Four Different Types of Dementia: The Causes, Symptoms, and Treatments

Dementia is a term that describes a group of symptoms associated with a loss of memory or other thinking skills. Alzheimer’s disease accounts for 60-80% of all dementia cases, but there are other types of dementia that are common. This guide will help you better understand the different types of dementia, along with their signs, symptoms, causes, and treatments.

1. Background
2. Four Different Types of Dementia
   i) Alzheimer’s Disease
   – Signs and Symptoms of Alzheimer’s Disease
   – Diagnosis of Alzheimer’s Disease
   – Treatment for Alzheimer’s Disease
   ii) Vascular Dementia
   – Signs and Symptoms of Vascular Dementia
   – Diagnosis of Vascular Dementia
   – Treatment for Vascular Dementia
   iii) Lewy Body Dementia
   – Signs and Symptoms of Lewy Body Dementia
   – Diagnosis of Lewy Body Dementia
   – Treatment for Lewy Body Dementia
   iv) Frontotemporal Dementia
   – Signs and Symptoms of Frontotemporal Dementia
   – Diagnosis of Frontotemporal Dementia
   – Treatment for Frontotemporal Dementia
3. 10 Stimulating Exercises for People with Dementia
4. Help from the Ontario Government
   i) Respite Care
   ii) Long-term Care Homes
5. Private Home Care
6. Conclusion
7. References

 

Background

There are currently more than 564,000 Canadians living with dementia, with approximately 25,000 new cases being diagnosed every year. This number is projected to reach 937,000 within the next 15 years. The extent of dementia is so severe that the annual cost to Canadians is estimated to be $10.4 billion.^[1]

Approximately 1 in 11 Canadians over the age of 65 is currently living with a form of dementia, with that number jumping to 1 in 3 for Canadians over the age of 80. Unfortunately, the risk for dementia doubles every 5 years after the age of 65. It’s no wonder Alzheimer’s disease has been identified as the second-most feared disease by aging Canadians.^[2]

Myth: Smoking does not increase the risk of developing dementia.
Reality: Those that smoke are 45% more likely to develop dementia.^[1]

 

Four Different Types of Dementia

Think of dementia as a tree. Dementia is the tree trunk and the branches are the various forms of dementia that extend from the trunk, each with their own set of leaves, representing the signs and symptoms. Each branch is slightly different from one another, but they still belong to the same tree.

This guide will look at four different types of dementia: Alzheimer’s disease (AD), Vascular Dementia (VaD), Lewy Body Dementia (LBD), and Frontotemporal Dementia (FTD). You’ll notice that these types of dementia share similar symptoms, but there are differences in the number of cases, signs, and treatments for each.

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Alzheimer’s Disease (AD)

Alzheimer’s disease is the most common type of dementia. It affects the part of the brain that gives individuals the ability to comprehend and verbalize language, form short-term memories, and understand information. Although Alzheimer’s disease is only one type of dementia, it accounts for 60-80% of all dementia cases.^[3] Using the tree example from before, Alzheimer’s is just one branch on the tree.

The most common form of Alzheimer’s disease is called sporadic Alzheimer’s disease – this means the disease does not have a specific family link and often begins after the age of 60. Another form of Alzheimer’s disease is inherited, or “familial”, and accounts for less than 5% of all Alzheimer’s cases.^[4] This form of Alzheimer’s is called Familial Alzheimer’s Disease (FAD), also known as early-onset dementia.

Unfortunately, Alzheimer’s disease is irreversible and causes an individual’s thinking ability and memory to deteriorate over time. There are two main attributes that contribute to Alzheimer’s: Amyloid plaques, and neurofibrillary tangles.

• Amyloid Plaques are tiny deposits of protein that clump together in the brain, preventing signals from being transferred between nerve cells. This causes the cells to die.
• Neurofibrillary Tangles are fiber clumps of protein called Tau. Tau proteins are like railroad tracks within the brain and allow nutrient to reach their final destination. In the unhealthy brain of someone with Alzheimer’s disease, the tau protein twists and forms tangles, preventing the nutrients from reaching the brain cells, resulting in cell death.

