Many people know someone who has dementia. What was previously a lively interacting personality may now be a flat-face “shell” of a person, with little resemblance to their former personality. This month, we’ll examine dementia’s symptoms, types and testing.
SYMPTOMS OF DEMENTIA
Dementia is the general term for a group of brain disorders that cause memory problems and make it difficult to think clearly. The symptoms of dementia often start off very mild and gradually worsen. Symptoms can include:
- Forgetfulness and confusion
- Difficulty speaking, concentrating and reasoning
- Difficulty with tasks such as managing finances
- Getting lost in familiar places
- Anger or aggression
- Hallucinations (seeing or hearing things that are not present)
- Impairment of activities of daily living (ADLs), such as eating, bathing, dressing
- Loss of bladder or bowel control
TYPES OF DEMENTIA
There are several forms of dementia, including:
- Alzheimer’s disease – Alzheimer’s disease is the most common cause of dementia. It is a disorder in which brain cells slowly die over time. There are multiple proposed causes, including genetics and environmental exposures, but there is much more to be learned about this condition. Alzheimer’s is the sixth-leading cause of death in the U.S. One in three seniors die with Alzheimer’s or another form of dementia. Almost two-thirds of Americans with Alzheimer’s are women.
- Vascular dementia – Vascular dementia happens when parts of the brain don’t get enough blood, often occurring when blood vessels in the brain get clogged with blood clots or fatty deposits. This form of dementia is most common among people who have had strokes or who are at risk for strokes. Smokers are also at high risk for vascular dementia.
- Parkinson’s disease dementia – Parkinson’s disease is a brain disorder that affects movement. It causes trembling, stiffness and slowness. As it gets worse, it also can cause dementia.
- Lewy body dementia – This is caused by abnormal protein structures called Lewy bodies forming within brain cells. It occurs with symptoms of Parkinson’s disease, such as trembling, stiffness and slowness. This disorder often causes vivid and long-lasting hallucinations. Dementia with Lewy bodies can also cause people to act out their dreams. This can be frightening to bed partners and sometimes causes injuries. It is important to report this symptom to a health care provider because it is treatable with medication.
- Frontotemporal dementia (formerly called Pick’s disease) – Like Alzheimer’s disease, frontotemporal dementia causes nerve cell loss in the brain, but it targets two specific parts of the brain, called the frontal and temporal lobes. This form of dementia usually arises at an earlier age than Alzheimer’s disease.
- Mixed dementia – Among persons at more advanced age (especially 85 and greater), there can be more than one cause of dementia, often both Alzheimer’s disease and vascular damage.
- Other causes of dementia – Dementia also can be caused by cumulative damage to the brain, which can occur in people with chronic alcoholism, a traumatic brain injury or repeated head injuries.
TESTING FOR DEMENTIA
Primary care providers will perform a medical history and physical exam. Memory tests in clinic will be performed, such as the clock-drawing test, mini-mental status exam, or others can be performed to test memory and level of functioning.
Labs may be ordered, to rule out a vitamin deficiency (B12), an infection (bladder infection or even undiagnosed syphilis, for example), a thyroid problem or other cause of memory loss.
Brain imaging with magnetic resonance imaging (MRI) or computed tomography (CT) scan may be indicated to further evaluate causes for dementia. These are not always necessary.
Stay tuned: Next month’s House Call will cover care, treatment, prevention and resources available to dementia sufferers and their loved ones.
Todd is a board-certified family physician at Moscow Medical at 213 N. Main St. She was an Army physician for 13 years and with Providence for three years and moved to the Palouse in the summer of 2016. She can be reached at (208) 882-7565.