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The many diseases of dementia
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The many diseases of dementia
"Mom doesn’t have Alzheimer’s, she just has dementia", so say many adult children to eldercare professionals. Somehow families find comfort in believing that a loved one only has dementia, as if it is the lesser of two evils.
Dementia is not a disease but a group of symptoms caused by gradual death of brain cells. The loss of cognitive abilities that occurs with dementia leads to impairments in memory, reasoning, planning, and personality. Alzheimer's disease is the most common cause, followed by vascular or multi in-farct dementia, Parkinson‘s disease, Lewy body dementia, Pick’s disease and Hydrocephalus dementia.
Can dementia be reversed or cured? Yes, in many cases dementia can be reversed or cured completely, or at least partially, by treating the underlying disorder, according to Dr. Samuel Gandy, a neurologist at Mt. Sinai School of Medicine in Manhattan. Doctors are better than they used to be at diagnosing pseudo-senility, according to Dr. Gandy. “Most physicians are taught in medical schools to evaluate a patient for dementia by first excluding the reversible causes,” he said.
Causes of reversible memory problems include:
Malnutrition
Dehydration
Fatigue
Depression
Adverse reaction to medication or anesthesia
Thyroid disease
Metabolic disorder
Head injuries
Benign brain tumors
Viral or bacterial infections
Vascular insufficiency
Because some types of dementia are treatable or partially treatable, it is important not to assume that a person who is showing any symptoms of dementia is suffering from Alzheimer's disease or another incurable disease.
The following is a list of diseases that have dementia as a primary symptom or characteristic:
Alzheimer's disease (AD) is a slowly progressive disease of the brain that is characterized by impairment of memory and eventually by disturbances in reasoning, planning, language, and perception. Many scientists believe that Alzheimer's disease results from an increase in the production or accumulation of a specific protein (beta-amyloid protein) in the brain that leads to nerve cell death. Plaques and tangles are among the abnormalities that kill nerve cells. Plaques build up between nerve cells. They contain deposits of beta-amyloid protein. Tangles are twisted fibers of another protein called tau.
At a scientific meeting in November 1906, German physician Alois Alzheimer presented the case of “Frau Auguste D.,” a 51-year-old woman brought to see him in 1901 by her family. She suffered with what today would be considered classic signs of Alzheimer’s, impaired memory, accusatory & suspicious behaviors and decline in speech and reasoning. Her symptoms rapidly grew worse, and within a few years she was bedridden. She died in the spring of 1906.
Symptoms of Alzheimer’s disease include:
Memory loss and poor memory of recent events
Unable to name common items
Asking the same question repeatedly
Getting lost
Difficulty dressing for the weather or occasion
Forgetting to perform daily hygiene tasks
Argue more often
Wandering, often at night
Needing close supervision
Unable to perform easy activities of daily living
Vascular dementia is probably the second leading cause of dementia, but has been somewhat overshadowed by the more well-known Alzheimer's disease. It is a degenerative cerebrovascular disease that leads to a progressive decline in memory and cognitive functioning. It occurs when the blood supply carrying oxygen and nutrients to the brain is interrupted by a blocked or diseased vascular system (arteries). Vascular dementia generally affects people between the ages of 60 and 75, and affects more men than women.
Causation can be blockages and breaches in the brain's blood supply that damage the brain, vascular dementia can be prevented and, in some cases, even reversed. So the best way to prevent vascular dementia is to lower the risk of stroke. The risk factors for stroke are well known. The single most important risk factor is high blood pressure, or hypertension.
Symptoms of vascular dementia include:
Loss of short term memory
Poor judgment
Impaired verbal communication
Laughing or crying inappropriately
Difficulty following instructions
Parkinson’s disease is believed to be caused by deterioration of the brain cells that produce dopamine, occurring primarily after the age of 60. It is a degenerative disorder of the central nervous system.
Symptoms of Parkinson’s disease include:
Resting tremor
Bradykinesia – slowness of movement
Gait & balance problems
Muscle rigidity
Mood disorders to include depression and anxiety
Memory impairment
Speech & Swallowing problems
Reduced facial expressions
Drooling
Lewy body dementia (LBD) is one of the most common types of progressive dementia.
In LBD, cells die in the brain's cortex, or outer layer, and in a part of the mid-brain called the substantia nigra. Many of the remaining nerve cells in the substantia nigra contain abnormal structures called Lewy bodies that are the hallmark of the disease. Lewy bodies may also appear in the brain's cortex or outer layer and contains a protein called alpha-synuclein that has been linked to Parkinson's disease and several other disorders. Researchers, who sometimes refer to these disorders collectively as "synucleinopathies," do not yet know why this protein accumulates inside nerve cells.
The symptoms of LBD overlap with Alzheimer’s disease and Parkinson’s disease. However, day to day fluctuations in the severity of symptoms and visual hallucinations generally provide enough evidence to distinguish Lewy body dementia.
Symptoms of Lewy Body dementia include:
Impaired short term memory
Recuring well defined hallucinations
Fluctuating cognition with pronounced variations in attention and alertness
REM sleep behavior and disorder
Repeat falls and syncope
Pick’s disease is also known as front-temporal dementia and is described as a clinical syndrome associated with shrinking of the frontal and temporal anterior lobes of the brain. Pick's disease involves drastic personality changes, deterioration of social skills, and a lack of empathy and emotion allowing physicians to identify Pick's disease from Alzheimer’s disease or other dementias. Memory loss is often the main, and earliest, symptom of Alzheimer's but not with Pick’s disease.
Symptoms of Pick’s disease include:
Can't keep a job
Compulsive behaviors
Inappropriate sexual behavior
Inability to function or interact in social or personal situations
Problems with personal hygiene
Repetitive behavior
Withdrawal from social interaction
Decline in short term memory
Normal pressure hydrocephalus dementia is derived from the Greek words "hydro" meaning water and "cephalus" meaning head. As the name implies, it is a condition in which the primary characteristic is excessive accumulation of fluid in the brain. Normal pressure hydrocephalus (NPH) is a type of hydrocephalus that occurs in adults, usually older adults. The average age of people with NPH is older than 60 years. NPH is different than other types of hydrocephalus in that it develops slowly over time. The drainage of CSF is blocked gradually, and the excess fluid builds up slowly.
The parts of the brain most often affected in NPH are those that affect the legs, the bladder and the "cognitive" mental processes such as memory, reasoning, problem solving, and speaking. The dementia symptoms of NPH can be similar to those of Alzheimer disease. The walking problems are similar to those of Parkinson’s disease. Experts believe that many cases of NPH are misdiagnosed as one of these diseases. The good news is that, unlike Alzheimer disease and Parkinson disease, NPH can be reversed in many people with appropriate treatment. But first it must be correctly diagnosed.
Symptoms of normal pressure hydrochepalus include:
Memory loss
Speech problems
Apathy (indifference) and withdrawal
Difficulties with reasoning, paying attention, or judgment
Gait disturbance and shuffling
Sudden & frequent falling
“Freezing” during ambulation
Urinary frequency & incontinence
In reviewing the many diseases of dementia it doesn’t appear that mom is better off just having dementia.
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