Understanding the Types of Dementia

Although “dementia” is often used interchangeably with terms such as Alzheimer’s disease or memory loss, it is actually an umbrella category of brain diseases that comprise more than 100 types of memory disorders.

Dementia refers to a collection of symptoms that signal cognitive declines, such as short-term memory loss, language deficits, poor judgment, and changes in behavior.

While Alzheimer’s disease is the most common form of dementia, comprising 50 to 70 percent of all dementia diagnoses, some of the other forms of dementia we will focus on today include:

• Lewy body dementia (LBD)
• Frontotemporal dementia
• Vascular dementia
• Parkinson’s disease dementia (PDD)

It’s important to understand the most prevalent types of dementia so you can begin to recognize the signs your loved one is exhibiting, arrange a medical assessment, and prepare for a potential move to a memory care community.

What Is Alzheimer’s Disease?

Neuropathologist Aloysius Alzheimer first identified the disease that bears his name in 1901. The most common form of dementia, Alzheimer’s disease (AD) currently affects 5.8 million Americans, and this number is projected to reach 14 million by 2050.

While many people assume memory loss is a normal part of aging, Alzheimer’s disease is not inevitable. As we age, it may become more difficult to recall someone’s name, and you may tend to misplace your reading glasses or leave your shopping list at home. But these forgetful moments are usually attributed to age-related memory loss and not necessarily signs of impending Alzheimer’s disease.

Part of the confusion around Alzheimer’s disease arises from the challenge in diagnosis. Like Lewy body dementia and frontotemporal dementia, Alzheimer’s disease can’t be determined with complete accuracy while someone is alive.

The biomarkers for AD — sticky plaques and tangles that accumulate in the brain from abnormally folded proteins, causing inflammation and cellular damage — can only be positively identified on autopsy. Thus, doctors generally make an Alzheimer’s diagnosis by testing for and eliminating other possibilities.

What Are the Signs and Symptoms of Alzheimer’s Disease?

Ten signs and symptoms that a senior’s memory loss might be Alzheimer’s include:

1. Disruptive memory loss. Inability to retain new information, forgetting important events, or needing to put reminder notes everywhere indicate a problem.
2. Problem-solving difficulties. Mom can no longer follow a recipe she knows by heart, or dad can’t balance the checkbook.
3. Getting lost driving to a familiar location.
4. Temporal or seasonal confusion: is it spring already?
5. Challenges with visual or spatial relationships: how far away is that sign?
6. Vocabulary issues: having trouble finding common words, such as calling a toaster, “the thing that makes bread dark.”
7. Odd misplacement. It’s one thing to leave your keys in a different room; quite another to place them in the freezer or dishwasher.
8. Loss of judgment. Giving money to phone scammers, neglecting to bathe.
9. Social withdrawal.
10. Personality changes: confusion, anxiety, suspicion, fear. Someone in the early stages of AD may become easily upset when out of their comfort zone.

What is the treatment for someone with Alzheimer’s Disease?

As with all types of dementia, and other health conditions in general, good nutrition, exercise, social engagement, mental stimulation and lifestyle choices that nurture the body, mind, and spirit may delay, slow the progression, or even prevent the onset of Alzheimer’s disease.

Let’s examine them in turn:

• Healthy eating. Here at The Kensington Place, fine dining is the cornerstone of our first-rate memory care. Our culinary craftsman, Tony Ng, is devoted to delivering a mealtime experience that each senior will savor, not only for the delicious and nutritious cuisine but also for the presentation and variety. While heavily processed foods laden with sugar, salt and preservatives can actually induce or increase memory loss, the healthy meals Tony prepares contain memory-boosting foods such as leafy greens, cold-pressed olive oil, and mouth-watering salmon.
• Exercise. Our Life Enrichment programs are renowned for offering an ever-changing calendar of events to residents seven days a week, from morning till evening. Whether it’s walking, dancing, yoga, or stretching, we encourage our residents to keep their bodies moving, which also boosts brain health.
• Social engagement. Building friendships and staying active has been shown to reduce stress, preserve wellness, keep the mind sharp, and increase feelings of worth, especially for seniors. And the Bay Area is one of the best locations in the country for staying active, with parks, museums, classes, art galleries…there’s something to interest everyone!
• Mental stimulation. While our life enrichment coordinators work full time with our core team to keep our senior residents active and engaged, there is a lot of options seniors can choose to do on their own to challenge their brains. Solving puzzles and math problems, reading, and learning a new skill such as surfing the Web, help light up the brain, decrease the buildup of plaque, and keep Alzheimer’s at bay.

