What is the difference between dementia and Alzheimer's disease? Dementia is not a specific disease, but a set of symptoms with many possible causes. More than 50 health conditions can cause dementia symptoms. Alzheimer's disease is the most common explanation.
About Dementia Symptoms, Diagnosis and Care
Dementia refers to a set of symptoms with many possible causes. Alzheimer's is the most common explanation, but this diagnosis can only be made with certainty after the patient dies. To help ensure that people get appropriate care, doctors can test for many other causes. The care plan will vary based on the diagnosis or suspected cause of dementia symptoms.
Symptoms of Dementia
General symptoms of dementia are:
- Impaired memory
- Impaired communication
- Decline in everyday living skills
More specifically, dementia symptoms may involve cognition, behavior, mood, psychology and muscle coordination as listed below. These symptoms vary from patient to patient. With Alzheimer's, Parkinson's and other progressive diseases, symptoms gradually become more numerous and more severe.
Cognitive Symptoms of Dementia
Impaired memory and disordered thinking are classic symptoms of dementia. These might be described as:
- Memory loss
- Mental confusion
- Inability to recognize common people, places and things
- Inability to speak
- Inability to understand speech
Confusion sometimes explain another symptom of dementia: “making things up” or confabulation. Possibly because a person cannot recall facts, he or she draws from different ideas to make sense of the world.
With Alzheimer's disease and other forms of dementia, confusion is strongest in the evening. This symptom is sometimes called sundowning.
Behavioral Symptoms of Dementia
Restlessness is a symptom associated with many types of dementia. It might be manifested as fidgeting, insomnia, pacing, and/or wandering and getting lost. With Lewy body dementia in particular, acting out dreams during sleep is a common complication.
Dementia is also associated with irritability. Irritability with dementia can stem from frustration, hormonal imbalances and other causes. Sometimes the irritability marks a profound personality change. It might accompanied by a general lack of restraint with words and actions.
Mood and Other Psychological Changes
As just mentioned, irritability is common with some forms of dementia. Loneliness, anxiety and depression are common too.
Paranoia is sometimes a symptom of dementia. In some cases paranoia is a response to memory loss and the inability to recognize others. Paranoia might also have a biological cause.
Hallucinations are common with Alzheimer's, Lewy body dementia and other kinds of dementia. For example, a person might perceive shapes that aren't present, or have a conversation with an unseen person. Hallucinations could be visual, auditory or sensory.
As explained below, antipsychotic medications are generally not recommended for seniors with dementia. The medications may increase the risk of stroke or death.
In addition to cognitive and psychological symptoms, dementia sometimes has muscular symptoms. The inability to coordinate muscle movements can bring unsteady walking and cause a person to fall. Trouble with muscle coordination may also lead to impaired speech, bladder control problems and other symptoms.
Diagnosing the Cause of Dementia
The most common forms of dementia are irreversible. These include Alzheimer's disease, Lewy body dementia and vascular dementia. However, some forms of dementia can be cured. Accurately diagnosing the cause of dementia allows for the most effective treatment and the best quality of life. It can also help patients and their families plan for senior care.
Tests for Dementia Causes
Diagnosing the cause of dementia can include a wide range of lab tests such as:
- Blood tests for electrolytes, glucose, vitamins, oxygen and other nutrients
- Blood tests for ammonia and heavy metals such as lead and arsenic
- Kidney tests (levels of BUN and creatinine)
- Liver tests
- Thyroid tests
- Spinal tap
Brain scans can be informative too. An EEG (electroencephalogram), CT scan or MRI scan can help rule out brain tumors and other possible causes of dementia.
Note that a PET scan may show the presence of amyloid plaque, which is associated with Alzheimer's, but it cannot diagnose the disease with certainty; many seniors who have amyloid plaque do not have dementia.
Neurological tests are also part of diagnosing dementia causes. These tests may focus on:
- Eye movement
- Muscle tone
- Sense of touch
Results from neurological tests could suggest that dementia results from stroke, Parkinson's disease, Lewy body dementia or other causes.
Reversible and Preventable Causes of Dementia
Tests listed above can help determine whether dementia is reversible. For example, blood tests might identify malnutrition and thyroid trouble as contributing to symptoms.
- Malnutrition – Malnutrition or having trouble absorbing protein, Vitamin B1, Vitamin B12 and other nutrients may cause symptoms of reversible dementia.
- Thyroid Hormone Imbalance – Too much or too little thyroid hormone can bring symptoms of dementia such as paranoia and memory loss. If treated early enough, dementia related to thyroid hormone disorders may be reversible.
- Reaction to Medication – Dementia can be an unintended but reversible side effect of medication.
