Have you or someone you love started to have trouble remembering someone’s name or where the car is parked? Mild forgetfulness is often a normal part of aging, but if memory problems are beginning to have a serious impact on your quality of life, it could be the early signs of Alzheimer’s or other types of Dementia.
There is often some confusion about the difference between dementia and Alzheimer’s disease (AD). To help clear up some of the confusion, I will outline the different types of dementia, but focus mostly on AD – as it is the most common type.
What is Dementia?
Dementia is a general term describing a spectrum of diseases which have two factors in common: memory and cognitive problems. The manifestation of symptoms differs depending on which area of the brain is affected, and those factors distinguish between the different types of dementias.
In general, all dementias are a neurodegenerative disease during which the brain cells and neuron synapses degrade and die over time. And they usually progress slowly over time. Therefore, by the time a patient is manifesting symptoms of the disease, he or she has had the ailment for several years.
With the above definition in mind, we can more easily understand that Alzheimer’s is a type of dementia, but not all dementias are Alzheimer’s.
Signs and Symptoms of Dementia
Cognitive problems are the hallmark of dementia. Memory problems alone are not enough for diagnosis.
Cognitive function is a higher operational function of the brain. It lets us make sense of our surroundings and solve problems.
Some of the more important cognitive functions are:
- Problem solving
- Decision making
- Working memory
The symptoms of different types of dementias vary depending on which area of the brain is most affected.
Types of Dementias
The most common type of dementia is Alzheimer’s disease (AD). AD makes up 50% to 70% of dementia cases.
Below are the most common types of dementia:
- Alzheimer’s Disease (AD)
- Mild Cognitive Impairment (70% of these patients eventually develop AD)
- Normal Pressure Hydrocephalus (NPH)
- Frontotemporal Dementia
- Lewy Body Dementia
- Dementia of Parkinson’s Disease
- Vascular Dementia also called Binswanger Disease
- Infectious causes, such as HIV, Syphilis, Lyme’s Disease, and CJD (Mad Cow Disease)
- Metabolic causes, such as Vitamin B12 deficiency and Hypothyroidism
It is important to mention here that depression, stress, and anxiety can cause short term memory problems and word finding difficulties. However, it is not dementia because there is no cognitive impairment.
Reversible Types of Dementias
It is important to take a few minutes and mention that it is extremely important to have the right diagnosis and not tag everyone as AD. Some of the causes of dementia such as infectious, hypothyroidism, and vitamin B12 deficiency are curable.
Normal Pressure Hydrocephalus (NPH)
Although not as common as Alzheimer’s disease (AD), it is important to discuss normal pressure hydrocephalus (NPH) first because it is easily treatable with early intervention. For NPH, correct and early diagnosis is the key.
Classic NPH has a triad of:
- Urinary incontinence
- Walking or balance problems
The diagnosis of this disorder is simple. It requires a very high degree of suspicion. A lumbar puncture is performed, and about 30-50 cc of the spinal fluid is drained. If the patient shows some improvement, such as walking easier, walking faster, better balance, better memory, etc., then the diagnosis is confirmed.
The cause of NPH is impaired drainage of the cerebrospinal fluid. The treatment is placing a shunt from the fluid chambers of the brain to the abdominal cavity to facilitate drainage. This is called a ventriculoperitoneal shunt.
This is the most common type of dementia. Previously, it was called “senile dementia” when a patient manifested his or her symptoms after 65 years of age. However, based on biopsies and microscopic examinations, we now know that earlier onset dementia is caused by the same entity. The main pathological hallmark of AD is neurofibrillary tangles inside the nerve cells (neurons) and amyloid plaques outside of the neurons.
Amyloid is an abnormal protein that can cause many diseases, namely Alzheimer’s and amyloidosis. However, the precursor to amyloid, called amyloid precursor protein (APP), is an important protein for the body’s functioning. APP is particularly found in high concentrations in the nerve synapses. Its function is not precisely known but we think that it functions as a stabilizer of the cell, helps plasticity of the neurons (nerve learning), synapse formation, as well as defense mechanisms, such as the antimicrobial mechanism.
Due to oxidative damage and other factors, the APP is damaged and forms amyloid which is then deposited around the neurons. In turn, the cells lose their stability and function, and they start dying off. The internal cellular organs accumulate in an abnormal way and form the neurofibrillary tangle.
