Types Of Dementia And How To Recognize Their Symptoms According To Experts
For most people, Alzheimers disease is the first condition they think of when they hear the word dementiaand for understandable reasons. The degenerative brain disease is the most common type of dementia, an umbrella term for loss of memory, language, and other thinking abilities that become severe enough to interfere with a persons daily life. However, Alzheimers is far from the only one.
There are literally hundreds of different conditions that can cause memory loss, confusion, personality changes, and problems with walking, speaking, and comprehension, says Douglas Scharre, M.D., director of the division of cognitive neurology at Ohio State Wexner Medical Center. Dementia means that the brain isnt working wellthere are treatable types, reversible types, and types we have limited options for, he says.
Finding out exactly which type of dementia you or your loved one has may be scary, but its important to identify the condition as early as possible, says Rebecca Edelmayer, Ph.D., senior director of scientific engagement for the Alzheimers Association. Early detection and an accurate diagnosis can help a person make lifestyle changes to possibly slow the rate of decline, make critical decisions about their healthcare, and even open the opportunity of participating in clinical trials for new treatments.
Ahead, experts break down eight different types of dementia and the symptoms theyre associated with.
What Is Mixed Dementia
It is common for people with dementia to have more than one form of dementia. For example, many people with dementia have both Alzheimer’s disease and vascular dementia.
Researchers who have conducted autopsy studies have looked at the brains of people who had dementia, and have suggested that most people age 80 and older probably have mixed dementia caused by a combination of brain changes related to Alzheimer’s disease,vascular disease-related processes, or another condition that involves the loss of nerve cell function or structure and nerve cell death .
Scientists are investigating how the underlying disease processes in mixed dementia start and influence each other. Further knowledge gains in this area will help researchers better understand these conditions and develop more personalized prevention and treatment strategies.
Other conditions that cause dementia-like symptoms can be halted or even reversed with treatment. For example, normal pressure hydrocephalus, an abnormal buildup of cerebrospinal fluid in the brain, often resolves with treatment.
Researchers have also identified many other conditions that can cause dementia or dementia-like symptoms. These conditions include:
S Doctors Take To Diagnose Dementia
Doctors typically go through 5 areas of evaluation to figure out whether or not someone has dementia. The doctor needs to check each area and document what they find.
1. Difficulty with mental functionsThis is usually evaluated with a combination of an office-based cognitive test and finding out about real-world problems by talking with their patient and people close to them.
2. Decline from previous level of abilityThis can be more difficult for a doctor to determine, so they need to talk with people who know the patient well to understand their previous abilities versus what they can do today.
For example, if a former accountant can no longer do basic math, thats a decline from their previous ability.
3. Impairment of daily life functionThis can also be tough for doctors to evaluate on their own.
So, the doctor will ask people close to their patient about what types of help the person is getting in their daily life and what problems family members have noticed.
4. Reversible causes of cognitive impairmentCertain conditions can cause temporary dementia-like symptoms.
Other medical problems that interfere with thinking skills include medication side effects, thyroid problems, electrolyte imbalances, B12 deficiency, substance abuse, and other treatable health conditions.
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What Does A Neurologist Do On Your First Visit
- A mental status exam, which tests your loved ones abilities to recall current events and perform routine activities
- A cranial nerve evaluation, which may include an eye test and an evaluation of their hearing and sense of smell
- A motor system exam to assess muscle tone and strength
- A sensory system exam, which tests their sensory response to things like temperature, pain and pressure
- A deep tendon exam, which measures reflex activity and assesses how tendons move
- A gait and coordination evaluation to test balance and walking abilities
Your loved ones neurologist may also order diagnostic tests, such as a CT scan or MRI, along with blood and urine tests.
Treating Behavioral Symptoms Of Alzheimer’s Disease
People with Alzheimer’s have symptoms that can include anxiety and restlessness.
They may not be able to communicate well. It’s up to caregivers to learn their physical and emotional needs.
Techniques that may help are to:
- Make eye contact.
- Not argue or point out that their memories aren’t correct.
- Maintain a calm setting.
- Use gentle touch instead of verbal communication.
- Stick to a routine.
- Hold their hand while you talk.
- Redirect their attention if need be.
- Be patient and flexible.
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Developing New Ways To Assess Patients
So how difficult is it to diagnose dementia?
One facet is to look for specific proteins, Gauthier explained.
There’s two key proteins that build up with age in the brain, he said. You can have a glimpse of how abnormal they are if you do a spinal tap, you can measure in the spinal fluid.
The other way to see those proteins is with PET scans. This is something that we’re very good at it in Montreal, but it’s very expensive.
