Dementia Care

Alzheimer's Disease

The most commonly feared form of dementia is Alzheimer’s disease. It is a progressive brain disorder that has no cure. Eventually those diagnosed with the disease will lose memory and thinking skills and will be unable to perform basic activities of daily living. 5.5 million Americans are considered to have some form of Alzheimer’s, most of them are 65 or older. Generally, symptoms appear in a person’s mid-60s.

The disease was discovered in 1906 by Dr. Alois Alzheimer when he examined a brain and found amyloid plaque clumps and tangled brain fibers called neurofibrillary tangles. The brain also loses the connections between neurons, which is transmit information from the brain to muscles and organs. This explains the motor and cognitive impairment suffered by Alzheimer’s sufferers.

Alzheimer’s is broken into three stages, each with its own symptoms:

Mild (usually lasts 2-4 years)

• Mood swings and depression
• Problems with explaining themselves clearly
• Less energy
• Low interest in social activities
• Recent memory recall issues
• Issues with previously completable tasks
• Getting lost while driving
• Coordination problems

Moderate (can last 2-10 years, people are aware of their loss of ability)

• Delusions
• Selecting inappropriate clothing
• Problem solving issues
• Inability to plan
• Speech that rambles
• Mixes up words and often uses incorrect words
• Confused about time or place
• Wandering
• Quick to anger

Severe (often lasts 1-3 years)

• Total confusion about time relationships
• Weight loss
• Mobility issues
• Inability to express themselves
• Cannot process information
• Seizures, skin infections, and illnesses become common
• Well-formed hallucinations
• Eating and toileting functions diminished

Lewy Body Dementia

This disease is named after its discoverer Frederich H. Lewy. He was working on Alzheimer’s disease in the early 1900s when he discovered a brain abnormality linked to the Alpha-synuclein protein. This form of dementia is considered the third most common and is often involved in 5 out of 10 cases of dementia. Lewy bodies are not only limited to this form of the disease, but are found in both Alzheimer’s and Parkinson’s patients.

Symptoms of Lewy Body dementia can include:

• Imbalance of gait, slowness, and feature typical to Parkinson’s disease
• Altered thinking and/or reasoning
• Confusion that differs from day-to-day
• Hallucinations and delusions
• Issues sleeping
• Memory loss
• Nervous system malfunctions
• Visual information interpretation issues More information about Lewy Body Dementia is available.

Parkinson's Disease Dementia

Often starting gradually with barely noticeable tremors in the hand, Parkinson’s disease is a progressive disorder that disrupts mobility. Beyond tremors, those with the disorder often have stiffness or slower movement. There are medications that help improve symptoms of Parkinson’s, but there is no cure. The disease causes neurons to die or break apart and often affect a dopamine imbalance and increase. This leads to the abnormal brain activity associated with Parkinson’s.

Identified by Dr. James Parkinson in 1817, the disorder has five stages those diagnosed travel though. The progression across stages has no concrete timeline. Sometimes there are years between stages, other times it can be measured in months. Stage 1 is the leads debilitating; activities of daily living are not affected and rarely does the disease interfere with normal living. Generally, there are tremors on one side of the body during this stage. Stage 2 sees an increase in previous symptoms and they become noticeable. Mobility issues become more prominent and speech can sometimes be an issue. Tasks take longer to complete, but the person with Parkinson’s can generally live on their own.

When Stage 3 begins, the disease interferes in prominent ways. Falls become common as the disorder affects movement more and activities of daily living are greatly inhibited. Stage 4 is marked by the loss of independence. Many people will need to begin using assistive devices, like a walker. Because of decreased reaction times and movement impediments, living alone becomes nearly impossible and dangerous. The final stage is can find someone suffering from the disease with a total lack of mobility; leg and joints are often frozen. In the latter stages, symptoms common to dementia often set in.

The major symptoms of Parkinson’s disease depend on the stage, but generally include:

• Tremors
• Slower movement
• Muscle rigidity
• Slurring or impaired speech function
• Minor motor function problems (like writing)
• Automatic movement issues (blinking, natural arm movement, facial expression)
• Balance and posture problems Knowing when it is time for Parkinson’s care is important. Without assistance, a person suffering from the symptoms can be in great danger.

Huntington's Disease

Huntington’s Disease is inherited and is a progressive, degenerative disease that affects the nerve cells in the brain. It was named after Dr. George Huntington, who wrote about it in 1872. He discovered the inherited gene is defective and therefore causes the affliction to manifest. The brain disorder is caused by a defect on chromosome 4 of a person’s DNA and is a dominant trait (being dominant means that the disease will develop). It has been discovered that a protein in the DNA is responsible for the defect but are unaware of its normal function.