Myth: If my mother or father had Alzheimer’s, that means that I will definitely get it too.
Reality: Although individuals have a 50% chance of inheriting Alzheimer’s if a parent has Familial Alzheimer’s Disease (FAD), the total number of people with FAD accounts for less than 5% of all Alzheimer’s cases.^[4]

 

 

Signs and Symptoms of Alzheimer’s Disease

The following are signs and symptoms that individuals can expect to see with the progression of Alzheimer’s disease:

• Reduced ability to understand and remember information
• Impacted ability to make decisions, perform simple tasks, or follow a conversation
• Memory loss of recent events, and eventually for long-term events and memories
• Confusion and inability to remember where one is
• Loss of interest in favourite hobbies
• Less expressive, apathetic, and withdrawn from activities
• Repetition of words, sentences, and thoughts
• Unordinary behaviour such as hiding possessions, physical outbursts, and restlessness
• Feeling paranoid or threatened
• Placing items in strange places, like soap detergent in the freezer
• Reduced fine motor skills that affects the individual’s coordination and mobility to the point where performing day-to-day tasks such as eating, bathing, and getting dressed become difficult

As the disease progresses, the signs and symptoms listed above can become more severe. However, if you begin to notice any changes in behaviour, memory, or motor skills, it’s best to visit a doctor so that treatment can begin to help minimize the symptoms.

 

 

Diagnosis of Alzheimer’s Disease

Currently, there is no single test that will prove whether or not a person has Alzheimer’s disease. A doctor will perform a complete assessment in which he or she will analyze the following:

• Medical history
• Mental status test
• Physical exam. This includes an inspection of the patient’s diet, blood pressure, heart and lungs, blood and urine tests, and medication use
• Brain imaging
• Neurological exam

If a person has Familial Alzheimer’s Disease (FAD), each of his/her children has a 50% chance of inheriting the gene that causes FAD. Genetic testing is an option to diagnose FAD (i.e. early-onset dementia) in which the doctor would test for alterations in the three FAD genes: PSEN1, PSEN2, and APP.^[5]

 

 

 

Treatment for Alzheimer’s Disease

Although there is no cure for Alzheimer’s disease, those who respond positively to exercises and medications can experience improvements to their quality of life. It’s possible to live a satisfying life with Alzheimer’s for several years after diagnosis.

Stimulating exercises can be used to help improve memory, language, and fine motor skills.

There are also several medications an individual with Alzheimer’s can take to reduce their symptoms, such as Aricept, Rivastigmine, and Reminyl ER.

*For more information about how Alzheimer’s drugs are approved in Canada, see the Drug Approval Process for the Treatment of Alzheimer’s Disease report from the Alzheimer’s Society.

Myth: There is nothing you can do to help prevent dementia.
Reality: Avoiding smoking, living a healthy lifestyle, and exercising the brain through reading and social interaction can help prevent dementia.^[6]

 

Vascular Dementia (VaD)

Vascular Dementia accounts for nearly 10% of all dementia cases, making it the second most common type of dementia after Alzheimer’s disease.^[7] Similar to Alzheimer’s disease, vascular dementia causes a decline in an individual’s thinking skills. However, it is not because of “plaques” and “tangles” found in the brain, but because of conditions that block or reduce blood flow to the brain, which deprives the brain of oxygen and nutrients.

Since the brain consists of a rich network of blood vessels, without sufficient blood flow, eventually cells throughout the body begin to die. For individuals with vascular dementia, the signs and symptoms tend to occur suddenly following a stroke that blocks major brain blood vessels.

 

Signs and Symptoms of Vascular Dementia

Many of the symptoms of vascular dementia are similar to that of other forms of dementia, especially Alzheimer’s. However, these symptoms are often experienced soon after a major stroke. These symptoms include:

• Confusion and disorientation
• Difficulty speaking and understanding conversations
• Vision loss
• Sudden headaches

Small vessel disease is considered to put people at high risk for vascular dementia, with more than 50% of vascular dementia cases being associated with small vessel disease.^[8] Early signs of small vessel disease that affect an individual’s cognitive behaviour include:

• Impaired judgement
• Uncontrollable laughing or crying
• Inability to pay attention
• Difficulty finding the right words for items

 

Diagnosis of Vascular Dementia

Since many of the symptoms are similar to that of other types of dementia, vascular dementia often goes unrecognized without professional screenings. When determining if someone has vascular dementia, doctors will use the following tests to determine a diagnosis:

• Memory, thinking, and reasoning tests
• History of strokes or a Transient Ischemic Attack (TIA, also known as a mini-stroke)
• Tests for high blood pressure, high cholesterol, or other factors that affect the heart and blood vessels
• Screening for depression. Individuals with depression are considered high-risk groups since depression commonly coexists with brain vascular disease and can contribute to cognitive symptoms
• Blood tests

