9/25:  Dementia:  Different Types & Changing Views

Dementia is a general name used for the decline of the brain’s ability to think, remember, and function normally. It can be caused by various underlying conditions and worsens over time.  Dementia symptoms can vary depending on the type of dementia and the stage of the condition, but they generally include a combination of cognitive, behavioral, and psychological changes. For a small number of people, a rare genetic variant has been identified as to cause dementia. In this lesson, we will discuss factors that may be able to slow down its progression with early detection and intervention.

Alzheimer’s Disease is the most common form and accounts for an estimate of 60-80% of the cases of dementia. Alzheimer’s Disease (AD) is a progressive and degenerative brain disorder, which can span over several years and the rate of progression varies among individuals. AD can lead to memory loss, cognitive decline, and behavior changes. AD is characterized by the accumulation of abnormal proteins in the brain, which leads to death of the brain cells and the gradual loss of cognitive and functional abilities. There is currently no cure for Alzheimer’s, but research continues to explore treatments and inventions to help manage its symptoms and improve the quality of life for those affected.

Alzheimer’s disease primary manifests in two main types:

Early-Onset AD typically affects individuals under the age of 65. It is relatively rare and can occur in people in their 40s or 50s. It often has a stronger genetic component, with specific gene mutations playing a role in its development.

Late-Onset AD is the most common type and typically occurs in individuals aged 65 and older. It has a more complex set of risk factors, including genetics, lifestyle, and environmental factors.

Additionally, AD can be further classified into stages, including mild, moderate, and severe, based on the progression of cognitive decline and the impact on daily functioning.

Below from Frontiers in Bioscience:  Alzheimer disease and its pathogenesis. (A) Characteristic symptoms at various stages of AD. (B) The hallmarks and causatives of Alzheimer disease.  

Vascular Dementia is the second most common form of dementia. Typically, this type results from reduced blood flow to the brain, often due to stroke or other vascular conditions. Symptoms can vary depending on the location of the brain damage.

Mixed Dementia: Some individuals may have a combination of Alzheimer’s disease and vascular dementia, which is referred to as mixed dementia.

Parkinson’s Disease Dementia: Individuals with Parkinson’s Disease can develop dementia as the disease progresses, leading to cognitive impairment in addition to motor symptoms.

Lewy Body Dementia: This type of dementia is associated with abnormal protein deposits called Lewy bodies in the brain. It can lead to cognitive fluctuations, visual hallucinations, and movement problems similar to Parkinson’s Disease.

Those are some of the main types of dementia, but there are other less common forms as well.

Diagnosing Dementia involves a comprehensive evaluation by a healthcare professional, typically a neurologist or geriatrician, and may include the following steps:

Diagnosing dementia can be complex. It may take time to arrive at a definitive diagnosis.  The diagnostic process may involve ruling out other conditions that can mimic dementia symptoms. An accurate diagnosis is crucial to provide appropriate care, support, and treatment options for individuals with dementia and their families.

There are some changing views and trends giving awareness of the complexity of dementia and the need for a multidisciplinary and compassionate approach to support individuals living with dementia and their caregivers.  For more information, click on the links below.  

Dementia as a Syndrome, Not Just a Disease: There’s a growing recognition that dementia is not just one specific disease but a syndrome with various underlying causes.

Early Detection and Diagnosis:   There’s an increased focus on early detection and diagnosis of dementia. Early diagnosis can enable better management of symptoms and the implementation of interventions to slow down the progression of the disease. Cognitive assessments and biomarkers are being explored for early detection.

Holistic Care Approach: Dementia care is shifting towards a more holistic approach that considers not only the medical aspects but also the emotional, social, and psychological needs of individuals living with dementia. Person-centered care, which tailors care plans to the individual's preferences and history, is gaining prominence.  Read more about holistic care for Alzheimer's and Dementia.  

Dementia- Friendly Communities: The concept of creating dementia-friendly communities is gaining traction. These communities aim to raise awareness, reduce stigma, and adapt public spaces to be more accessible and supportive for people with dementia, allowing them to remain engaged in community life.  Visit the website Dementia Friendly America for more information.

Technology: Technology is being increasingly utilized in dementia care.  Telehealth can be used for remote consultation and support along with development of apps and assistive technologies to support individuals with dementia and their caregivers. Interested in learning more?  The Alzheimer's Society website offers a variety of technology ideas to help your loved one with their care. 

Research and Drug Development: Ongoing research is exploring potential treatments and interventions for dementia. There is hope that new drugs and therapies may emerge to slow down or halt the progression of the disease, although this area has faced significant challenges.

