What Are The Different Types Of Dementia?

HOW DIFFERENT TYPES OF DEMENTIA CAN AFFECT YOUR LOVED

We know how worrying and stressful it can be when faced with the reality that a loved one is living with dementia. Watching someone close whose life is impacted by the varying symptoms presented by different types of dementia can be upsetting. Depending on the type of dementia your loved one is living with, will determine the symptoms, severity and progression of the condition.

Dementia describes different brain disorders that trigger a loss of brain function. These conditions are all usually progressive and worsen over time. Alzheimer’s disease is the most common type of dementia, affecting between 50 -75% of those diagnosed. Other types of dementia include vascular dementia affecting up to 20% of those diagnosed, frontotemporal dementia affecting 2%and dementia with Lewy bodies between 10-15%. Symptoms of dementia include memory loss, confusion and problems with speech and understanding and sadly it is a terminal condition.

Here we explain the types of dementia and the most common type of dementia. We explore the symptoms of each, the risk of developing this type of dementia and how they are diagnosed and treated. We aim to provide you with all the information you need to better support your loved one and manage their symptoms.

Dementia care options

GETTING A DIAGNOSIS TO DETERMINE TYPE OF DEMENTIA

It is important to get a dementia diagnosis as soon as possible, if you feel your loved one is experiencing any of the challenges the condition presents. A dementia diagnosis will determine the type of dementia your loved one is living with. This enables the person and their families to adapt and put in place the right programme of care and support.

There is no single test that can determine whether you have dementia or not. A diagnosis will be based on a range of medical tests and your medical history. If your loved one is exhibiting symptoms of dementia you should contact your GP for an assessment in the first instance. It is worth remembering that not all confusion and memory loss means your loved one has dementia. It is important to rule out other health conditions that may be the cause of the symptoms, including a urinary tract infection (UTI) or thyroid problems. A GP will be able to rule out other physical causes for the problems your loved one might be experiencing.

The GP will wish to ascertain whether your loved one is having any problems with concentration, memory, reasoning and spatial awareness. Depending on the outcome of the GPs assessment, he may refer your loved one to a specialist memory clinic to an assessment team or a dementia specialist to understand if there is some sort of cognitive impairment.

When you attend a memory clinic the specialist will talk to you about your concerns. They will be seeking to better understand your loved one’s experiences. The experts will listen to your concerns so they can build up an accurate picture of what has been happening. Your loved one will then undergo a series of cognitive assessments and brain scans to determine the types of dementia, better understand the dementia timeline for your loved one and what stage of dementia they are at.

Memory Test

Following an initial consultation, it is likely you will then meet with a neuropsychologist with your loved one. They will get a deeper understanding as to your loved one’s current cognitive function and memory. The first stage is to conduct a Neuropsychology Assessment or ‘memory clinic test’ as it is more commonly known.

This assessment will determine how well each part of the brain (known as lobes) are functioning. The test is focused on understanding recall and short-term memory. Both are impacted if someone is living with dementia. If a person struggles to complete the memory test successfully, this may indicate damage to the frontal lobe or temporal lobe in the brain. The frontal lobe covers thinking, planning and problem solving. The temporal lobe is responsible for memory.

The neuropsychologist will initially conduct a general screening of your loved one’s brain. Many neurologists use the Addenbrooke’s Cognitive Examination (third edition). This tests attention, orientation, memory, language, visual perceptual and visuospatial skills. It is useful in the detection of cognitive impairment. It is especially helpful in the detection of Alzheimer’s disease and frontal-temporal dementia. Depending on the outputs of this test, the neuropsychologist will undertake more detailed testing of areas of concern.

MRI Brain Scan

The memory clinic may then organise for an MRI scan of the brain. This will enable them to understand whether there is damage and to what part of the brain. The MRI will give information on the brain’s blood supply. This will determine if any blood vessels are affected which are impacting memory. It will also identify any brain swelling or a tumour.

Consultation

Once the neuropsychologist has the results of the MRI scan, they will discuss with you and your family the diagnosis and outline next steps in terms of treatment and any support you require.

It may be that you are asked to return to the memory clinic in a few months’ time so further tests can be done to see how your condition has progressed.

