this is part of normal aging.
Your doctor is the best person to speak with regarding these
concerns. There are many conditions that are treatable that may
be contributing to periodic memory lapses.
Often when we think of dementia we
think of Alzheimer's disease. While Alzheimer's disease is
considered to be the underlying cause of between 60 and 80% of
all dementia cases, there are also other conditions that might
cause dementia. It is important to know about the other types
and causes of dementia because treatment can vary between
diseases and early detection can be beneficial in slowing the
progression of incurable dementias.
According to Dr. Harvey
Gilbert, MD of the Gilbert Guide, (www.gilbertguide.com some of
the most common types of dementia and their causes are:
1. Vascular Dementia
This type of dementia is the second most common. It is caused by
poor blood flow to the brain, depriving brain cells of the
nutrients and oxygen they need to function normally. Vascular
dementia can be caused by any number of conditions which narrow
the blood vessels, including stroke, diabetes and hypertension.
2. Mixed Dementia
Sometimes dementia is caused by more than one medical condition.
Most commonly, mixed dementia is caused by both Alzheimer's and
vascular disease.
3. Dementia with Lewy Bodies
(DLB)
Sometimes called Lewy Body Disease, this type of dementia is
characterized by abnormal protein deposits called Lewy bodies
that develop in nerve cells in the brain stem. This disrupts the
brain's ability to function normally and impairs cognition and
behavior. It can also cause tremors and is often linked with
Parkinson's Disease and dementia. It is not reversible and there
is no known cure.
4. Parkinson's Disease
Dementia (PDD)
Parkinson's disease is a chronic, progressive neurological
condition, and in its later stages can affect cognitive
functioning. Not all people with Parkinson's disease will
develop dementia, however. This type of dementia is also a lewy
body dementia. Symptoms include tremors, muscle stiffness and
speech problems. Reasoning, memory, speech, and judgment are
also usually affected.
5. Frontotemporal Dementia
Pick's disease is the most common and recognized form of
frontotemporal dementia. It is a rare disorder which causes
damage to brain cells in the frontal and temporal lobes. This
affects the individual's personality significantly, usually
resulting in a decline in social skills, along with emotional
apathy. Unlike other dementias, Pick's disease usually results
in behavior and personality changes occuring before memory loss
and speech problems.
6. Creutzfeldt-Jacob
Dementia (CJD)
A degenerative neurological disorder, CJD is also known as "mad
cow disease". The incidence is very low, occurring in only about
one in one million people. There is no cure. Caused by viruses,
CJD progresses rapidly, usually over a period of several months.
Symptoms include memory loss, speech impairment, confusion,
muscle stiffness and twitching, and a general lack of
coordination, which makes the individual susceptible to falls.
Sometimes blurred vision and hallucinations also occur with this
form of dementia.
7. Normal Pressure
Hydrocephalus (NPH)
Normal pressure hydrocephalus involves an accumulation of
cerebrospinal fluid in the brain's cavities. When this fluid
does not drain as it should, the associated build-up results in
added pressure on the brain, interfering with the brain's
ability to function normally. Individuals with dementia caused
by normal pressure hydrocephalus often experience problems with
ambulation, balance and bladder control, as well as cognitive
impairments involving speech, problem-solving abilities and
memory.
8. Huntington's Disease
Huntington's disease is an inherited progressive dementia that
affects the individual's cognition, behavior and movement.
Symptoms include memory problems, impaired judgment, mood
swings, depression and speech problems (especially slurred
speech). Delusions and hallucinations may also occur.
Individuals with Huntington's disease may also experience
difficulty walking, and uncontrollable jerking movements of the
face and body
9. Wernicke-Korsakoff
Syndrome
Wernicke-Korsakoff syndrome is caused by a vitamin B1 (Thiamine)deficiency
and often occurs in alcoholics, although it can also result from
malnutrition, cancers, abnormally high thyroid hormone levels,
long-term dialysis and long-term diuretic therapy (used to treat
congestive heart failure). The symptoms include confusion,
permanent gaps in memory, and impaired short-term memory.
Hallucinations may also occur. If treated early by supplement,
this dementia can be reversed.
10. Mild Cognitive
Impairment (MCI)
Dementia can be due to illness, medications and a host of other
treatable causes. With mild cognitive impairment, an individual
will experience memory loss, and sometimes impaired judgment and
speech, but they are usually aware of this decline. These
problems usually don't interfere with the normal activities of
daily living. Individuals with mild cognitive impairment may
also experience behavioral changes that involve depression,
anxiety, aggression and emotional apathy. This is often due to
the awareness of and frustration related to his or her
condition.
With an understanding of the
types of dementia, questions begin to arise about how these
diseases are diagnosed. What can a patient expect when trying to
determine whether he or she has some form of dementia? What can
a caregiver expect?
When you initially meet with
your doctor, it is important to be honest with them about the
symptoms the patient is experiencing, their duration, frequency
and rate of progression. The doctor will then review your
current health status, family history and medication history.
This includes evaluating the patient for depression, substance
abuse and nutrition, and other conditions that can cause memory
loss, including anemia, vitamin deficiency, diabetes, kidney or
liver disease, thyroid disease, infections, cardiovascular and
pulmonary problems. The patient also undergoes a physical exam
and blood tests. Diagnosing specific diseases causing dementia
can be difficult and it may be necessary to ask for a referral
to a doctor with expertise in this area. Additional tests that
may be used in conjunction with the aforementioned approaches
include the Mini Mental State Evaluation (MMSE), the Mini Cog
Screen, and Medical Imaging (CT, MRI and PET scans).
The MMSE is an evaluation of
the patient's cognitive status. The patient is required to
identify the time, date and place where the test is taking
place, be able to count backwards, identify objects previously
known to him or her, be able to repeat common phrases, perform
basic skills involving math, language use and comprehension, and
demonstrate basic motor skills.
The Mini Cog Screen takes only
a few minutes to administer, and is used as an initial screening
for dementia. The patient is required to identifying three
objects in the office, then draw the face of a clock in its
entirety from memory, and finally, recall the three items
identified earlier.
Finally, medical imaging helps
doctors see images of the patient's brain to determine whether
there are any growths, abnormalities or general shrinkage which
occurs in Alzheimer's disease. These medical imaging tests can
help improve the accuracy of a dementia diagnosis to 90%.
Once a diagnosis has been made,
doctors can help patients to look at various treatment options
and can often provide information for caregivers and families
about support groups and organizations that can provide them
with information about their specific diagnosis. It is
recommended that patients and their families try to learn as
much as they can about the disease and how it is expected to
progress. Organizations like
Alzheimer's Society of Canada or the
Parkinsons Society can provide valuable information about
the disease, its progression and tips on how to slow the
progression of the disease and deal with symptoms. These
organizations also provide support groups to both the patient
and their caregivers to help deal with the blow of a dementia
diagnosis. As mentioned earlier, early detection is often key in
being able to reverse or slow the progression of many of these
diseases. Having a basic understanding of the many dementias
that may occur and how they are diagnosed will be beneficial to
physicians and families alike.
If you find that you simply do
not know where to begin or how to handle this change in status
and what it means for your future, a Geriatric Care Manager can
assist you in making plans for the future.