Symptoms for the disease normally appear sometime during mid-life (between 30-50), but can appear in younger and older people. Medication is available to alleviate symptoms, but decline is inevitable. Typical symptoms include:

Movement issues:

• Jerking or other involuntary movements
• Problems with eye movements
• Speech and swallowing difficulty
• Rigid muscles
• Balance, posture, and walking problems

Cognitive issues:

• Unaware of one’s own behavior
• Organizational and task completion issues
• Little impulse control
• A hard time learning
• Slowed verbal processes
• Often getting stuck on a thought

Psychiatric issues:

• Depression
• Irritability
• Sleeplessness
• Low energy
• Withdrawal

Creutzfeldt-Jakob Disease

Often called CJD, this affliction is caused by a prion protein in the brain. An infected prion will cause other proteins that have folded correctly to become misfolded. Most people have no family history of CJD, but 7.5% of cases are inherited. Hans Gerhard Creutzfeldt was one of the first people to describe the disease, and he was closely followed by Alfons Maria Jakob (hence the shared naming).

Many people are aware of CJD because of an outbreak of a variant of the disease that was attributed to people eating tainted beef in the UK in the 1990s. This variant was different than classic CJD (there is not discovered correlation between CJD and beef consumption). This is a rare disease with only one in a million people being diagnosed each year. Eventually, most of those suffering from the disease will fall into a coma and with this, heart or respiratory failure may occur, as well as contracting pneumonia and infections.

Beyond mental degeneration, symptoms include:

• Changes in personality
• Depression and anxiety
• Sudden, uncontrolled movements
• Memory loss
• Insomnia
• Difficulty speaking and swallowing
• Vision issues, including blindness
• Impaired thinking

Wernicke-Korsakoff Syndrome

This rare form of dementia is often caused by extensive alcohol use and is caused by a deficiency of thiamine, also known as vitamin B-1. People who’s bodies do not absorb food correctly can also be diagnosed with this disease. The disorder is caused when the brain becomes damaged in the thalamus and hypothalamus, which ultimately results in permanent damage in memory activities of the brain. The brain receives the damage when thiamine is missing and does not produce energy from sugar, this results in the brains inability to function properly.

Korsakoff syndrome is often paired with Wernicke encephalopathy, but not always. This is the brains reaction to the lack of thiamine and is a life-threatening emergency.

Symptoms of Korsakoff Syndrome include:

• Memory loss after diagnosis
• Memory loss of events prior to diagnosis
• Short-term memory loss
• Memory gaps
• Lack of conversational abilities
• Low insight in conversation
• Severe apathy
• Creating alternate memories for those that are lost

Vascular Dementia

When people face issues with reasoning, planning, judgement, and memory caused by low blood flow to the brain due to damage, they are often diagnosed with vascular dementia. This form of dementia will often, but not always, form after a stroke.

Vascular dementia can also be diagnosed if someone has damaged blood vessels and reduced circulation, which doesn’t allow oxygen and nutrients to flow to the brain. Low or inadequate blood flow to any part of the body will damage and kill cells, but when this occurs to the brain, larger issues develop.

Many medical experts have begun to use the term “vascular cognitive impairment” or VCI to describe the condition since it more accurately reflects the thinking issues that are derived. This is considered the second most common form of dementia after Alzheimer’s.

VCI has many symptoms, but the severity depends on the amount of damage to the brain. They can include:

• Confusion
• Concentration issues
• Lack of organizational thought
• Unstable gait
• Analysis and synthesis of information problems
• Disorientation
• Trouble with speech
• Loss of vision
• Lack of bladder control
• Depression

Frontotemporal Dementia

Not a single condition, but a grouping of disorders, frontotemporal dementia (FTD) is often called “the cruelest disease.” The disorder can alter personality and create behavior and language issues. The disease occurs when the frontal and temporal lobes begin to shrink.

Many people have been misdiagnosed with Alzheimer’s or with a psychiatric issue, but actually have FTD. This form of dementia will often appear in people during their 40s, and was formerly known as “Pick’s Disease.” There are many different forms of FTD that need to be diagnosed for correct symptom relief.

There is a lot of difficulty in defining the symptoms of FTD due to the multiple variants, but generally symptoms are defined by:

Behavior Changes

• Inappropriate actions
• Not or little empathy
• Apathy
• Compulsive behavior
• Lack of hygiene
• Attempting to consume inedible objects

Speech and Language Changes

• Loss of speaking ability
• Inability to use language to communicate

Mobility Changes

• Appearance of tremors
• Weak muscles
• Muscle spasms
• Rigid limbs
• Lack of coordination

Mixed Dementia

When someone experiences two or more forms of dementia, they can be diagnosed with mixed dementia. There are numerous combinations of different disorders that can manifest, and many believe mixed dementia is the most common dementia in the elderly.

Many people assume that mixed dementia is solely Alzheimer’s, but since many symptoms overlap, actual diagnosis by a professional can reveal the multiple disorders involved. Having a proper diagnosis can greatly help in the treatment of symptoms. One of the most common forms of mixed dementia is Alzheimer’s and vascular dementia.