DIFFERENT TYPES OF DEMENTIA

ALZHEIMER’S DISEASE

Alzheimer’s disease is the most common type of dementia, although it comparatively rare for a person under 65 to be diagnosed with Alzheimer’s. Whilst the exact cause is unknown, we know that plagues and tangles form in the brain due to two proteins presenting – amyloid (plaques) and tau (tangles).
People diagnosed with Alzheimer’s may also have a reduction of a chemical in the brain called acetylcholine. This functions as a chemical messenger to take information to and from brain cells (neurons), so a reduction in this chemical leads to information not being transmitted effectively.

Alzheimer’s symptoms

Research suggests that changes in the brain can occur up to ten years before a person starts to experience the symptoms of Alzheimer’s disease. The symptoms are typically mild at the beginning and gradually worsening over time. Symptoms of Alzheimer’s disease include:

  • Difficulty remembering recent events while having a good memory for past events
  • Poor concentration
  • Difficulty recognising people or objects
  • Poor organisation skills
  • Confusion
  • Disorientation
  • Slow, muddled or repetitive speech
  • Withdrawal from family and friends
  • Problems with decision making, problem solving, planning and sequencing tasks

Risk factors for developing Alzheimer’s disease

The two main risk factors for developing Alzheimer’s disease are lifestyle and genetics.

By leading a healthy lifestyle, you will be reducing the risk. This includes being active and exercising, eating a healthy and balanced diet, not smoking, maintaining a good weight and controlling alcohol intake and blood pressure.

There is also a greater risk of a person developing Alzheimer’s disease if a parent or grandparent developed the condition over the age of 65. Where people develop the disease before the age of 65 it can run in families and can be caused by faulty genes. In these cases, many members of the same side of a family are affected, however this type of dementia which is inherited is very rare.

Treatments for Alzheimer’s disease

Whilst there is no cure for Alzheimer’s disease, there are some medications and treatments that help improve some of the symptoms the most common type of dementia:

Acetylcholinesterase (AChE) inhibitors
Gene therapies

These are used to help nerve cells communicate with each other and are only prescribed by specialists, including psychiatrists or neurologist. The main AChe inhibitors are Donepezil, galantamine and rivastigmine for early-stage Alzheimer’s disease and mid-stage. Whilst there is little difference in each inhibitors’ effectiveness, each can cause different side affects including loss of appetite, vomiting and nausea. Side effects generally get better within two weeks of starting the medication.

Memantine

This medication works by blocking the effects of the chemical glutamate. It can be used for those living with moderate to severe Alzheimer’s disease. For those who cannot tolerate inhibitors, this is a suitable alternative. It can also be taken with inhibitors for those with severe Alzheimer’s disease. Memantine does however cause side effects, including headaches, constipation and dizziness. These side effects are generally short lived.

Alternative treatments and therapies

There are other treatments and activities that are helpful to those living with dementia. These can be activities and treatments you can do with your loved one or they can do with their live-in carer.

Cognitive rehabilitation – working with a trained professional and a family member or friend, it is an approach based on setting and achieving personal goals. For example, completing an everyday task, like loading the washing machine, or making a bed. The focus of cognitive rehabilitation is getting the parts of your brain working that are not.

Reminiscence and life history therapy – this involves talking about events and times from your past. Reminiscence and life story work brings together objects from childhood to present day that have positive memories for someone living with Alzheimer’s disease. Examples include photos and keepsakes, and music therapy is a very powerful reminiscence tool. There is strong evidence that this type of therapy boosts mood, builds self-esteem and improves well-being.

Cognitive stimulation therapy – these are activities and exercises designed to improve problem-solving and memory.

VASCULAR DEMENTIA

Vascular dementia is the second most common types of dementia, affecting around 150,000 people in the UK, around 17% of cases. It is caused by diseased or damaged blood vessels that cause a reduction in blood flow to the brain. This ultimately causes the death of brain cells causing dementia symptoms. Symptoms vary depending on the part of the brain affected. This type of dementia can be caused by a stroke, depending on the severity of the stroke and the part of the brain affected by it.

Vascular dementia symptoms

The most common symptoms of vascular dementia are:

  • Slowness in thinking and thought
  • Concentration problems
  • Changes to mood, behaviour or personality
  • Frequent disorientation and confusion
  • Problems with planning and understanding

Risk factors for developing vascular dementia

Factors that increase a person’s risk of vascular dementia include anything that can cause damage to the blood vessels in the brain. This includes factors like smoking, high blood pressure (also known as hypertension), high cholesterol, type 2 diabetes, obesity and heart problems.

