10 Types of Dementia: What to Look For
The term dementia is used broadly to describe a condition which is characterized by cognitive decline, but there are many different types of dementia. Although it is usually progressive, properly diagnosing dementia can reverse the effects and be treated and even cured completely by addressing the underlying cause. However, dementia caused by incurable conditions such as Alzheimer’s disease, are irreversible.
What are the different types of dementia?
Experts estimate that Alzheimer’s disease is the underlying cause of — of all dementia cases. However, there are many other conditions which can also cause dementia, which makes it vital for the patient to obtain accurate diagnosing of dementia early on in order to get proper treatment. Following are some of the most common types of dementia and their causes.
1. Vascular Dementia
The second most common form of dementia, vascular dementia is caused by poor blood flow to the brain, which deprives brain cells of the nutrients and oxygen they need to function normally. One of the ten dementia types, vascular dementia can result from 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. This is called mixed dementia. The most common form of mixed dementia is caused by both Alzheimer’s and vascular disease.
3. Dementia with Lewy Bodies (DLB)
Sometimes referred to as Lewy Body Disease, this type of dementia is characterized by abnormal protein deposits called Lewy bodies which appear in nerve cells in the brain stem. These deposits disrupt the brain’s normal functioning, impairing cognition and behavior and can also cause tremors. DLB is not reversible and has no known cure.
4. Parkinson’s Disease Dementia (PDD)
Parkinson’s disease is a chronic, progressive neurological condition, and in its advanced stages, the disease can affect cognitive functioning. Not all people with Parkinson’s disease will develop dementia, however. Dementia due to Parkinson’s is also a Lewy body dementia. Symptoms include tremors, muscle stiffness and speech problems. Reasoning, memory, speech, and judgment are usually affected.
5. Frontotemporal Dementia
Pick’s disease, the most common of the frontotemporal dementia types, is a rare disorder which causes damage to brain cells in the frontal and temporal lobes. Pick’s disease affects the individual’s personality significantly, usually resulting in a decline in social skills, coupled with emotional apathy. Unlike other types of dementia, Pick’s disease typically results in behavior and personality changes manifesting before memory loss and speech problems.
6. Creutzfeldt-Jacob Dementia (CJD)
CJD is a degenerative neurological disorder, which is also known as mad cow disease. The incidence is very low, occurring in about one in one million people. There is no cure. Caused by viruses that interfere with the brain’s normal functioning, dementia due to CJD progresses rapidly, usually over a period of several months. Symptoms include memory loss, speech impairment, confusion, muscle stiffness and twitching, and general lack of coordination, making the individual susceptible to falls. Occasionally, blurred vision and hallucinations are also associated with the condition.
7. Normal Pressure Hydrocephalus (NPH)
Normal pressure hydrocephalus involves an accumulation of cerebrospinal fluid in the brain’s cavities. Impaired drainage of this fluid leads to the build-up and 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, in addition to 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. The cognitive and behavioral symptoms of dementia due to Huntington’s include memory problems, impaired judgment, mood swings, depression and speech problems (especially slurred speech). Delusions and hallucinations may occur. In addition, the individual may experience difficulty ambulating, and uncontrollable jerking movements of the face and body.
9. Wernicke-Korsakoff Syndrome
Wernicke-Korsakoff syndrome is caused by a deficiency in thiamine (Vitamin B1) and often occurs in alcoholics, although it can also result from malnutrition, cancer which have spread in the body, abnormally high thyroid hormone levels, long-term dialysis and long-term diuretic therapy (used to treat congestive heart failure). The symptoms of dementia caused by Wernicke-Korsakoff syndrome include confusion, permanent gaps in memory, and impaired short-term memory. Hallucinations may also occur.
10. Mild Cognitive Impairment (MCI)
Dementia can be due to medical 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 is usually aware of the 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; these can be due to the awareness of and frustration related to his or her condition.
The health care professional you meet with will need to know the symptoms the patient is experiencing, their duration, frequency and rate of progression. The doctor will do everything he or she can to make the patient comfortable while diagnosing dementia, which includes addressing the patient’s fears regarding the types of dementia and condition. Diagnosing dementia requires a full review of the patient’s health care, 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 must also undergo a physical exam and blood tests in order to determine which types of dementia the patient may be suffering from.
Not every doctor is familiar with the complexities of dementia diagnosis, so you will need to find a doctor who is experienced at diagnosing dementia types. Currently, there is no single test that proves Alzheimer’s, although it is possible to achieve 90% accuracy. However, we may have difficulty in discovering the true underlying cause. In patients with advanced findings of brain dysfunction, diagnosing dementia is fairly straightforward. But in patients with some early findings of diminished brain function, the diagnosis and its type is seldom clear. Following are some of the approaches that are commonly used in determining types of dementia.
Mini Mental State Evaluation (MMSE)
The mini-mental status exam is a very brief evaluation of the patient’s cognitive status used in diagnosing dementia types. The patient is required to identify the time, date and place (including street, city and state) 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.
Another test for diagnosing dementia, the mini-cog takes only a few minutes to administer and is used as an initial screening for various types of dementia. The patient is required to identify 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.
Imaging Tests: CTs, MRIs and Pet Scans
Physicians diagnosing dementia may study the structure of the patient’s brain by CT or MRI to see if there are any growths, abnormalities or general shrinkage (as seen in cases of Alzheimer’s). Studies of brain function, using a PET scan and a special form of MRI can more definitively confirm the diagnosis of various types of dementia and raise the accuracy of the diagnosis to 90%. A PET scan administered and reviewed by an expert delivers the most accurate and suggestive results while diagnosing dementia. The most accurate form of PET scanning for types of dementia is called Stereotactic Surface Projection, which involves an advanced statistical analysis of the data.
In 2007, led by Dr. Norman Foster, head of the Alzheimer’s Center at the University of Utah, a group of elite PET scientists and dementia experts conducted a study in which they performed PET scans and clinical tests on multiple patients. The accuracy with the tests was 90% for both Alzheimer’s and frontotemporal dementia types. They stated that scans increased the experts’ confidence in diagnosing dementia types and made them question and sometimes change the diagnosis in 42% of cases. They stated that early and accurate diagnosing of dementia is critical to avoid misdiagnosis and mistreatment. The results of this study show that PET scanning is highly predictive of the patient’s clinical course and essential to properly diagnosing dementia.
By Dr. Harvey Gilbert, MD