This article ran in the Westfield News on 10/06/12.
Health Wise
A health & wellness column by Victor Acquista, MD, Director Pathways
Integral Health & Wellness, LLC; Author Pathways to Health: An
Integral Guidebook
Dementia Differences
I receive a lot of questions about dementia. Often people use the
diagnosis of Alzheimer’s disease as though it describes all types of
dementias but this is not the case. Alzheimer’s disease is only one of
many conditions which are all variations of dementing illnesses. In
this column I’ll describe some of the more common subtypes of
dementias and some of their distinguishing characteristics.
Let’s start with a definition: Dementia is a syndrome of progressive
cognitive decline, often accompanied by additional symptoms in
behavior and movements. The specific areas or domains of cognitive
functioning that are most often affected are: memory, learning, and
executive functioning (this includes things such as organization and
planning, staying on task, and problem solving). Other cognitive
domains which are frequently affected include language, visuospacial
processing, and mood/emotion.
More technically, the DSM IV (this is the guidebook for diagnosing
mental disorders) requires the following elements to establish a
diagnosis of dementia:
Impairment of recent memory and at least one other cognitive domain
Represents a decline from previous level of function and be severe
enough to interfere with daily function and independence
Occur in the absence of other psychiatric, neurologic, or systemic disease
Does not occur only with delirium (delirium is caused by other processes)
Alzheimer’s disease
This is the most common form of dementia and accounts for anywhere
between 60--80%. Typically this presents as a progressive decline in
many areas of intellectual functioning. Recent memory is often
severely affected; personality less so. As the disease progresses it
usually follows a path of retrogenesis, which literally means back to
the beginning. Skills and memories regress almost like reverse aging.
In the final stages, adults with Alzheimer’s type dementia require
total care, much like an infant.
Vascular dementia
Vascular refers to blood vessels. When blood vessels are diseased, the
tissues supplied by these blood vessels may suffer from reduced blood
flow and be damaged as a result. When the blood vessels are those in
the brain or supplying the brain, the result may be a stroke if the
territory of brain is large, or they be relatively small portions of
brain tissue. These small areas of damage may not be large enough to
cause a stroke, but when there are many small areas, the cumulative
affect may be vascular dementia. This typically occurs in individuals
with risk factors for vascular disease: diabetes, hypertension,
smoking, and/or high cholesterol. Vascular dementia is the second most
common type of dementia and may coexist with other dementing processes
such as Alzheimer’s disease (mixed dementia).
Dementia with Lewy bodies
Lewy bodies describe a characteristic pathologic finding seen by
pathologists examining brain tissue. There is almost always a motor
component to Lewy body dementia, i.e. muscles and therefore movement
is affected. Most often the motor symptoms are increased rigidity and
stiffness as is also seen with Parkinson’s disease (described below).
The cardinal features of Lewy body dementia are fluctuating cognitive
impairment, hallucinations, along with the motor symptoms. A
particular sleep disorder called REM sleep behavior disorder, in which
people physically act out their dreams is sometimes present. Men are
more often affected than women. Some of the medications use to treat
hallucinations and/or Parkinsonian features may actually worsen
symptoms. Although relatively common (over a million affected
individuals in the United States), Lewy body dementia is often under
diagnosed.
Parkinson’s disease with dementia
Many experts consider Parkinson’s disease with dementia and Lewy body
dementia to be clinical variations of the same disease process. As a
result of a specific neurodegenerative process in the motor cortex
area of the brain which depletes the production of a neurotransmitter,
Parkinsonism manifests with a variety of motor symptoms. These include
rigidity, reduced facial expression described as masked facies,
slowing of movement, tremor, and difficulty initiating movement. As
the disease progresses, swallowing difficulties frequently occur which
significantly increase the chance for aspiration pneumonia. Depression
often accompanies Parkinson’s disease. While the motor symptoms
predominate, over time, this degenerative process involves other areas
of the brain and causes cognitive decline.
Frontotemporal dementia
There are several disorders with a variety of symptoms which may
result in Frontotemporal dementia. As suggested by the name, the areas
of brain involved are in the frontal and temporal cortex. Because some
of these parts of the brain are involved in regulating emotional
response, the most common manifestations include changes in
personality and behavior. This type of dementia can be especially
challenging as the behaviors might be very inappropriate. Poor
personal hygiene, sexually inappropriate behaviors, compulsions, or
apathy might occur. Typically, the individual affected is unaware of
the behaviors or unable to recognize them as inappropriate. Sometimes
language, speech, or movement may be affected.
Other dementias
I have tried to cover some of the more common forms of dementia, but
briefly want to include a few others. Certain neurotoxic substances
can damage the brain and cause dementia. Alcohol is the most common of
these toxic substances. There are different infectious agents which
can damage the brain and lead to dementia. Some of the more common of
these include syphilis, HIV, and Creutzfeld-Jacob disease (similar to
mad cow disease). Two metabolic disorders which may lead to dementia
include hypothyroidism (low thyroid hormone) and vitamin B12
deficiency. Fortunately, both of these types of dementia are
reversible with proper treatment. Finally, severe depression can
sometime mimic the signs and symptoms of dementia. Doctors sometimes
refer to this as pseudo dementia.
As you can see, there are many differences which characterize many
types of dementias. Any of these types can be difficult to deal with
both for individuals affected and their families. It is especially
difficult to witness the cognitive changes, behavioral disturbances,
and functional decline which accompany dementia. The Alzheimer’s
Association, your health care provider, and local community resources
are good places to turn for help.