The following two criteria can suggest that Mild Cognitive Impairment (MCI) or dementia is caused by vascular changes:

1. Dementia or MCI can be confirmed by neurocognitive testing, which may take several hours. These tests provide a detailed evaluation of an individual’s thinking skills, planning, problem-solving, and memory.
2. Brain imaging (from an MRI) can provide the evidence needed to dictate if a person has had a:
   • recent stroke, or
   • other brain blood vessel change

 

Treatment for Vascular Dementia

Similar to Alzheimer’s disease and other forms of dementia, advancing age is a major risk factor for vascular dementia. However, with vascular dementia, risk factors for stroke and other diseases that affect the blood vessels need to be considered. Making positive lifestyle changes can help reduce your risk of stroke, and therefore vascular dementia. Some examples include:

• Don’t smoke
• Limit alcohol consumption
• Keep blood pressure and cholesterol at a healthy limit
• Eat a healthy diet
• Exercise regularly
• Maintain a healthy weight

Controlling risk factors that could lead to blood vessel damage is the most important prevention strategy for vascular dementia. By following the suggestions listed above, individuals can help prevent symptoms of stroke, and therefore lower their risk of vascular dementia.

Myth 2: Doctors can easily identify if a patient has vascular dementia.
Reality: Since Alzheimer’s disease and vascular dementia share many symptoms, it is not easy to identify if a patient has vascular dementia. An MRI can help determine if the patient has had a stroke, and therefore if their symptoms are associated with vascular dementia. ^[9]

 

Lewy Body Dementia (LBD)

Lewy Body Dementia accounts for 5-15% of all dementia cases, and can occur alone, or together with Alzheimer’s or Parkinson’s.^[10] This form of dementia takes place when abnormal deposits of protein (Lewy bodies) affect the area of the brain that promotes thinking and physical movement. Essentially, the Lewy bodies interrupt the brain’s messages to the body.

 

Signs and Symptoms of Lewy Body Dementia

An individual with Lewy body dementia may show similar signs and symptoms as someone with Alzheimer’s or Parkinson’s. These symptoms of early-stage Lewy body dementia include:

• Loss of memory, language, and reasoning
• Inability to calculate numbers and find the right word when speaking
• Symptoms of depression and anxiety
• Insomnia
• Apathy

As the disease progresses, individuals with Lewy body dementia may experience visual hallucinations and errors in perception. For example, the individual may see a person’s face in the pattern of wallpaper. Patients can also experience symptoms similar to Parkinson’s disease, including tremors, stiffness of muscles, shuffling movements, and stooped posture.

 

Diagnosis of Lewy Body Dementia

Sometimes, the diagnosis for Lewy body dementia can be delayed since many of the symptoms are similar to those of other diseases. However, doctors have recently been able to diagnose Lewy body dementia more easily by using the following criteria:

1. Determining if there are symptoms of dementia such as:
   • Memory loss and confusion
   • Inability to think of the right words during conversations
   • Mood changes
   • Apathy
   • Loss of balance and fine motor skills
2. Determining if the patient has any of the following:
   • fluctuating cognitive hallucinations (unpredicted changes in thinking)
   • REM sleep behaviour disorder
   • Repeated visual hallucinations
   • Parkinsonism (i.e. slow movements, tremors, and muscle rigidity)

 

Treatment for Lewy Body Dementia

Similar to the other types of dementia previously discussed, there is no cure for Lewy body dementia; however, a doctor may prescribe medications to manage the symptoms. These medications are often the same ones prescribed to patients that suffer from Parkinson’s disease, depression, and/or hallucinations. One type of medication used is Cholinesterase inhibitors, which is a group of medicines that helps with learning, motivation, memory, and muscle function.