What is Lewy Body Dementia (LBD)?

Up until a few years ago, Lewy Body Dementia (LBD) was not a familiar term to the general public. Even MDs weren’t necessarily familiar with it unless they specialized in geriatrics or neurology.

However, Lewy body dementia gained widespread attention in 2014, after beloved comedian and actor Robin Williams chose to take his own life rather than slowly succumb to the disease.

Lewy body dementia is the second most common dementia after Alzheimer’s, accounting for up to a third of all cases, according to autopsy reports. There is not yet a cure, and symptoms tend to worsen over time.

LBD comprises a spectrum of diseases involving an array of dementia and motor symptoms. Identifying Lewy body dementia can be challenging, because its pathology is similar to that of Alzheimer’s, while many symptoms appear to mimic Parkinson’s.

However, there are notable distinguishing characteristics. Unlike people with Alzheimer’s or Parkinson’s disease dementia, patients with LBD exhibit:

• strong psychotic symptoms (hallucinations)
• extreme sensitivity to antipsychotic medications
• day-to-day symptom variability

In addition, Lewy body dementia is twice as common in men as in women (Alzheimer’s occurs equally in both genders) and is rarely genetically linked.

What Are Lewy Bodies?

Lewy bodies are abnormal structures in the midbrain: microscopic protein deposits found in nerve cells that disrupt the brain’s normal functioning, causing it to slowly deteriorate. Frederick Lewy, a colleague of Aloysius Alzheimer (for whom Alzheimer’s disease is named) first discovered them in 1912.

While the presence of Lewy bodies in the mid-brain has long been recognized as the hallmark of Parkinson’s disease, in the 1960s Lewy bodies were discovered in the cortex (the brain’s outer layer) of people with dementia.

People with Lewy body disease have Lewy bodies in both the midbrain and cortex. Lewy body disease patients often have the plaque characteristic of Alzheimer’s disease, while people with Alzheimer’s may also have cortical Lewy bodies. This overlap leads to frequent misdiagnosis.

What Are the Signs and Symptoms of Lewy Body Dementia?

Many of the symptoms of Lewy body dementia bear a striking resemblance to Alzheimer’s or Parkinson’s disease dementia. However, a physician familiar with LBD will be alert to the following signs that the illness is in fact LBD:

• Mental decline: reduced alertness and lowered attention span
• Visual hallucinations, usually related to people or animals. These hallucinations occur in 80 percent of LBD patients, often at night.
• Poor response to antipsychotic medications known as neuroleptics, which are usually given to people with mental health problems. In the case of an LBD patient, however, this class of drugs may actually amplify rigidity and confusion, and can even cause sudden death.
• Increasing problems handling the tasks of daily living
• Repeated falls
• Sleep disturbances, including insomnia and acting out dreams
• Delusions or depression
• Fluctuations in autonomic processes, including blood pressure, body temperature, urinary difficulties, constipation, and difficulty swallowing.

If a patient exhibits some of the above symptoms, the additional presence of Parkinson’s motor symptoms can help facilitate a Lewy body dementia diagnosis. These include:

• Tremors
• Muscle stiffness
• Difficulties with balance
• Shuffling gait, stooped posture, slow movements
• Restless leg syndrome.