But doctors may be able to measure these proteins by looking at just the blood.
Gauthier explained that over the past five years in Montreal, they have been having volunteers with a range of ages, types of dementia and symptoms receive PET scans, spinal taps and blood tests.
And we were able to show conclusively that what you pick in the blood correlates with what you see in the spinal fluid and what you see in the brain, he said. So we just need one more study worldwide to confirm if this is true elsewhere. And then these blood tests that could be used in daily practice.
He said this is still considered experimental right now, but that labs in McGill and also the University of British Columbia are gearing up for this.
I predict there’ll be maybe a two-year where we will measure both blood and spinal fluid, just to be sure we get the equivalent results, he said. And then we can go into a proper use and clinical practice.
There’s other factors at play, Gauthier said.
Why Early Detection Can Be Difficult
Alzheimers disease usually is not diagnosed in the early stages, even in people who visit their primary care doctors with memory complaints.
- People and their families generally underreport the symptoms.
- They may confuse them with normal signs of aging.
- The symptoms may emerge so gradually that the person affected doesnt recognize them.
- The person may be aware of some symptoms but go to great lengths to conceal them.
Recognizing symptoms early is crucial because medication to control symptoms is most effective in the early stages of the disease and early diagnosis allows the individual and his or her family members to plan for the future. If you or a loved one is experiencing any of the following symptoms, contact a physician.
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How To Choose The Best Healthcare Team
Your primary care physician can help you assemble your healthcare team and refer you to specialists for further evaluation and treatment as needed.
There are many primary care doctors who are comfortable with treating dementia, says Graff-Radford, This is especially true if they see a lot of older patients who have been diagnosed with Alzheimers.
The Seven Stages Of Dementia
One of the most difficult things to hear about dementia is that, in most cases, dementia is irreversible and incurable. However, with an early diagnosis and proper care, the progression of some forms of dementia can be managed and slowed down. The cognitive decline that accompanies dementia conditions does not happen all at once – the progression of dementia can be divided into seven distinct, identifiable stages.
Learning about the stages of dementia can help with identifying signs and symptoms early on, as well as assisting sufferers and caretakers in knowing what to expect in further stages. The earlier dementia is diagnosed, the sooner treatment can start.
What Doctors Need To Do To Diagnose Dementia
Now that we reviewed the five key features of dementia, lets talk about how I or another doctor might go about checking for these.
Basically, for each feature, the doctor needs to evaluate, and document what she finds.
1. Difficulty with mental functions. To evaluate this, its best to combine an office-based cognitive test with documentation of real-world problems, as reported by the patient and by knowledgeable observers
For cognitive testing, I generally use the Mini-Cog, or the MOCA. The MOCA provides more information but it takes more time, and many seniors are either unwilling or unable to go through the whole test.
Completing office-based tests is important because its a standardized way to document cognitive abilities. But the results dont tell the doctor much about whats going on in the persons actual life.
So I always ask patients to tell me if theyve noticed any trouble with memory or thinking. I also try to get information from family members about any of the eight behaviors that are common in Alzheimers. Lastly, I make note of whether there seem to be any problems managing activities of daily living and instrumental activities of daily living .
Driving and managing finances require a lot of mental coordination, so as dementia develops, these are often the life tasks that people struggle with first.
Checking for many of these causes of cognitive impairment requires laboratory testing, and sometimes additional evaluation.
A Flood Of People Seeking New Treatments
Gauthier pointed out that the advent of new treatments that are aimed at specific types of dementia will make accurate diagnosis increasingly important as the years go by.
Earlier this year, a new treatment became available in the U.S. for Alzheimers the first of its kind to be approved. Called aducanumab, it is a novel therapy aimed at addressing the underlying cause of Alzheimers disease by targeting amyloid beta plaques in the brain. It was given an accelerated approval for use by the U.S. Food and Drug Association under the understanding that more studies would be completed.
Gauthier said Canada could follow suit within the next two years.
Other drugs that target the specific proteins that serve as biomarkers for dementia are being tested, and Gauthier expects two or three to be approved in Canada within three years.
Gauthier said no country is ready for the coming influx of patients seeking dementia diagnosis in the next few years.
Even the U.S. says, not enough family doctors that are trained to do the diagnosis in mild stages and disclose and manage, he said. There’s not enough specialists, especially neurologists, in any country right now.
He said that with medications beginning to be approved, therell be more demand by people with mild symptoms to get a diagnosis.