It is thought that oxidative stress plays a major role in this disease. A lot of effort has been put into finding a genetic link to AD, but truly hereditary AD is very rare.
Signs, Symptoms, and Stages of Alzheimer’s Disease
There are different stages of Alzheimer’s Disease (AD). And each stage comes with its own set of signs, symptoms, and challenges for the patient and their family.
In mild Alzheimer’s disease, a person may seem to be healthy, but has more and more trouble making sense of the world around him or her. The realization that something is wrong often comes gradually to the person and his or her family.
Problems that may come with AD include:
- Memory loss
- Poor judgment leading to bad decisions
- Loss of spontaneity and sense of initiative
- Taking longer to complete normal daily tasks
- Repeating questions
- Trouble handling money and paying bills
- Wandering and getting lost
- Losing things or misplacing them in odd places
- Mood and personality changes
- Increased anxiety and/or aggression
Alzheimer’s disease is often diagnosed at this stage. However, patients will often deny that there is anything wrong with them. It is usually the family who brings the patient to seek medical attention.
In the moderate stage, more intensive supervision and care becomes necessary, which can be difficult for many spouses and families.
Symptoms may include:
- Increased memory loss and confusion
- Inability to learn new things
- Difficulty with language and problems with reading, writing, and working with numbers
- Difficulty organizing thoughts and thinking logically
- Shortened attention span
- Problems coping with new situations
- Difficulty carrying out multi-step tasks, such as getting dressed
- Problems recognizing family and friends
- Hallucinations, delusions, and paranoia
- Impulsive behavior such as undressing at inappropriate times or places, or using vulgar language
- Inappropriate outbursts of anger
- Restlessness, agitation, anxiety, tearfulness, wandering—especially in the late afternoon or evening
- Repetitive statements or movement
- Occasional muscle twitches
People with late stage AD cannot communicate, and are completely dependent on others for their care. Near the end, the person may be in bed most or all of the time as the body shuts down.
Their symptoms often include:
- Inability to communicate
- Weight loss
- Skin infections
- Difficulty swallowing
- Groaning, moaning, or grunting
- Increased sleeping
- Loss of bowel and bladder control
A common cause of death for people with Alzheimer’s disease is aspiration pneumonia. This type of pneumonia develops when a person cannot swallow properly and takes food or liquids into the lungs instead of air. This usually happens because patients cannot remember to swallow or how to swallow.
Lewy Body Dementia (LBD)
Lewy body dementia (LBD) is the second most common type of dementia after AD. Just like AD, LBD presents with an accumulation of abnormal proteins that result in cell death and loss of function. The proteins in this case are called alpha-synuclein. This protein in its normal state is a very important player in the nerve synapses. However, due to oxidative damage and other factors throughout the years, the protein gets damaged and forms a clump that results in cell death. The clumps of alpha-synuclein are known as Lewy body.
Dementia due to Lewy body is very similar to Parkinson’s disease in that patients have movement difficulties, slowness, muscle rigidity, and tremors. LBD tremors tend to be less noticeable than those of Parkinson’s.
On top of movement disorders, LBD patients have cognitive and memory problems, along with hallucinations. A distinguishing characteristic of these hallucinations are that they are “waxing and waning” visual hallucinations. These hallucinations tend to be very realistic and detailed.
Signs and Symptoms of Lewy Body Dementia
Below are some of the more common signs and symptoms of LBD:
- Changes in thinking and reasoning
- Confusion and alertness that varies significantly from one time of day to another or from one day to the next (“waxing and waning”)
- Slowness, gait imbalance, and other Parkinsonian movement features
- Well-formed visual hallucinations
- Trouble interpreting visual information
- Sleep disturbances
- Malfunctions of the “automatic” (autonomic) nervous system
- Memory loss that may be significant but less prominent than in Alzheimer’s
Frontotemporal Dementia (FTD)
In this type of dementia, the affected areas are the frontal and temporal lobes of the brain.
The frontal lobe is responsible for higher functions such as behavioral control and social appropriateness.
Signs and Symptoms of Frontotemporal Dementia
Below are the signs and symptoms of FTD:
- Poor judgment
- Loss of empathy
- Socially inappropriate behavior
- Lack of inhibition
- Repetitive compulsive behavior
- Inability to concentrate or plan
- Frequent, abrupt mood changes
- Speech difficulties
- Problems with balance or movement
- Memory loss
The distinguishing factor between AD and FTD are the behavioral symptoms. In FTD, behavior problems and social inappropriateness are some of the first signs. Some patients may show signs of hypersexuality, and men with FTD usually have erectile dysfunction as well. Memory problems usually come in a little later as FTD progresses.