Myth: Men and women have equal risk of acquiring Lewy body dementia.
Reality: This myth is false – Lewy body dementia is almost twice as common in men as in women. ^[11]

 

Frontotemporal Dementia (FTD)

Frontotemporal Dementia is actually an umbrella term for a group of disorders that affect the frontal and temporal lobes of the brain. These areas of the brain are associated specifically with a person’s personality and behavior. Frontotemporal dementia accounts for approximately 2-5% of all dementia cases and about 20% of dementia cases for individuals under the age of 65.^[12]

In some cases of frontotemporal dementia, the brain cells in the frontal and temporal lobes shrink, while in other cases, the brain cells get larger. When the brain cells get larger, they contain “Pick bodies”, which relate to a subtype of frontotemporal dementia called Pick’s disease. In addition to Pick’s disease, other types of frontotemporal dementia include:

• Frontal lobe dementia
• Pick’s complex
• Primary progressive aphasia
• Corticobasal degeneration
• Semantic dementia

 

Signs and Symptoms of Frontotemporal Dementia

Frontotemporal dementia often occurs at a younger age than other forms of dementia, such as Alzheimer’s disease. However, unlike Alzheimer’s disease, a person with early stages of frontotemporal dementia will not have memory loss, or difficulty comprehending time. The early symptoms of frontotemporal dementia that you should look out for include:

• Difficulty with speech and conversations. Repetition of thoughts and stuttering may also occur
• Behavioural issues including emotional outbursts, decreased motivation, and apathy
• Loss of interest in maintaining personal hygiene
• Overeating and compulsively putting objects in their mouth
• Incontinence

It isn’t until the later stages of the disease that the general symptoms of dementia begin to occur – these include confusion, forgetfulness, and loss of motor skills.

 

Diagnosis of Frontotemporal Dementia

Much like the other cases of dementia, there is no single test that can diagnose frontotemporal dementia. Doctors will conduct a complete assessment including brain imaging, medical history analysis, and cognitive tests to determine if an individual has symptoms associated with frontotemporal dementia.

 

Treatment for Frontotemporal Dementia

There is no known cure or effective way to slow down the progression of frontotemporal dementia. However, there are many things that can be done to allow individuals with frontotemporal dementia to live a satisfying life.  Speech Language Pathologists, stimulating exercises, and physical exercises can all be used to manage the symptoms of frontotemporal dementia.

Myth: Like Alzheimer’s disease and other forms of dementia, frontotemporal dementia also occurs at a later stage in life.
Reality:  Frontotemporal dementia actually tends to occur earlier than other forms of dementia. An individual may start to see symptoms of frontotemporal dementia by age 40, with age 54 being the average age of onset.^[13]

 

10 Stimulating Exercises for People with Dementia

Dementia is a progressive disease, meaning symptoms get worse over time. The progression of dementia is different for every individual – for some people, it progresses rapidly, whereas for others, it may progress over the span of several years. However, research shows that cognitive stimulation helps reduce decline in cognitive function for individuals with mild to moderate dementia.

Here are 10 stimulating exercises for people with dementia:

1. Create a Memory Box

Since most forms of dementia affect an individual’s memory, looking through a memory box with pictures of their loved ones and happy moments can be a great reminiscent activity. The memory box can consist of anything, not just pictures. It promotes engagement opportunities for patients living with dementia, as well as for their loved ones and caregivers.

2. Cook Simple Recipes

The process of cooking and baking requires motor skills, thinking, and short-term memory. Also, the smell or taste of their favourite childhood recipe allows the individual to have a reminiscent experience while cooking. Cooking healthy recipes helps improve general health, and is also beneficial for brain health.

3. Listen and Dance to Music

Similar to the memory box, listening to music that the individual enjoys can provide comfort and feelings of nostalgia. A bonus benefit of this activity is that it encourages dancing, a physical activity that helps keep you in healthy shape!

4 . Work on a Picture Puzzle

Those with dementia may have difficulty with problem solving and thinking. Doing a puzzle offers cognitive stimulation to help keep the brain engaged.

5. Household Chores

A simple chore routine can help ease the anxieties that individuals with dementia may have. It’s important to first determine the individual’s capabilities, especially in the later stages of dementia. Engaging in every day chores such as folding towels, dusting, or sweeping will not only help manage symptoms of lost motor skills, but will encourage physical activity for better overall health.

6. Physical Exercises

Engaging in physical exercise helps boost a person’s mood and self-esteem, which in turn contributes to their overall wellbeing. Depending on the capabilities of the individual, it may be best to practice physical exercises in a chair – this allows the individual to remain balanced and prevent any injuries associated with falls.

7. Tend to the Garden

Gardening therapy allows individuals to spend time outside and has many physical and mental health benefits. However, when gardening with someone that has dementia, you should avoid giving them any sharp gardening tools in case there is a social outburst.

8. Read a Book

Researchers have found that reading can improve a dementia patient’s quality of life. At the earlier stages of Alzheimer’s disease, many patients may enjoy reading books themselves. As the disease progresses and reading becomes more difficult, large-print reading material can be helpful. You can also read out loud for the individual, which prompts cogent responses, even if they have difficulty with verbal exchanges.

