Understanding the Different Types of Dementia Or 'Neurocogntive Disorder'
Eugene - Springfield, Oregon

The conversation about Alzheimer’s needs to start with the understanding of the terminology that is used by professionals.  These terms will help in your communications with doctors to be your own or a loved one’s best advocate.

Dementia

Dementia is an umbrella name for many conditions involving memory loss. The newest term used by professionals is Neurocognitive Disorder (NCD).

It is important to understand the differences between each type of Dementia as, in addition to the memory loss, they are different in their causes, symptoms and prognosis. As a result, each will respond to disease-modifying agents, pharmacological intervention and behavior approach differently. In spite of the differences, one can have multiple types of Dementia.

When a person shows early signs of memory loss prior to the full signs of Dementia, he or she may be diagnosed with Mild Cognitive Impairment (MCI), which may or may not progress to a diagnosis of Dementia.

How is Dementia diagnosed?

Regardless of the type of Dementia one may have, in order to diagnose Dementia, one must show significant cognitive decline in two or more neurocognitive domains with associated functional decline in the following:

Attention (able to maintain focus on tasks), language (word finding), executive function (follow daily schedule and instruction sequences) learning and memory, social cognition (appropriate social interaction), perceptual- motor coordination (fine motor skills).

What needs to be ruled out?

There are several conditions that can affect memory or increase confusion and need to be ruled out as part of the process of diagnosing Dementia:

• Constipation
• decreased level of oxygen in the blood
• poor nutrition
• low fluid intake
• urinary retention
• bladder infection
• sleep deprivation
• infection
• medications (opioids)
• depression
• anxiety
• stress

Alzheimer’s Disease (AD)

One of the hallmarks of Alzheimer's disease is the accumulation of amyloid plaques between nerve cells (neurons) in the brain.

Amyloid is a general term for protein fragments that the body normally produces. Beta amyloid is a fragment of a protein snipped from another protein called amyloid precursor protein (APP). In a healthy brain, these protein fragments would break down and be eliminated. In Alzheimer's disease, the fragments accumulate to form hard, insoluble plaques.

Neurofibrillary tangles are insoluble twisted fibers found inside the brain's nerve cells. They primarily consist of a protein called tau.

Typical symptoms of Alzhiemer's include:

• 60% of all people with Dementia have Alzheimer’s Disease.
• Very active and busy: move around and burn a lot of energy.
• Poor short-term memory: will ask again and again the same question, forgot they already ate.
• Visually triggered: they see a door, they’ll walk through it.
• Early loss of verbal skills, attention and concentration: word finding, don’t stay on task.
• Social awkwardness and personality change.
• In late stage: incontinent and loss of mobility

Vascular Dementia

Vascular Dementia is associated with stroke (not every stroke causes Dementia), mini strokes or heart disease. Vascular dementia can also result from other conditions that damage blood vessels and reduce circulation, depriving the brain of vital oxygen and nutrients.

Typical symptoms of Vascular Dimentia include:

• Decreased mobility: becoming a ‘couch potato’, obesity,
• Depressed and less engaged
• Poor executive function
• Memory is easily prompts: when reminded memories can easily retrieved
• In early stage loss of ability of personal care: incontinent, dressing, shower.
• Maintain verbal skills through late stage: ability to converse intact.

Lewy Body Dementia (LBD)

This Dementia is associated with Parkinson’s and is associated with abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, affect chemicals in the brain whose changes, in turn, can lead to problems with thinking, movement, behavior, and mood.

Typical symptomsof Lewy Body Dimentia include:

• Problem with balance, gait coordination with memory loss: looks lie Parkinson’s disease
• Competencies fluctuate: have good days and bad days
• Scary hallucinations and delusions: 70-80% will suffer.
• REM sleep disorder

Frontotemporal Lobe Dementia (FTD)

Caused by degeneration of the frontal and/ or temporal lobe of the brain (Pick’s disease). It is more common to occur between the age of 45-64

Typical symptoms of Frontotemporal Lobe Dimensia include:

• Disinhibition, compulsive, perseveration: may be sexually inappropriate, aggressive, say what comes to mind (may be insulting, rude or mean).
• Loss of empathy and personality change
• Difficulty changing tracks
• Socially awkward

Substance/Medication Induced Dementia

Dementia as results of prolong use of abusive substance such as of alcohol (such as Korsakoff Syndrome) or drugs.

If there is no underlying other type of Dementia, it can be reversable with treatment in the early and moderate stages.