Vascular Dementia (or Binswanger Disease)
Vascualar dementia or Binswanger disease is the result of many “mini strokes,” which accumulate to significant damage to the brain over time. Once there are enough affected neurons, symptoms start to manifest. Like any other type of dementia, patients manifest with memory problems and cognitive issues. However, they tend to be less severe than AD or others. MRI brain scans show extensive areas of mini strokes deep within the brain.
The cause of vascular dementia is damaged arteries, particularly the capillaries, of the brain. Some of the risk factors are hypertension, high cholesterol, smoking, alcohol, and a sedentary lifestyle.
Vascular Dementia Treatment Options
Before talking about treatment, we have to clarify a few facts:
- Memory and cognitive functions are formed slowly over years. New synapses are formed in the brain based on life experiences and how we deal with them.
- Once the Synapses are lost, the memory, or any function they may have controlled, is lost and we cannot recover lost memories because memories are formed based on life experiences and each memory consists of a specific nerve circuit and synapses.
- The damage to the cells start many years before the symptoms manifest themselves. Our brains have certain functional reserves and backup systems. Once there is enough damage to the brain that the reserves and backup systems are also affected, then the symptoms manifest.
The above facts are extremely important to keep in mind because the time in which one starts the treatment is of utmost importance. Once a patient has lost a big part of his/her memory, any kind of treatment will be less successful.
Current Recommended Treatments for Dementia
So far, pharmaceutical treatments have concentrated on pushing the remaining neurons to work harder and make up for the lost or dead neurons.
For example, the medications available for Alzheimer’s disease increases a brain neurotransmitter called acetylcholine. Neurons communicate with each other through neurotransmitters. Adding these chemicals is like making a phone call to ask for help. However, if there are very few neurons left in that area of the brain, there is no one to answer the call. Also, we are doing nothing to prevent further cell death. Therefore, if a certain medication works to some extent in the early stages of the disease, it will eventually stop working because the patient is losing neurons every minute of every day. This is why all the dementia treatments have failed so far.
How to Properly Treat Dementia
Correct treatment for any illness has to address the following:
- Removing the offending agent that is causing the damage
- Preventing more damage, such as cell death
- Promoting regeneration of the remaining cells to fill up the void
With this model we can approach dementia, including Alzheimer’s Disease in a much more structured manner and be more successful in treatment.
Proper Dementia Treatment
Biological treatment ascertains such an approach, if done done well, be as follows:
- We know that the damage that converts good proteins into bad proteins causing cell death, is mostly due to oxidative damage, which is an environmental phenomenon. Also as we age our body’s ability to fight this damage decreases. Therefore, we start the patient on an infusion program to increase their ability to fight oxidative stress, and handle free radicals much better. This way we are removing the offending agent.
- All cells of our body, including neurons, have a programmed cell suicide gene. This is called apoptosis. Simply put, once the damage to the cell and its immediate surroundings is too much, the cell cannot function and through some genetic coding, apoptosis is set into motion. To prevent this step, we resort to biological treatment using exosomes. Exosomes carry the gene sequence to stop the cell suicide and promote regeneration of the cells. At the same time, they are small enough to be able to pass through the blood brain barrier and enter the brain. Exosomes are a very important part of the treatment.
- Once the patient’s progress has slowed down or stopped, then maintenance is required. This step varies from patient to patient. Some patients may only need the anti-oxidant infusions every so often. Other patients may require exosome infusions in addition to antioxidant infusions.
If you’re worried you have dementia, look objectively at how you are functioning. Are you unable to complete a task you previously could handle with ease? Are you forgetting to do things that have been part of your daily habit for years, like take your morning medications or weekly shopping trips? Also, ask your family or friends to see if they’ve noted changes in your behavior like becoming socially isolated or having new difficulties at your job.
Once you’ve thought about these things, don’t wait to contact a physician. It is extremely important to start treatment as early as possible. Once memories are gone, you can’t get them back.
Another important fact to remember is that the damage to the brain that leads to dementia, starts earlier in life (in your 40’s and 50’s). Therefore, getting antioxidant infusions on a regular basis for prevention of any neurodegenerative condition is recommended.