Some of the cognitive symptoms found in both Alzheimer’s and Lewy body dementia patients include:

• Behavioral changes
• Decreased judgment
• Confusion and temporal/spatial disorientation
• Difficulty following directions
• Decreased ability to communicate.

Since the Lewy bodies themselves can only be identified by autopsy, accurate diagnosis relies heavily on physician awareness of the defining characteristics of the disease. A brain scan can detect mental deterioration, but not the actual Lewy bodies.

A thorough medical history that focuses on the pattern of symptoms and looks particularly for the hallucinations and sleep disturbances that are common to LBD patients is the optimal route for diagnosis, once other possible conditions have been ruled out.

What Is the Treatment for Someone with Lewy Body Dementia?

Being diagnosed with an incurable illness, especially one that involves dementia, can be an overwhelming experience. Because LBD is a multi-system disease, with treatment focusing primarily on symptom management, it’s helpful to take as proactive an approach as possible from the outset. This means working with your physician to:

• Become informed. Learn as much as you can about Lewy body dementia and how it may affect your loved one, given the senior’s health history, age, and lifestyle.
• Strengthen the senses. Have your loved one’s doctor evaluate each of his or her five senses — sound, sight, touch, taste, and smell — in order to identify and treat any abnormalities. Then ask about exercises to improve them. By challenging themselves to enhance their senses, seniors will boost both mental and physical capabilities.
• Manage symptoms with behavioral changes. One example of symptom management in LBD involves low blood pressure (hypotension), a common Lewy body dementia symptom that can lead to falls. To help stabilize blood pressure and minimize the risk of fall-related injuries, someone with LBD needs to:
  • Stay hydrated
  • Exercise
  • Avoid prolonged bed rest
  • Stand up slowly.
• Choose medications prudently. The potential benefits of any medication need to be carefully balanced with possible side effects that may occur. In people with LBD, the treatments for hallucinations, delusions, and behavioral disturbance tend to make the Parkinson’s symptoms worse; treating the Parkinson’s symptoms can make the delusions and behavior problems worse. However, depression and sleep disorders can and should be treated with medications that the patient can safely tolerate.

What Research is Being Done on Lewy Body Dementia?

The National Institute of Neurological Disorders and Stroke (NINDS), a division of the National Institutes of Health, conducts and supports research on a wide array of dementia-related diseases, including Lewy body dementia. The goal is to learn more about diagnosis, treatment, and prevention of LBD. Researchers are also exploring the Lewy bodies themselves, in an effort to understand the mechanisms of disease formation and progression.

One study that made recent headlines used a lumbar puncture (spinal tap) to diagnose LBD in living persons, with a high degree of accuracy. Up until now, the only way to prove someone’s symptoms were Lewy body dementia was via a brain autopsy.

What is Frontotemporal Dementia?

First described by Arnold Pick in 1892 and originally called Pick’s disease, frontotemporal dementia (FTD) encompasses six types of dementia involving the frontal (behind your forehead) or temporal lobes (behind your ears).

FTD causes the frontal and temporal lobes of the brain, which control speech and behavior, to slowly atrophy, leading to an irreversible decline in mental functioning over a period of years.

According to the National Institute of Neurological Disorders and Stroke, the following conditions are currently grouped together as frontotemporal dementias:

• Pick’s disease,
• Primary progressive aphasia,
• Semantic dementia.

While up to seven million Americans may be afflicted with FTD, Pick’s disease accounts for just five percent of all progressive dementias. It is frequently misdiagnosed in the early stages as depression, mental illness or Alzheimer’s disease, because of the manner in which symptoms initially appear.

What Causes Frontotemporal Dementia?

As in Lewy body dementia, frontotemporal dementia is the result of a build-up of protein in the affected areas of the brain. The accumulation of abnormal brain cells eventually leads to changes in character, socially inappropriate behavior, and poor decision making, progressing to severe impairment in intellect, memory, and speech.

