Less than thirty years ago, people were attributing dementia-related symptoms as senility or old age. Researchers are now better at understanding the brain, how it works and what impacts its functionality. Advancements in technology and in-depth research has given the medical field a way to better identify brain disorders including the types of dementia and dementia-like diseases.
There are various types of dementia including the most common Alzheimer’s, Vascular, Lewy bodies and frontotemporal. Mixed dementia is often diagnosed when multiple dementia symptoms appear without a clearly defined set of symptoms. Other diseases such as Parkinson’s, Huntington’s, Creutzfeldt-Jakob disease and Human Immunodeficiency Virus (HIV) exhibit symptoms that may point to dementia. Post-traumatic stress disorder (PTSD) and traumatic brain injuries (TBI) also can also exhibit similar symptoms making the diagnosis of dementia more difficult.
Some diseases and medical conditions can have dementia-like symptoms, but those diseases can often be treatable or reversible. Infections, like urinary infections, sleep disorders and hormonal diseases can mimic dementia. Depression, negative reactions to medications and delirium can also be misdiagnosed or dismissed as signs of aging.
Alzheimer’s is the most common type of dementia, and the term is often used to identify any dementia. In a brain with Alzheimer’s, abnormal clusters of protein fragments, called plaques, build up between nerve cells causing the nerve cells to die. Twisted strands of another protein found in the brain also build up to form knots or tangles in and around the dead and dying nerve cells. Plaques and tangles represent damage both inside and outside of brain cells.
A brain with Alzheimer’s has fewer nerve cells as a result of the damage caused by the plaques and tangles. Synapses and the nerve cells die, thereby causing some of the obvious changes in the person living with dementia and eventually leaving a person with little or no cognitive functions. The average life expectancy of those with Alzheimer’s is from three to 10 years, however, some may live up to 20 years, depending upon age, health and level of care.
Vascular dementia, the second most commonly diagnosed dementia, is caused by the degeneration of the vascular system within the brain usually the result of a stroke or excessive cerebrovascular disease. Symptoms can be varied, depending upon the affected area of the brain. Mental slowness and recall, difficulty with language, walking and uncontrolled urination may all be signs of vascular dementia. In addition, diseased blood vessels in the brain become ineffective in getting blood to brain cells and deprive affected brain cells from getting necessary oxygen and nutrients. Often a person with diminished blood flow to the brain has a problem retrieving information that has been stored in the brain and exhibits specific symptoms that can aid in diagnosing Vascular Dementia. Life expectancy is usually around 5 years due mostly to the higher risk of death from stroke or heart attack.
Lewy Body dementia (LBD), the third most diagnosed dementia, is caused when abnormal proteins form inside the nerve cell rather than outside or around the nerve cell. Lewy Body dementia is an umbrella term for two related clinical diagnoses. The first diagnosis is Dementia with Lewy bodies and the second is Parkinson’s disease dementia. Both Lewy body dementias share the same underlying changes in the brain, but symptoms appear at different stages of the disease, depending upon where in the brain the Lewy bodies first form. Eventually the symptoms of Dementia with Lewy bodies and Parkinson’s disease dementia are similar and indistinguishable between the two diagnoses.
Dementia with Lewy bodies symptoms first show as dementia with impairments in cognitive functionality, planning and problem-solving abilities, and visual recognition that are severe enough to impact the performance of daily activities. Eventually motor skills deteriorate impacting walking gait, trembling or shaking unsupported hands, arms or legs. These symptoms often mimic other dementias, however, combined with deterioration to plan and solve problems, cognitive impairments and finally muscle weakness and rigidity are more commonly presented in Dementia with Lewy bodies.
Other symptoms include a change in the walking gait thus “shuffling”, hallucinations, disturbances in REM sleep, slowness, shortened attention-span and mood swings. Progression with dementia with Lewy bodies vary from day to day, however dementia symptoms present slowly and worsen gradually. Life expectancy averages between five to eight years, however, the first few years may go undiagnosed because of the gradually decline of those area affected by Lewy Bodies.
Parkinson’s disease dementia symptoms start with a deteriorated muscle control and tremors, and within a year or so after a Parkinson’s diagnosis, the dementia symptoms begin to present. Parkinson’s disease is caused by a drop in the production of dopamine-nerve cells. Motor symptoms and mild cognitive impairment are often the early symptoms of Parkinson’s disease and may develop into Parkinson’s disease dementia later. Average life expectancy once Parkinson’s disease dementia is diagnosed is five to eight years.
Frontotemporal Degeneration dementia (FTD) is less common than other forms of dementia. Frontotemporal Degeneration dementia affects the temporal lobes and is associated with language, personality, and behavior. It is often diagnosed between the ages of 45 and 60.
Those with frontotemporal dementia may have dramatic changes in personality and become socially inappropriate, emotionally indifferent, and lose the ability to use language properly or lose their second language. Often FTD is confused with other types of neurological disorders because obvious changes to speech, personality and behavior. It can be misinterpreted as a psychiatric problem or early Alzheimer’s onset. Life expectancy for Frontotemporal degeneration ranges from three to ten years after diagnosis.