As we age it is therefore important to ensure we regularly exercise and have a healthy diet to reduce the risk of developing vascular dementia. It is also advisable not to smoke.

In rare cases vascular dementia is caused by an inherited genetic disorder. One such disorder is called CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy). Those living with this disorder typically have a family history of vascular problems, for example strokes.

Diagnosis and treatments for vascular dementia

CTI and MRI scans are used to determine what type of dementia a person has and whether it is vascular dementia. They allow for doctors to identify changes in blood vessels that are common with vascular dementia. Scans also allow you to rule out other conditions that may be causing similar symptoms, for example stroke.

There are currently no specific treatments for vascular dementia. Inhibitors and memantine used to treat Alzheimer’s disease are not effective for those living with vascular dementia. A GP will recommend controlling underlying conditions, such as high blood pressure and cholesterol. Regular exercise and a healthy diet will help to reduce the risks.

DEMENTIA WITH LEWY BODIES (DLB)

DLB is the third most common type of dementia with approximately 100,000 people in the UK living with it. DLB can also develop with other types of dementia such as Alzheimer’s disease. This is referred to as ‘mixed dementia’ (see below). The cause of DLB is small round lumps of protein that build up inside the nerve cells inside the brain. The proteins are called alpha synuclein and the clumps the protein forms are referred to as Lewy bodies. These Lewy bodies damage the nerve cells the way they communicate. It impacts the parts of the grain that control movement, memory and thinking.

SYMPTOMS OF DLB:

  • Increasing problems with alertness and attention
  • Unpredictable confusion
  • Movement problems like Parkinson’s symptoms, for example tremors and shaking
  • Disturbed sleep
  • Hallucinations – seeing things that are not there
  • Problems with sense of smell

RISK FACTORS FOR DEVELOPING DLB

Age is the predominant risk with DLB. Other ways to limit the risk is to manage other lifestyle factors like blood pressure and cholesterol. Whilst there are studies on-going about the genetic factors that present a risk, nothing has concluded that you have an increased risk of this type of dementia with these genes.

DIAGNOSIS AND TREATMENTS FOR DLB

As with other common types of dementia, CTI and MRI scans are used to determine whether a person has DLB or not. There is a type of scan called a SPECT scan which is also used to diagnose DLB. It will identify changes in the brain that are more common with DLB. As symptoms of DLB are specific and obvious it may not be necessary to have this scan.

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MIXED DEMENTIA

The fourth most common type of dementia is mixed dementia. This is when two types of dementia present in a person. The most common combination is Alzheimer’s disease and vascular dementia and is more prevalent in those over the age of 75 years old. People who are living with mixed dementia may not be diagnosed properly. Specialists may believe the person has one of the types of dementia – Alzheimer’s or vascular dementia. Unfortunately, an inaccurate diagnosis can mean a person is missing out on treatments that could help the unrecognised disease.

Symptoms of mixed dementia

Symptoms of mixed dementia are common with those experienced by those living with Alzheimer’s disease or vascular dementia. Symptoms depend on what part of the brain is affected. Living with two types of dementia or mixed dementia can mean symptoms are very prominent, and in some progress more quickly.

Diagnosis and treatments for mixed dementia

The same process for diagnosing Alzheimer’s and vascular dementia is used to diagnose mixed dementia. As with these two types of dementia, the treatments are the same. With mixed dementia you can benefit from using inhibitors and memantine for controlling symptoms of Alzheimer’s disease. Other lifestyle changes like a healthy diet and manging cholesterol and blood pressure are important to help with symptoms of vascular dementia.

USEFUL DEMENTIA RESOURCES

To support you and your family we have created a useful dementia care guide, which provides you with information and advice on how to provide person-centred dementia care following a diagnosis of dementia. There is also a number of dementia charities across the UK who provide families with help, advice and support when they need it most, including Dementia UK and the Alzheimer’s Society.

TALK TO US ABOUT DEMENTIA ADVICE AND YOUR CARE NEEDS

Our friendly and experienced team is here to help you and your family make sense of the options available to you. Call us today we will help you every step of the way.


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