Frontotemporal dementia typically strikes adults between the ages of 40 and 60 and is slightly more common in women than in men. While the cause is still unknown, there is a strong genetic component: about a third of FTDs are hereditary.

What Are the Signs and Symptoms of Frontotemporal Dementia?

Because the frontal lobes affect behavior and emotional response, people with FTD will usually show signs of changes in personality before they manifest evidence of dementia. This may begin as impulsiveness or a lack of inhibition. While the progression of symptoms in FTD is fortunately slow, symptoms do worsen over time.

The following symptoms are typical of patients with frontotemporal dementia. More severe symptoms will appear in later stages of the illness:

Behavioral Changes

• Impulsivity
• Obsessive/compulsiveness (e.g., overeating or only eating one type of food)
• Drinking alcohol to excess (when not previously a problem)
• Rudeness or impatience, leading to aggression
• Poor judgment
• Withdrawal or seclusion
• Inability to function or interact in social situations
• Inability to hold a job
• Lack of attention to personal hygiene
• Sexual exhibitionism or promiscuity

Emotional Changes

• Abrupt mood changes
• Lack of warmth, concern, or empathy
• Indifference to events or to one’s environment
• Easily distracted; difficulty maintaining a line of thought
• Unaware of the changes in behavior
• Decreased interest in personal care

Language Changes

• Reduced quality of speech: shrinking vocabulary, difficulty finding a word
• Difficulty speaking or understanding speech (aphasia)
• Repeating words others say (echolalia)
• Weak, uncoordinated speech sounds
• Decreased ability to read or write
• Complete loss of speech (mute)

Neurological/Physical Problems

• Increased muscle rigidity or stiffness
• Difficulty moving about
• Lack of coordination
• General weakness
• Memory loss
• Urinary incontinence

How is Frontotemporal Dementia Diagnosed?

As with Lewy body dementia, frontotemporal dementias can only be conclusively determined by a post-mortem examination of the brain. Careful symptomatic evaluation, together with brain scans and EEGs, are the best methods currently available for reaching a probable diagnosis. These techniques can help ascertain whether the presenting condition is likely to be FTD or a related disorder, such as Alzheimer’s disease.

If at least three of the following five distinguishing characteristics are present in the early stages, the diagnosis is likely to be FTD rather than Alzheimer’s:

• Onset before age 65
• Initial personality changes
• Loss of normal controls, e.g., gluttony, hypersexuality
• Lack of inhibition
• Roaming behavior.

Also, as compared with Alzheimer’s disease, obvious mental impairment and memory loss occur later in frontotemporal dementia patients than in Alzheimer’s patients.

What Is the Treatment for Frontotemporal Dementia?

While there is no specific treatment for FTD, a supportive environment can yield surprising bright spots. For example, at the University of California/San Francisco Medical Center’s Memory and Aging Center, doctors discovered a small group of frontotemporal dementia patients who developed new creative skills in music and art. The artistic talents emerged when the brain cell loss occurred predominantly in the left frontal lobe, which controls functions such as language.

As the ability to communicate through words declined, these patients’ brains somehow accessed other realms of self-expression. So exploring and encouraging the development of latent skills is one way in which FTD patients can maintain their quality of life, and possibly slow the progress of mental deterioration.

In addition, consider the following steps to help manage the symptoms of FTD:

• Sensory function aids, such as eyeglasses, hearing aids, etc.
• Behavior modification that rewards positive behaviors
• Speech therapy and/or occupational therapy
• Medication to control behaviors that can be dangerous to oneself or others. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may offer some relief from apathy and depression, and help reduce food cravings, loss of impulse control and compulsive activity.

What Research is Being Done on Frontotemporal Dementias?

The National Institute of Neurological Disorders and Stroke (NINDS), and other branches of the National Institutes of Health conduct regular research related to frontotemporal dementia. They also support additional research through grants to major medical institutions across the country. Their goal is to learn more about the causes, diagnosis, treatment, and possible prevention of Pick’s disease and other FTDs.