Mixed dementia is diagnosed when symptoms appear to be a combination of different forms of dementia. For example, a person may have difficulty finding a word or recognize an item even with prompting (Alzheimer’s disease), problems with gait and walking (Lewy body dementia) and non-related symptoms depending upon the location of brain deterioration (Vascular dementia). Other symptoms can include difficulty finding a specific word, confusion as to the day or time, learning new information and memory loss. Mixed dementia is usually caused by a combination of the major dementias. Further testing, either through imaging or autopsy after death, may conclusively diagnose mixed dementia. As the disease progresses, brain functionality decreases significantly impacting daily life and cognitive awareness. Life expectancy is often shorter than for any of the other dementias because of the interaction of each of the dementias within the brain.
Post-traumatic Stress syndrome (PTSD) is not a true dementia, however many of the symptoms are similar to dementia and often confuse diagnosis, especially in the elderly. PTSD is often caused by being exposed to a traumatic event, either witnessing or learning about severely traumatic event.
In addition, the brain structure and high levels of stress hormones in the body may also be a factor in developing PTSD. Research found those with PTSD have smaller hippocampus than those without PTSD. However, it is unclear if those individuals already had a small hippocampus prior to developing PTSD. Researchers do believe that a malfunctioning hippocampus could stop the brain from processing trauma properly and thereby leading to PTSD.
There are many symptoms that define PTSD, but the ones that mimic dementia are interrupted sleep, vivid dreams or hallucinations, trouble concentrating and reduced awareness, and emotional distancing.
Wernicke-Korsakoff syndrome (Wernicke encephalopathy and Korsakoff syndrome) is not a true dementia but is included in the category of diseases that damage the brain. Wernicke-Korsakoff syndrome happens when a severe lack of thiamine (vitamin B1) damages the brain. Usually Wernicke-encephalopathy is characterized by changes in vision and eye function, confusion, leg or muscle tremors, and a decrease in mental function. It is often associated with alcohol abuse and requires immediate hospital treatment. Often Wernicke encephalophagy can be reversed if treated quickly.
Korsakoff syndrome consists of impaired memory, confabulation (making up stories) and hallucinations, and is often a chronic condition. -Because ongoing symptoms of Korsakoff syndrome are most times associated with Wernicke encephalopathy, there may not be a full recovery from Wernicke-Korsakoff syndrome. Life expectancy from this syndrome varies by person and alcohol consumption.
Creutzfeldt-Jakob disease is not a true dementia, but it impacts the brain initially with symptoms of a marked decrease in cognitive functions. The disease is caused by abnormal prions within the body that eventually enter the brain, causing voids in the brain. It is often called “Mad cow disease” because of the similarity between the two diseases in the cause and symptoms, although not related to mad cow disease.
Infection can be from contamination (unclean instruments used in surgery or eating raw or under-cooked contaminated meat), or from heredity or age when normal prions become abnormal. Cognitive functions are impacted first usually in the form of personality changes, memory loss, impaired thinking, vision problems, sudden muscle spasms, inability to speak or eat, poor or lack of coordination, hallucinations, and insomnia. The brain eventually becomes unable to function effectively to sustain life and death is often within a year of diagnosis. Currently, there is no known cure for Creutzfeldt-Jakob disease.
Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome dementia (HIV/AIDS dementia) is not a true dementia, however, the deterioration of the brain caused by the impact of HIV or AIDS can cause symptoms similar to dementia. Those with HIV-related dementia often have difficulty concentrating, shortened attention span and compromised memory retention. Initially, personality and behavior may be impacted, and as the disease progresses, physical abilities may also decline including difficulty with walking and eye-hand coordination. Life expectancy is determined by the body’s response to HIV treatments (HAART).
Fatal Familial Insomnia (FFI) is a rare hereditary condition and not a true dementia. FFI exhibits many of the dementia symptoms like insomnia, vivid dreams and hallucinations. Occasionally anorexia is also a symptom. Walking and ability to move the body decreases as well as memory, attention, and concentration. Finally, as speech functionality is impacted and a person with fatal familial insomnia becomes unable to talk. Life expectancy is usually 12 to 18 months, however, some live only for a few months or even a few years after diagnosis.
Chronic Traumatic Encephalopathy/Traumatic Brain Injury (TBI) is not a true dementia, but includes loss of consciousness, personality and behavior changes, slow, slurred speech, and memory loss. Usually damage to the brain caused by a blow the head, commonly called a concussion, is often temporary and symptoms disappear as the brain heals. Chronic traumatic encephalopathy is caused by repeated blows to the head and usually not reversible. Later symptoms include aggression, poor decision-making ability, lack of motor coordination, and slurred speech or poor communication skills. Life expectancy depends upon the severity of the trauma.Normal Pressure Hydrocephalus (NPH) is not a true dementia but presents similar symptoms as dementia. It is commonly classified as the triad of symptoms: cognitive decline, difficulty walking and urinary incontinence. NPH can sometimes be reversed with prompt diagnosis and treatment. This disease is usually not fatal and as treatment continues, symptoms disappear is the order of improved walking, continence and finally cognitive functionality.