“Dementia” is a catchall term for several progressive brain disorders including Alzheimer’s disease. Alzheimer’s is often singled out because it is by far the most common; up to 80 percent of dementia cases are specifically Alzheimer’s cases.
Alzheimer’s is so common that it is basically synonymous with dementia, but there are several types of dementia with varying symptoms, including some that are much different than Alzheimer’s. Very broadly, Alzheimer’s takes a person’s memory first while other dementias can have a stronger effect on mood or personality, changing someone in significant ways without taking away their memory.
In this article we will describe the differences between Alzheimer’s and other dementias (specifically vascular, Lewy body, and frontotemporal), and explain why someone with symptoms of these diseases should figure out exactly which kind it is.
There is no definitive test that tells doctors whether someone has Alzheimer’s disease or another kind of dementia. Nor is the process different in significant ways if a doctor suspects a certain type of dementia. The diagnostic process for both Alzheimer’s or other dementia entails the following:
– Medical history: What are the patient’s specific symptoms, history of illnesses or psychiatric issues, and do any diseases run in the family?
– Physical exam: Doctors make sure symptoms aren’t from some other illness occurring outside the brain.
– Neurological testing: Is the nervous system working correctly? Doctors will check reflexes, eye movements, coordination, and senses like smell, touch, and hearing.
– Mental-status testing: A person is asked a series of questions to assess thinking ability, like naming common objects or doing simple math. The most common test is the mini-mental state exam (MMSE).
– Brain scans: Changes in the brain may show up on computerized tomography (CT), magnetic resonance imaging (MRI), and/or positron emission tomography (PET) scans.
– Labwork: Checking blood count, nutrition, and thyroid hormone levels can rule out other illnesses like infections and diabetes.
As doctors perform the steps above, they will get a sense of exactly which type of dementia is present. Because Alzheimer’s is by far the most common, most doctors start there and look for specific indicators of other dementias. For example, if someone has a history of strokes or mini-strokes, doctors will screen for vascular dementia. An indicator of Lewy body dementia is movement symptoms coming on first, followed within a year by cognitive (thinking) symptoms like memory loss that are more typical of Alzheimer’s. Diagnosing frontotemporal dementia requires neurological exams and a careful analysis of symptoms. MRIs and glucose positron emissions scans are also part of getting a diagnosis.
Because dementia is such a devastating illness that strongly impacts a person’s ability to think and function, you might wonder why it even matters whether someone has Alzheimer’s disease or another kind of dementia. The differences are important and can have a major impact on decisions about treatment and lifestyle.
A person diagnosed with dementia will want to know what to expect. If you know what the side effects are for your particular kind of dementia, it makes it possible to plan. Someone with Alzheimer’s disease will want to prepare for dealing with memory loss, and take steps like labeling doors and drawers, or using technological devices like talking photo albums that can actually speak the names of important friends or loved ones.
It is important to know what will be needed in subsequent stages. The people who care for someone with dementia will be better able to deal with conflicts that might arise when a personality is being impacted by Frontotemporal dementia, for example. Helping someone with activities of daily living (ADLs), like eating and dressing, may sound simple, but there are learned techniques to make the process easier and to encourage independence, which improves symptoms. Caregiving is difficult work, but it will be easier if the caregiver knows whether memory or personality will be more strongly affected, and how the brain will change.
Also, dementia gets expensive. Home modifications might be necessary to keep someone with Alzheimer’s disease safe. As the disease advances, moving into assisted living with memory care will probably become necessary, so full-time staff can see to dementia-specific needs. Having an understanding of this process before important decisions must be made will make the transition easier, and the sooner you look at assisted living homes and applying for financial assistance, if necessary, the better. Anyone moving into these residences will need to be assessed beforehand, and this includes knowing the exact type of dementia.
Particularly on the internet, there are groups caregivers can join to help each other with the problems that arise related to dementia. These groups, however, are more helpful when they can answer specific questions, and this means narrowing down the issues related to your particular dementia. Someone who cares for a loved one with CTE or frontotemporal dementia (FTD), for instance, would want to talk with others about helping someone who is younger cope with symptoms like aggression. Caregivers for people with Alzheimer’s might have questions about what to do when elderly their loved ones start wandering. Online support networks are also a way for someone dealing with rare dementias, like FTD, to feel less alone. FTD is not rare on an FTD message board.