The NINDS is currently recruiting patients for a number of clinical trials that will explore various treatments for the frontotemporal dementias, including Pick’s disease and primary progressive aphasia, as well as related dementias.

What Is Vascular Dementia?

Conditions that commonly occur as we age, such as high blood pressure, high cholesterol, and diabetes, block the arteries and impede blood flow to the brain, creating what is known as vascular dementia.

If vital oxygen and nutrients can’t reach the brain easily, parts of the brain die. This is called an infarct and is similar to what happens in a heart attack, or myocardial infarction. When brain tissue dies, the person begins to exhibit signs of cognitive impairment.

While nearly as common as Alzheimer’s disease, vascular dementia remains under-diagnosed, in part because the symptoms mimic many other conditions.

What Are the Signs and Symptoms of Vascular Dementia?

The signs and symptoms of vascular dementia can look remarkably similar to those of other dementias.

Physical Symptoms Include:

• Tremors (common in Parkinson’s disease dementia and LBD)
• Leg or arm weakness
• Balance problems (common in FTD)
• Shuffling steps (common in most dementias)
• Loss of bladder or bowel control (common in many dementias in the later stages)

Mental Symptoms Include:

• Sluggish thinking and forgetfulness (common to all dementias)
• Hallucinations and delusions (common in LBD)
• Depression and irritability (common in Alzheimer’s)
• Personality changes (common in Parkinson’s disease dementia and FTD)
• Confusion (common to all dementias)

Behavioral Symptoms Include:

• Language problems and slurred speech (common in FTD)
• Inappropriate emotional response (common in most dementias)
• Difficulty planning or following instructions (common in Alzheimer’s and most dementias)
• Becoming lost in familiar surroundings (common to most dementias).

What Is the Treatment for Someone with Vascular Dementia?

Although there is currently no cure for vascular dementia, by addressing the factors that lead to mini-strokes, such as high blood pressure or diabetes, a senior may be able to arrest or even reverse some symptoms, preventing memory loss and the need for memory care.

Treatment modalities such as physiotherapy, occupational therapy, and speech therapy can help someone with vascular dementia to regain some or all lost functions following a stroke. In addition, some of the medications used to treat the cognitive symptoms of Alzheimer’s disease appear to work for vascular dementia as well, since many of the symptoms overlap.

What is most important is minimizing the risk of having additional strokes, which will worsen vascular dementia symptoms.

As with Alzheimer’s treatment suggestions, the best course of action is positive lifestyle changes. Someone exhibiting signs of vascular dementia would be well advised to:

• Quit smoking
• Maintain their optimal weight
• Eat healthfully
• Reduce salt intake to manage blood pressure
• Reduce alcohol consumption
• Engage in moderate exercise
• Stay socially active
• Stimulate their brain with puzzles, games, reading, and other mental activities that help keep the mind sharp.

What Is Parkinson’s Disease Dementia?

Parkinson’s disease is a neurodegenerative disorder that is chronic and progressive. The hallmarks include muscle tremors, stiff or rigid movement, gait and balance problems, and cognitive impairment. Non-motor symptoms can include difficulty sleeping, constipation, anxiety, depression, and fatigue.

Approximately one million Americans are living with Parkinson’s disease. One of the better-known advocates for Parkinson’s research is actor Michael J. Fox of “Back To The Future” fame. Now in his late 50s, Fox was diagnosed with Parkinson’s disease at just 29. While most people develop symptoms after age 50, Fox is one of the 10-20 percent with Early Onset Parkinson’s Disease.

Though Parkinson’s disease dementia (PDD) affects only 20-30 percent of Parkinson’s patients in the early stages of the disease, cognitive decline tends to become apparent as the disease progresses and the brain changes that Parkinson’s causes gradually spread, affecting memory and judgment.

What Causes Parkinson’s Disease Dementia (PDD)?

