Dementia, what is is (and what it isn't)
One of the most frequent questions asked when patients and families come to my office is "What is the difference between dementia and Alzheimer's disease". Dementia is not a disease. It describes a set of symptoms that an individual is experiencing. This may include changes in memory, language, behaviors and being able to do normal daily tasks. There are many causes of dementia, for example Alzheimer's disease, strokes, Parkinson's disease, Lewy body dementia, as well as some that may be reversible. The most common form of dementia is Alzheimer’s disease.
Your doctor may use different terms for these processes, also known as neurocognitive disorders. We use the term "dementia" as it is the most familiar.
Alzheimer’s disease (AD) is a progressive dementia, which means it will worsen over time as the brain deteriorates. The majority of individuals are diagnosed after the age of 65. Gradually an individual will experience memory loss, changes in ability ability to recall words and loss of ability to do normal every day tasks. They may also experience behavioral changes such as depression, anxiety, hallucinations, delusions or other issues. Currently there is no cure for AD however there are medications that can address the symptoms of the disease.
Please visit the Alzheimer's Association for more information and resources
Lewy body disease
Lewy body Disease (aka dementia with Lewy bodies or Lewy body dementia) is a very interesting disease, although some caregivers might not agree with that statement. It is characterized by Lewy bodies, or specific proteins in the neurons, only detectable at autopsy. Diagnosing Lewy body dementia is dependent upon neurologic examination, medical workup, neuropsychological testing, but also reporting about behaviors (specifically hallucinations) by patient and/or caregivers.
So why do I call it interesting. First, because patients and caregivers have taught me so much about their daily challenges of managing this disease. But that is of no consequence to you I know. I find this an interesting dementia as there has been so much discussion about what it is, what it is not and treatments. Let me explain...
Frederick Lewy first discovered the abnormal proteins sometime in the early 1900’s. However, it wasn’t until the early to mid-1990’s that it became more recognizable as a diagnosis. But even then, Lewy body was thought by some scientist to be part of Parkinson’s disease and others to Alzheimer’s disease. It is now known to be, and diagnosed as a disease in and of itself.
Lewy body dementia is characterized by the following:
- fluctuating cognition, which can vary in a short or long period of time.
- change in functional status
- parkinsonian symptoms including rigidity, poor coordination, shuffling gait, tremor and slowness of movement.
- visual hallucinations, often preceeding memory loss or other symptoms of a dementia.
It is difficult to diagnose at times. Why? Because the symptoms can mimic initially Parkinson’s disease, and/or Alzheimer’s disease. The marker is often the vivid visual hallucinations. I have had cases that the patient will note strange visions, such as elephants in a field knowing that they were in New England and this is not likely. The hallucinations can be followed by agitation and paranoia. But who wouldn’t be abit agitated or frightened if they saw elephants running towards their car? Of course not all hallucinations are as vivid, but you get the picture. Here is another little caveat: there is an eye disease that also causes hallucinations, as well as some mental health disorders. So, it is crucial that a specialist such as a neurologist or a geriatric psychiatrist specializing in memory disorders be consulted. Treatment management can be delicate due to side effects. Again, the need for a specialist. There is no cure for LBD. Management of behavioral symptoms should include behavioral management strategies, a crucial component of the treatment to help caregivers.
To the caregiver: as difficult as it may be, it is important not to react to the behaviors, but remain calm and help the individual through the moment. I know, you are feeling like I don’t understand. But let me ask you a question. When there is a behavior, how does it make you feel? Afraid, anxious, angry, all of the above? Understand how it makes you feel personally? How does it make you feel about the disease? How does it make you feel about your situation? Okay, now breathe. Accept how you feel. You are allowed to have these emotions. But, and this is a big but, how you react in front of the patient will have a direct effect on how they work through the hallucination. They too are afraid, but they can’t process their emotions, as the disease is robbing them of this ability.
SO, you must process your own emotions, and that is when you will be able to set them aside and begin to help them. This is a challenge, I understand. It won’t happen over night. But I do know that it will begin to help you help not only them, but yourself. Please visit the National Institute on Aging (Lewy Body) or Lewy Body Dementia Association for more information and resources
Mild Cognitive Impairment
Mild Cognitive Impairment (MCI), also known as a mild neurocognitive disorder (mNCD), is defined as a noticeable loss of cognitive functioning, more than what would be considered "normal" aging. Although the medical term is mNCD, most people still refer to the syndrome as MCI. For this discussion, we will use the term MCI.
Let's make one thing clear, MCI is NOT a dementia.But, MCI, as stated, is more than normal aging. There is a mild but noticeable change in thinking, which may include memory Individuals (or family members) may notice the individual's memory is not as good as it used to be, maybe items are misplaced or they can't recall the names of people they recently met. MCI doesn't automatically mean that an individual will get dementia, although many do within about three or more years. What is important is to get a evaluated by your healthcare provider to better understand why these changes are happening to you and your loved one.
Before you go to your doctor sit down with your loved one and write out a list of your concerns about memory. For some suggestions, please see the "Dear Doctor" letters available to start the conversation.
Parkinson’s (PD) is a progressive disease that affects movement, coordination,causing shuffling gait, rigidity and tremors. This is occurs as the result of a loss of dopamine producing brain cells. Falling can often be an issue as the disease progresses. Although not all PD patients experience dementia, it is not uncommon for individuals with advanced disease to demonstrate behavioral changes as well as symptoms of dementia. Depression is a common occurrence in PD. At present, there is no cure for PD, however medication can help manage symptoms.
A stroke is a neurologic condition. It occurs when either a blood vessel bursts in the brain, or the blood supply to the brain is suddenly interrupted. Brain cells may die when there is no oxygen being supplied, or if there is bleeding into or around the brain.
From the National Institute of Neurological Disorders and Stroke:
“The symptoms of a stroke include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble with walking, dizziness, or loss of balance or coordination; or sudden severe headache with no known cause. There are two forms of stroke: ischemic - blockage of a blood vessel supplying the brain, and hemorrhagic - bleeding into or around the brain.”
Not all patients who have had a stroke experience a dementia. A stroke occurs, and often times an individual, with therapy, returns to previous or near previous level of functioning. However, some individuals experience a severe stroke or several strokes, resulting in Vascular dementia (once called Multi-Infarct dementia). It is generally non-progressive, unless the individual continues to experience additional strokes. Research has determined that individuals often experience a combination of Vascular dementia as well as Alzheimer’s disease (a mixed dementia), in which case the dementia becomes progressive.
This may be a preventable cause of dementia. Talk to your doctor about medication management for such conditions as high blood pressure (hypertension), diabetes and other conditions that may impact your cardiovascular health.
My stroke of insight with Dr. Jill Bolte Taylor
The following video is a TED Talk video (via YouTube) that offers insight into what it is like to have a stroke. We urge to watch the entire video. Dr. Bolton offers personal insight into the experience of having a stroke.