When a loved one begins to show troublesome signs of changes in behavior, especially if related to memory, understanding the why behind the behavior is extremely important. Dementia is only the word used to describe the collection of changed behaviors, not a separate disease. They are only symptoms pointing to a variety of different causes. Often, symptoms may be the result of physical problems or illness unrelated to long term dementia. Examples might be urinary tract infections or other causes for which treatments might eliminate the problem behaviors.
Managing and treating dementia behaviors depends in great measure on knowing which underlying disease is behind the change. Not only does understanding enable proper treatment, it can impact long term care planning and the necessary legal documents.
For example, knowing which disease(s) may be involved helps project the time-frame for asset preservation strategies, the kinds of documents and interventions that may be required along the way, and the variety of supportive services available. Most importantly, it gives guidance as to what care options might be needed as the disease progresses, for example, home-care, assisted living, memory care or skilled nursing.
WHAT IS DEMENTIA?
Dementia is a descriptor for changes in a variety of behaviors:
MEMORY - look for changes in ability to retain new learning and recall. Memory involves the processes of encoding, storing and retrieving information. In dementia, making new memories is generally most impaired. That is why individuals with dementia can often remember minute details from their past, but be unable to remember what they did ten minutes earlier.
LANGUAGE - look for what is referred to as aphasia. Individuals with aphasia may have one or more of these problems:
Difficulties producing language:
- difficulty coming up with the words; finding the wrong words
(e.g., “beef” for “steak”);
- switching word sounds (e.g., “wave migrator” for “microwaver”);
- difficulty putting words together to form sentences;
- making sentences that flow, but make no sense.
Difficulty understanding language:
- misunderstanding, especially when spoken fast (e.g., radio or television news);
- finding it hard to understand what is said in large groups or with loud background noise (e.g., in restaurants);
- misinterpreting jokes or taking figures of speech literally
(e.g., “he eats like a pig”; “she’s dying of shame.”)
Difficulty reading and writing:
VISUAL - look for what is referred to as agnosia, difficulties with visual/spatial matters. Individuals with agnosia may have one of more of these problems:
- inability to locate items in space;
- inability to identify (e.g., faces or objects)
MOVEMENT - Apraxia refers to movement issues that are not related to physical causes. Apraxia can occur in a variety of forms. For example, someone suffering from orofacial apraxia is unable to voluntarily perform certain movements involving facial muscles (e.g., inability to lick their lips or wink). Apraxia can also affect a person’s ability to intentionally move their arms or legs.
EXECUTIVE FUNCTION - look for changes in a person’s ability to organize ideas or the flow of steps in a complex task (e.g., organizing or following schedules for medications) or exercise good judgement (e.g., handing someone a blank check to fill out).
WHAT ILLNESSES CAN DEMENTIA POINT TO?
Symptom and behavior management and treatment require as clear as possible correct diagnosis of the underlying disease. Treatment for the wrong disease in someone showing signs of dementia can be like pouring kerosene on an open fire.
Here are five different diagnoses that can be made in dementia:
Lewy Body Disease
Mild Cognitive Impairment
Let’s look at each one.
Alzheimer’s Disease (generally slow decline with plateaus of stability)
This is a brain pathology that reveals itself through structures that over-run the brain and are believed to be the source of damaging and killing of brain cells. Plaques are deposits of protein fragments called beta-amyloid which build up in the spaces between nerve cells. The other, Tangles, are twisted fibers of another protein called tau that build up inside cells. Though most people develop some plaques and tangles as they age, those with Alzheimer’s tend to develop far more. They also tend to develop them in a predictable pattern, beginning in areas important for memory before spreading to other regions. While scientists don’t know specifically the role of plaques and tangles in Alzheimer’s, it is suspected that they block communication among nerve cells and disrupt processes that cells need to survive. It is this destruction and death of nerve cells that causes the memory failure, personality changes, problems in performing daily activities and the other symptoms of Alzheimer’s Disease.
Vascular Dementia (progressive decline)
Vascular dementia is a dementia generally related to stroke or similar brain traumas. VD can show a progression as the number of strokes or TIAs (small stroke incidents) increase. Often it will appear as a focal deficit (a neurological problem affecting a specific location (e.g., the left side of the face, the left arm or even a small area of the tongue.)
Lewy Body Disease (LBD) (often rapid, dramatic declines)
Pathologically, LBD is characterized by the development of abnormal collections of certain kinds of protein within the cytoplasm of neurons (these proteins are known as Lewy bodies.) These are intracellular collections of protein and are very similar to the pathologies associated with Parkinson’s disease. For many, it is like having Parkinson’s without the tremors. It presents itself via difficulties in balance, falls, blackouts and often hallucinations.
Frontal-temporal Dementia (progressive)
Frontal-temporal disorders are the result of damage to neurons (nerve cells) in the parts of the brain called the frontal and temporal lobes. As neurons die in these regions, they atrophy, or shrink. Gradually, this damage causes difficulties in thinking and behaviors normally controlled by these parts of the brain. For example, victims may exhibit inappropriate social behaviors such as bizarre dress (e.g., dressing for work without socks and shoes) or shouting in a theater as well as focusing on insignificant matters while ignoring serious ones (e.g., focusing on the style of sunglasses the officer who puller her over is wearing).
Mild Cognitive Impairment (MCI)
MCI is generally the diagnosis for individuals who are experiencing isolated episodes of memory loss or mild changes in a number of areas of thinking. These difficulties don’t impact activities of daily living but are nevertheless noticeable; which can cause distress both in the individual experiencing the changes as well as those around him. In a society where the concern for Alzheimer’s disease is so strong, these experiences can be terrifying. However, examination by a health-care professional trained in the differential diagnoses of dementia can determine if the experiences are precursors to Alzheimer’s or the impact of physical ailments or other causes such as depression.