Some dementias can be cured. Normal Pressure Hydrocephalus is a rare condition with symptoms that include loss of short-term memory, difficulty walking, and urinary incontinence. It can seem at first like Alzheimer’s, but it’s important to receive a diagnosis because NPH can be reversed with an operation (a “shunt” is inserted into the brain to relieve pressure).
That option unfortunately does not exist for most kinds of dementia, but symptoms can be managed. Because there are different symptoms for different kinds of dementia, it’s important to know what kind you’re dealing with. Pharmaceutical, therapeutic, and other treatments can improve the quality of life for a dementia sufferer, but they need to know which symptoms to target.
It’s also worth noting that participation in clinical trials is a way of receiving cutting-edge treatment and possibly getting a jump on medications or treatments that aren’t available to the public. You’ll need as many specifics as possible to participate in clinical trials, including exactly which type of dementia is present.
About 10 percent of dementia cases are vascular dementia, also called “vascular cognitive impairment,” making it the second-most-common type of dementia (vs. 80% that are Alzheimer’s). Vascular dementia comes from blood flow problems to the brain as opposed to a buildup of plaques causing cell-death associated with Alzheimer’s. People who have had a stroke, or a series of mini-strokes called “transient ischemic attack” (TIA), are most at risk. Mini-strokes may not be painful or impactful enough to make a person go to the doctor, but they can cause the blood-flow problems that lead to vascular dementia. Other illnesses that affect blood flow, like diabetes, also raise the chances a person will develop vascular dementia.
Vascular dementia impacts different parts of the brain, and symptoms depend on where it occurs. Usually, the left side of the brain is affected and symptoms start with those similar to Alzheimer’s: memory loss, inability to concentrate, etc. Movement and coordination problems may come on first, however, so problems walking might occur before thinking is affected.
A distinct difference between vascular dementia and Alzheimer’s is that vascular dementia can come on suddenly after a stroke, whereas Alzheimer’s symptoms are slow to develop. Symptoms have also been known to disappear for a period of time, causing caregivers to think the disease may be subsiding, before coming back suddenly.
The average number of years a person lives with vascular dementia is about five years, or half as long as someone diagnosed with Alzheimer’s.
The third most common dementia—between five and 10 percent of cases—is Lewy body dementia, caused by deposits of a specific kind of protein called “alpha-synuclein” in brain cells. This same protein builds up in the brains of people with Parkinson’s disease, making Lewy body dementia similar to Parkinson’s disease dementia.
A major difference between Lewy body and Alzheimer’s disease symptoms is that people with Lewy Body dementia have hallucinations earlier than people with Alzheimer’s. Hallucinations are one of the key symptoms of Lewy Body. Paranoia also is stronger earlier, and memory decline happens more quickly. Physical movements also deteriorate quicker. Strong blood-pressure drops upon standing, which make a person lightheaded and prone to dizziness and falls, are more common in Lewy body dementia.
The life expectancy for a person diagnosed with Lewy body dementia is much shorter than with Alzheimer’s. The average number of years a person lives following a diagnosis of Lewy body is between two and eight years.
Frontotemporal dementia comes from damage in the brain’s frontal (behind the forehead) and temporal (under the temples) lobes. Symptoms arrive at a much younger age (between 40 and 45) and are less likely to include memory loss. Instead of forgetting important information, a person with FTD often experiences a major change in personality. Mood swings are common, as well as depression and aggressive behavior. Language can also be affected, so someone with FTD has a harder time understanding and responding to speech. The hallucinations and delusions that become common in the middle and late stages of Alzheimer’s are not common for people with FTD, and people with FTD do not get lost or lose track of their sense of place like people with Alzheimer’s. The rate of progression for the disease, or how quickly symptoms worsen, is similar to Alzheimer’s.
This is the most common type of dementia for people under 60, affecting between 50,000 and 60,000 Americans. Because of the younger age at which it first impacts the individual, there can be confusion between early-onset Alzheimer’s and FTD. The life expectancy for someone with FTD is about seven years after diagnosis vs. ten years with Alzheimer’s.