Some causes of dementia are preventable. Knowing this, you can avoid causing or exacerbating the symptoms. Some examples:
- Repeated episodes of hypoglycemia (low blood sugar) sometimes cause dementia. One way to avoid hypoglycemia is to avoid developing diabetes, or to manage Type II diabetes with diet and exercise so that insulin injections aren't needed.
- Environmental toxins sometimes cause dementia. Lead is an example. Other heavy metals causing dementia are arsenic, mercury and manganese. Ensuring that your household water supply isn't contaminated by heavy metals can help prevent dementia.
- Alcoholism causes dementia in different ways. One is by creating a thiamine deficiency (a low level of Vitamin B1). Normally the brain uses thiamine to convert sugar to energy.
- Vascular dementia is caused by a stroke, which starves the brain of oxygen. Many cases of dementia would be prevented if blood pressure were kept within a healthy range through diet, exercise and/or medication.
The best dementia care is tailored for specific symptoms and their causes. Here we provide care details for common dementia causes.
Care for Reversible Dementia
Examples of reversible dementia are cases caused by hormonal imbalances, nutritional deficits and tumors.
Hormonal imbalances might be treated with thyroid medication, which can regulate the thyroid hormone triiodothyronine and its precursor thyroxine.
In the case of nutritional deficits, dietary changes and vitamin supplements might be the most obvious treatment. Also keep in mind:
- Nutrient absorption can be compromised by treatable gastrointestinal problems.
- If malnutrition is a complication of a mental health issue such as anorexia or depression, then the best dementia care would include help from a psychologist, psychiatrist and/or social worker.
- If malnutrition results from poor mental health and/or physical decline, then home care might be part of treatment. Meals on Wheels or help from a professional homemaker could help prevent a dementia relapse.
Tumors are sometimes reversible causes of dementia. If a tumor interferes with the pituitary gland or adrenal glands, for example, dementia could result. Removal of the tumor could restore mental functions.
This set of reversible conditions is not exhaustive. Dementia resulting from sleep deprivation, alcoholism and other causes may be reversible as well.
Korsakoff Syndrome Dementia Care
Korsakoff Syndrome or Wernicke-Korsakoff Syndrome is dementia resulting from a severe deficiency of thiamine or Vitamin B1. Approximately 25 percent of patients recover completely.
Treatment includes Vitamin B1 supplements, often in the form of injections. Other vitamins may be part of therapy as well. Additionally, Korsakoff Syndrome generally results from a condition such as alcoholism or anorexia that requires its own treatment.
Parkinson's and Lewy Body Dementia Care
Parkinson's disease and Lewy body dementia are separate diagnoses, but each is associated with the buildup of Lewy bodies on brain cells. Lewy bodies are made of a protein called alpha-synuclein. Additionally patients with these diagnoses have the neural build-up of a protein that's associated with Alzheimer's.
Treatment for dementia resulting from Lewy body dementia and Parkinson's may include Alzheimer's drugs called cholinesterase inhibitors, which support higher levels of neurotransmitters in the brain. These drugs have not been FDA-approved for treatment of these diseases but have been shown effective in some patients.
Lewy body dementia generally should not be treated with antipsychotic drugs. These drugs could worsen problematic behaviors and may even cause death.
Note that drugs prescribed to treat the Parkinson's symptoms of rigid muscles and slow movement sometimes cause dementia.
Vascular Dementia Care
Vascular dementia is caused by the loss of oxygen to the brain. (Loss of oxygen kills brain cells.) It is abbreviated VaD and is also called multi-infarct dementia.
Vascular dementia is diagnosed by brain scans that show weakened blood flow to the brain. Most often the condition results from a stroke.
Medication to increase blood flow is a primary treatment for vascular dementia. After that, the required care varies depending on which part of the brain is damaged. For example, one stroke patient might benefit from physical therapy for help with walking, and another might benefit from speech therapy.
Vascular dementia care may also include medications called cholinesterase inhibitors, which support a chemical messenger in the brain.
In some cases symptoms of vascular dementia diminish over time. The body grows new blood vessels, and different brain cells replace those that were damaged.
Care for less common forms of dementia is outlined at the Alzheimer's Association website alz.org. Remember that regardless of diagnosis, the quality of caregiving makes a difference to the patient's well-being. Here are a few general tips for caregivers:
- All dementia patients benefit from peaceful settings without noise, bright lights or clutter.
- Dementia patients sometimes express worries that seem illogical. Caregivers can minimize stress by resisting the urge to correct the logic, giving gentle reassurance that all is under control, and then attempting to redirect attention.
- Following a daily routine adds predictability to life and can help offset anxiety and confusion. Having regular times for arising, eating meals and going to bed can also help ease sleep disturbances that accompany Alzheimer's disease and some other forms of dementia.