Abnormal microscopic protein deposits of alpha-synuclein, whose normal function is not yet known, lead to Parkinson’s disease dementia. These deposits are known as Lewy bodies, after Frederick H. Lewy, the neurologist who discovered them while working with neuropathologist Aloysius Alzheimer in the early 1900s.

Although Parkinson’s disease dementia is one of the Lewy body dementias (LBD), it is not to be confused with dementia with Lewy bodies, which can include Alzheimer’s or vascular dementia (see below). Lewy bodies are found in both brain disorders (PDD and LBD), which indicates that they may be linked to the same underlying abnormalities in brain processing.

Additionally, many people diagnosed with either Parkinson’s disease dementia or Lewy body dementia also have the plaques and tangles that are the biomarkers of Alzheimer’s disease.

What Are the Signs and Symptoms of Parkinson’s Disease Dementia?

Although researchers and physicians typically focus on the movement disorders that define Parkinson’s disease, loved ones observe personality changes in those who are developing Parkinson’s disease dementia.

As the American Parkinson Disease Association (APDA) notes, the concept of a “Parkinson Personality” is controversial, because the idea that disease could alter who we are makes us uncomfortable. However, states the APDA, “There is no question that the brain is changing because of Parkinson’s disease. Because a substantial part of our personality relies on our brain function, it is not a stretch of logic to ask if a changing brain produces a changing personality.”

What Is the Treatment for Parkinson’s Disease Dementia?

There are presently no treatments to arrest brain cell damage in Parkinson’s disease dementia; however, memory care focuses on reducing and relieving symptoms.

The Kensington Place Redwood City is uniquely positioned to care for residents with various types of dementia, including Parkinson’s disease dementia. Our extensive team of health care professionals, as well as our alliances with community senior care programs and resources, make The Kensington your premier partner in providing unsurpassed memory care for your loved one.

Because exercise remediates many age-related physical and mental health conditions, our community offer some Parkinson’s-specific programs. One example is Energized Fitness for Parkinson’s, in partnership with the Parkinson Foundation and Genesis Rehab.

Research shows that various forms of exercise, such as treadmill training, dance, stationary bicycle training, Tai Chi, and cognitive training combined with motor training involving stretching and strengthening exercises have been effective in promoting the preservation or improvement of cognitive function in patients with Parkinson’s disease. Treadmill training showed the most improvements.

The Kensington has also sponsored webinars on Parkinson’s disease dementia, such as ABC’s of DBS (Deep Brain Stimulation), in which board-certified neurosurgeon Zachary Levine, MD, shares powerful, practical information about how this new technology can help seniors with memory loss due to PDD.

Memory Care As Individual As Your Loved One

At The Kensington Place Redwood City, we’re committed to providing an optimal life experience for each of our memory care residents. Memory care is our sole focus, which is why we have thoughtfully designed a memory care program geared for the entire family.

We believe the degree of memory loss is an important consideration when planning care. We empathize with both residents and their loved ones, each confronting the challenges and changes involved with memory loss.

The Kensington Place offers a full spectrum of memory care support across two specialized “neighborhoods,” depending on a resident’s stage of memory loss and specific care needs. These cozy environments enable residents to remain comfortable and safe while participating as fully as possible in our life enrichment activities and events.

We’re also fortunate to be located in a very senior-friendly community, which supports older residents with a range of services to complement life at The Kensington Place.

If your loved one is experiencing memory loss, we invite you to visit with us and see how The Kensington Place stands apart from other memory care communities, both in understanding and in serving those with dementia. We honor the past, savor the present, and are dedicated to making the times ahead manageable, comfortable and ultimately, peaceful.

We look forward to meeting you soon.

Recommended Additional Reading:

• Mixed Dementia – What Is It?
• Alzheimer and Dementia Caregiver Resources
• Early Signs and Symptoms of Dementia
• What is Reminiscence Therapy?
• Eating Well As We Age: the Importance of Dining to Memory Care