Dementia-Friendly Workplaces:  Employers are recognizing the need to support employees who are caregivers for individuals with dementia. This includes offering flexible work arrangements and providing resources and education to help employees balance their caregiving responsibilities with their jobs.

Legal and Ethical Issues:  As the number of individuals with dementia increases, there's a growing focus on legal and ethical issues surrounding decision-making, guardianship, and end-of-life care for people with dementia. Advance care planning and discussions about preferences are becoming more important.  Do you know someone who struggles with dimentia who is in need of legal advice?  NIH offers some valuable information on their web site.

Diverse Perspectives: There's a recognition that dementia affects people from diverse backgrounds, and cultural competency in dementia care is gaining importance. Understanding and respecting the cultural beliefs and values of individuals and their families is crucial for providing effective care.

Global Action: Dementia is recognized as a global health challenge, and various international organizations, governments, and advocacy groups are working together to raise awareness, promote research, and develop strategies for better care dementia care and support.  World Health Organization has prepared a fact sheet on dementia, which includes the global impact.  You can view it here.

Reducing the risk of dementia involves adopting a healthy lifestyle and making choices that support brain health.  Here are some steps to consider:

Stay Mentally Active:  Engage in activities that challenge your brain, such as puzzles, reading, learning new skills, or playing musical instruments.

Stay Physically Active:  Regular exercise can improve blood flow to the brain and reduce the risk of cognitive decline. Aim for at least 150 minutes of moderate-intensity aerobic activity per week.

Eat a Healthy Diet:  Consume a diet rich in fruits, vegetables, whole grains, and lean proteins. Foods high in antioxidants and omega-3 fatty acids, like fish, may be particularly beneficial.

Manage Cardiovascular Risk Factors:  High blood pressure, diabetes, obesity, and high cholesterol can increase the risk of dementia. Manage these conditions through a healthy diet, regular exercise, and medication if necessary.

Get Quality Sleep:  Aim for 7-9 hours of restful sleep each night, as poor sleep can contribute to cognitive problems.

Socialize:  Stay socially active and maintain strong relationships. Social engagement is linked to better cognitive health.

Mental Health:  Manage stress, anxiety, and depression, as these conditions can contribute to cognitive decline.

Stay Hydrated:  Proper hydration is important for brain function.

Limit Alcohol:  Excessive alcohol consumption can increase the risk of dementia, so limit your intake.

Don’t Smoke:  Smoking is a risk factor for cognitive decline, so if you smoke, seek help to quit.

Protect Your Head:  Prevent head injuries by wearing helmets during sports and using seat belts in cars.

Stay Engaged:  Keep your mind active through hobbies, volunteering, or part-time work, especially after retirement.

The idea of you or a loved one experiencing any form of dementia can be frightening. However, preventive actions can significantly mitigate the risk. The exact level of risk reduction is dependent on several factors, including an individual’s genetics, lifestyle and the specific preventive measures taken. Adherence to some or all the preventive opportunities noted in this lesson will not only reduce your chances of getting this disease but are good guidelines for an overall better quality of life.

Making positive lifestyle choices and managing risk factors can make a meaningful difference in preserving cognitive health as we age.

Fifield, K (2023, May), Dementia vs. Alzheimer’s: Which is it?

Retrieved from https://www.aarp.org/health/dementia/info-2018/difference-between-dementia-alzheimers.html

Do Memory Problems Always Mean Alzheimer’s Disease? (2018, Jan 24).

Retrieved from National Institute of Aging https://www.nia.nih.gov/health/do-     memorypproblems-always-mean-alzheimers-disease

John Hopkins Medicine, Dementia Prevention: Reduce Your Risk, Starting Now

Retrieved from https://hopkinsmedicine.org/health/com

Koronyo Y, et al. Retinal pathological features and proteome signatures of Alzheimer’s disease. Acta Neuropathologica. 2023. Epub Feb. 11. doi:10.1007/s00401-023-02548-2.

What is Dementia? Retrieved from https://www.alzheimers.gov/alzheimers-dementias/what-is-dementia

Ford-Martin (2022, August 28). Types of Dementia. Retrieved from https://www.webmd.com/alzheimers/alzheimers-dementia

Dementia Diagnosis Retrieved from https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/dementia/diagnosis.html

Logsdon, McCurry, Ten Evidence-Based Interventions to Improve Quality of Life for Individuals with Dementia 2007. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585781/

DeAngelis Improving the quality of life for patients with dementia and their caregivers (2023, April 1). Retrieved from: https://www.apa.org/monitor/2023/04/continuing-education-patients-dementia-caregivers

Can I Prevent Dementia? Retrieved from https://www.alzheimers.gov/life-with-dementia/can-i-prevent-dementia