Differentiating Different Types of Dementia


The most common form of dementia is Alzheimer ’s Disease, (AD), a progressive illness that often begins with mild memory problems and progresses to the point where a person is dependent on others for care. Although the specific causes of AD have not been identified, scientists suspect that genetic, medical, and lifestyle risk factors may ultimately contribute to the development of AD. Some of these factors may be a genetic predisposition, poor cardiovascular health, and/or a head injury. AD causes significant structural changes in the brain including amyloid plaques (a type of protein) and neurofibrillary tangles that are markers of this disease. These build up around the nerve cells in the brain and cause cells to become unable to communicate, which ultimately results in cell death.

The second most common type of dementia is Vascular Dementia.  Vascular Dementia is a condition caused by a reduction in blood flow to the brain, and its symptoms can differ depending on where the blood flow was disrupted. When blood flow is blocked or reduced, it causes the brain to be starved of vital materials such as oxygen and nutrients, and ultimately causes cells to die. The cell death is what results in difficulties in thinking and functioning. Like all forms of dementia, these difficulties can appear very different from person to person. Some may have mild trouble remembering things; others may have severe memory impairments.  Others may not have overt memory lapses, but may be easily confused or disoriented.

Another common type of dementia that results from the buildup of proteins in the brain is Dementia with Lewy Bodies (DLB). This form of dementia also results in a progressive decline in thinking skills but has some additional characteristics. First, there are notable changes overall alertness and attention. For example a person with Lewy Body Dementia may frequently appear drowsy or lethargic, seem as if they are often “lost in thought,” or have disorganized speech patterns. Secondly, persons with Lewy Body Dementia often experiences visual illusions of hallucinations. These hallucinations along with the other symptoms can cause significant emotional turmoil. The final characteristic associated with a diagnosis of Lewy Body Dementia relates to motor functioning. A person with DLB will often develop motor rigidity and the loss of spontaneous movement. These symptoms are caused by a buildup of Lewy Bodies (called alpha-synuclein proteins). Lewy Bodies accumulate inside the nuclei of neurons that mediate both memory and motor control.

Differentiating between these three common types of dementia can be challenging. Further complicating the diagnostic picture is the fact that some individuals can have multiple forms of dementia at the same time. Because a neuropsychological evaluation includes the full assessment of mental status, attention, language, visuospatial, memory, and executive functioning skills this approach can determine whether there are hallmark symptoms of Alzheimer’s Disease vs. Lewy Body Dementia vs. Vascular Dementia. Simply doing brain imaging cannot provide all of this information. To learn more about neuropsychological testing on the context of dementia, please contact Dr. Brietzke at Brainpsych@gmail.com

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