9. Do a Crossword Puzzle

Crossword puzzles also prompt cogent responses. The Alzheimer Society of Canada provides easy-to-solve crossword puzzles for dementia patients, as well as word searches and Sudoku puzzles.

10. Painting and Colouring

Art therapy is a powerful treatment that stimulates the brain, stirs dormant memories, and helps boost cognitive function in various areas of the brain. Depending on the type of dementia the patient has, he or she may need some help guiding the art tool.

Myth: Only seniors develop dementia
Reality: Although dementia is more common among seniors, younger individuals can also have dementia. In fact, head injury, infection, and alcoholism are the three most common causes of dementia for individuals under the age of 50.^[14]

 

Help from the Ontario Government

Caring for someone with dementia can be difficult, but help is available. Each province in Canada offers different resources and programs for dementia patients and caregivers. We’re going to look at the options available in Ontario, however if you live in a different province, similar options will likely be provided.

 

Respite Care

Caring for someone with dementia can be overwhelming. Oftentimes, the primary caregiver for a dementia patient is a loved one or family member. If you’re a caregiver for someone with dementia and need a break, respite care is provided by the Ontario government. There are three different types of respite care available, including:

1. Respite care at home
2. Short-term stay in a long-term care home
3. Adult day programs

The type of respite care that will be most appropriate depends on the caregiver’s reason for needing respite. For example, if the caregiver needs surgery, is going on vacation, or has other job responsibilities, one of these respite options may be provided for free or a subsidized cost.

For more information, read our blog post 3 Types of Respite Care Options for Caregivers.

 

Long-term Care Homes

Long-term care homes are places where patients can receive access to 24-hour nursing and personal care. If a caregiver can no longer care for a loved one with dementia, the Ontario government will help pay for their care. However, depending on your financial capabilities (based on your income and the type of accommodation required), you may be required to provide a copayment to subsidize these costs. For more information, read the long-term care accommodation costs and subsidy article by the Ontario government.

 

Private Home Care

The publicly funded options listed above are provided by the Ontario Government, or more specifically, the Local Health Integration Networks (LHINs). However, if you don’t qualify for government-funded care, or if the wait-lists for long-term care homes are too long, private home care is another affordable option.

Depending on the stage of the person’s dementia, they may require a Nurse, Home Support Worker, or Personal Support Worker. These types of support workers can assist with medical tasks and chores around the home, and can help ease the responsibilities of the primary caregiver. They can also offer watchful companionship, accompaniment to appointments, and more.

 

Conclusion

Dementia is a scary reality for many Canadians, but it is comforting knowing that there are resources available for dementia patients, their caregivers, and their families. Although dementia cannot be cured, there are many things a person can do to prevent the symptoms from getting worse. Individuals with dementia are still capable of living a happy and satisfying life; it just takes patience, ongoing treatment, cognitive exercises, and love.

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References

 
^[1] https://www.newswire.ca/news-releases/new-campaign-highlighting-the-devastating-impact-of-alzheimers-disease-543880392.html
 
^[2] http://alzheimer.ca/en/Home/About-dementia/What-is-dementia/Dementia-numbers
 
^[3] https://www.alz.org/alzheimers-dementia/what-is-dementia
 
^[4] http://alzheimer.ca/en/bc/About-dementia/Alzheimer-s-disease/Myth-and-reality-about-Alzheimer-s-disease
 
^[5] https://www.sciencedirect.com/science/article/pii/S0929664615003022
 
^[6] https://www.helpguide.org/articles/alzheimers-dementia-aging/preventing-alzheimers-disease.htm
 
^[7] https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia
 
^[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2854938/
 
^[9] https://www.verywellhealth.com/the-differences-between-alzheimers-vascular-dementia-98750
 
^[10] http://alzheimer.ca/en/Home/About-dementia/Dementias/Lewy-Body-Dementia
 
^[11] https://www.lbda.org/content/incidence-lewy-body-dementias-general-population
 
^[12] http://alzheimer.ca/sites/default/files/Files/national/Other-dementias/other_dementias_FTD_e.pdf
 
^[13] https://www.griswoldhomecare.com/blog/stages-of-frontotemporal-dementia-symptoms-age-of-onset-risk-factors-life-expectancy/
 
^[14] https://www.webmd.com/alzheimers/dementia-head-injury