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What Are The Benefits Of An Early Alzheimer’s Diagnosis
Early, accurate diagnosis is beneficial for several reasons. Beginning treatment early in the disease process may help preserve daily functioning for some time, even though the underlying Alzheimers process cannot be stopped or reversed.
Having an early diagnosis helps people with Alzheimers and their families:
Mental Cognitive Status Tests
These are usually conducted to evaluate memory, simple problem-solving abilities, and thinking.
The tests can be BRIEF or COMPLEX and intensive depending on what the doctor wants to achieve.
Complex tests are offered by professional neuropsychologists to evaluate judgment, executive function, language, and attention.
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Neurologists: Do Seniors With Alzheimer’s Need One
If you someone you care for has Alzheimers, do you need to get them to a Neurologist?
While most experts agree that anyone with any form of dementia should see a specialist, there are several types to choose from. That can make it confusing as to what course of action to take.
Do Seniors with Alzheimers Need to See a Neurologist?
The short answer to this question is maybe. Here are some important points for consideration to help you make an informed decision.
Consideration#1: Your Best Choice May Not Be Your Family Doctor
Although a preliminary diagnosis may begin with your primary care doctor, theyll most likely refer you to a specialist. Some people express a preference to continue seeing their family doctor because its someone they know and trust. Others may feel disheartened by their diagnosis and question the use of seeing a specialist.
Thats an understandable, but misinformed way of thinking. New research is published every month about findings in Alzheimers treatment. Although scientists havent yet found a cure, they have uncovered much that is helpful for people who have been diagnosed.
Dementia is a rapidly-developing area of study, and its likely that the family doctor wont be as up-to-date with the latest information. This may be especially true in the case of early onset Alzheimers, where symptoms and treatment are less well-known among most regular doctors.
Consideration #2: Not All Dementia Specialists are Trained in Neurology
What Is Dementia Symptoms Types And Diagnosis
Dementia is the loss of cognitive functioning thinking, remembering, and reasoning to such an extent that it interferes with a person’s daily life and activities. Some people with dementia cannot control their emotions, and their personalities may change. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.
Dementia is more common as people grow older but it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia.
There are several different forms of dementia, including Alzheimers disease. A persons symptoms can vary depending on the type.
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Who Can Diagnose Dementia
Visiting a primary care doctor is often the first step for people who are experiencing changes in thinking, movement, or behavior. However, neurologists doctors who specialize in disorders of the brain and nervous system are often consulted to diagnose dementia. Geriatric psychiatrists, neuropsychologists, and geriatricians may also be able to diagnose dementia. Your doctor can help you find a specialist.
If a specialist cannot be found in your community, contact the nearest medical school neurology department for a referral. A medical school hospital also may have a dementia clinic that provides expert evaluation. You can also visit the Alzheimers Disease Research Centers directory to see if there is an NIA-funded center near you. These centers can help with obtaining a diagnosis and medical management of conditions.
Choosing The Right Doctor
Choosing a doctor is a very important decision, one that is best made when you are healthy. Not only do you want a doctor who is competent and well-trained particularly in the types of health issues you have but you also want one who gives you the time necessary to listen to and address your health problems or questions. A doctor who knows you and is familiar with your health concerns is a good starting point however, some experts believe that your long-time family physician is NOT the best person to go to for a diagnosis, because the familiarity he or she has with you or your loved one may affect the doctors medical judgment. If you have a family doctor that you know and trust, you may want to ask him or her for a referral to a doctor who specializes in diagnosing Alzheimers disease. Seek out a physician whose specialty is geriatrics, neurology, or clinical psychiatry, because these types of doctors are generally well-trained in the diagnosis of Alzheimers and other related dementias. Click here to use the Resource Locator tool to find physicians near you.
There are a number of things you can do to help ensure youre seeing the right doctor:
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How Is Alzheimer’s Disease Diagnosed
To diagnose Alzheimers, doctors may:
- Ask the person and a family member or friend questions about overall health, use of prescription and over-the-counter medicines, diet, past medical problems, ability to carry out daily activities, and changes in behavior and personality
- Conduct tests of memory, problem solving, attention, counting, and language
- Carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem
- Perform brain scans, such as computed tomography , magnetic resonance imaging , or positron emission tomography , to rule out other possible causes for symptoms
These tests may be repeated to give doctors information about how the persons memory and other cognitive functions are changing over time. They can also help diagnose other causes of memory problems, such as stroke, tumor, Parkinsons disease, sleep disturbances, side effects of medication, an infection, mild cognitive impairment, or a non-Alzheimers dementia, including vascular dementia. Some of these conditions may be treatable and possibly reversible.
People with memory problems should return to the doctor every 6 to 12 months.