Be Healthy…
Victor Acquista MD is author of "Pathways To Health: An Integral
Guidebook" http://pathstohealth.info/
A health & wellness column by Victor Acquista, MD, Director Pathways
Integral Health & Wellness, LLC; Author Pathways to Health: An
Integral Guidebook
Dementia Differences
I receive a lot of questions about dementia. Often people use the
diagnosis of Alzheimer’s disease as though it describes all types of
dementias but this is not the case. Alzheimer’s disease is only one of
many conditions which are all variations of dementing illnesses. In
this column I’ll describe some of the more common subtypes of
dementias and some of their distinguishing characteristics.
Let’s start with a definition: Dementia is a syndrome of progressive
cognitive decline, often accompanied by additional symptoms in
behavior and movements. The specific areas or domains of cognitive
functioning that are most often affected are: memory, learning, and
executive functioning (this includes things such as organization and
planning, staying on task, and problem solving). Other cognitive
domains which are frequently affected include language, visuospacial
processing, and mood/emotion.
More technically, the DSM IV (this is the guidebook for diagnosing
mental disorders) requires the following elements to establish a
diagnosis of dementia:
Impairment of recent memory and at least one other cognitive domain
Represents a decline from previous level of function and be severe
enough to interfere with daily function and independence
Occur in the absence of other psychiatric, neurologic, or systemic disease
Does not occur only with delirium (delirium is caused by other processes)
Alzheimer’s disease
This is the most common form of dementia and accounts for anywhere
between 60--80%. Typically this presents as a progressive decline in
many areas of intellectual functioning. Recent memory is often
severely affected; personality less so. As the disease progresses it
usually follows a path of retrogenesis, which literally means back to
the beginning. Skills and memories regress almost like reverse aging.
In the final stages, adults with Alzheimer’s type dementia require
total care, much like an infant.
Vascular dementia
Vascular refers to blood vessels. When blood vessels are diseased, the
tissues supplied by these blood vessels may suffer from reduced blood
flow and be damaged as a result. When the blood vessels are those in
the brain or supplying the brain, the result may be a stroke if the
territory of brain is large, or they be relatively small portions of
brain tissue. These small areas of damage may not be large enough to
cause a stroke, but when there are many small areas, the cumulative
affect may be vascular dementia. This typically occurs in individuals
with risk factors for vascular disease: diabetes, hypertension,
smoking, and/or high cholesterol. Vascular dementia is the second most
common type of dementia and may coexist with other dementing processes
such as Alzheimer’s disease (mixed dementia).
Dementia with Lewy bodies
Lewy bodies describe a characteristic pathologic finding seen by
pathologists examining brain tissue. There is almost always a motor
component to Lewy body dementia, i.e. muscles and therefore movement
is affected. Most often the motor symptoms are increased rigidity and
stiffness as is also seen with Parkinson’s disease (described below).
The cardinal features of Lewy body dementia are fluctuating cognitive
impairment, hallucinations, along with the motor symptoms. A
particular sleep disorder called REM sleep behavior disorder, in which
people physically act out their dreams is sometimes present. Men are
more often affected than women. Some of the medications use to treat
hallucinations and/or Parkinsonian features may actually worsen
symptoms. Although relatively common (over a million affected
individuals in the United States), Lewy body dementia is often under
diagnosed.
Parkinson’s disease with dementia
Many experts consider Parkinson’s disease with dementia and Lewy body
dementia to be clinical variations of the same disease process. As a
result of a specific neurodegenerative process in the motor cortex
area of the brain which depletes the production of a neurotransmitter,
Parkinsonism manifests with a variety of motor symptoms. These include
rigidity, reduced facial expression described as masked facies,
slowing of movement, tremor, and difficulty initiating movement. As
the disease progresses, swallowing difficulties frequently occur which
significantly increase the chance for aspiration pneumonia. Depression
often accompanies Parkinson’s disease. While the motor symptoms
predominate, over time, this degenerative process involves other areas
of the brain and causes cognitive decline.
Frontotemporal dementia
There are several disorders with a variety of symptoms which may
result in Frontotemporal dementia. As suggested by the name, the areas
of brain involved are in the frontal and temporal cortex. Because some
of these parts of the brain are involved in regulating emotional
response, the most common manifestations include changes in
personality and behavior. This type of dementia can be especially
challenging as the behaviors might be very inappropriate. Poor
personal hygiene, sexually inappropriate behaviors, compulsions, or
apathy might occur. Typically, the individual affected is unaware of
the behaviors or unable to recognize them as inappropriate. Sometimes
language, speech, or movement may be affected.
Other dementias
I have tried to cover some of the more common forms of dementia, but
briefly want to include a few others. Certain neurotoxic substances
can damage the brain and cause dementia. Alcohol is the most common of
these toxic substances. There are different infectious agents which
can damage the brain and lead to dementia. Some of the more common of
these include syphilis, HIV, and Creutzfeld-Jacob disease (similar to
mad cow disease). Two metabolic disorders which may lead to dementia
include hypothyroidism (low thyroid hormone) and vitamin B12
deficiency. Fortunately, both of these types of dementia are
reversible with proper treatment. Finally, severe depression can
sometime mimic the signs and symptoms of dementia. Doctors sometimes
refer to this as pseudo dementia.
As you can see, there are many differences which characterize many
types of dementias. Any of these types can be difficult to deal with
both for individuals affected and their families. It is especially
difficult to witness the cognitive changes, behavioral disturbances,
and functional decline which accompany dementia. The Alzheimer’s
Association, your health care provider, and local community resources
are good places to turn for help.
Be Healthy…
Victor Acquista MD is author of "Pathways To Health: An Integral
Guidebook" http://pathstohealth.info/
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