Understanding Dementia Types And What Caregivers Need To Know

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Welcome to Patty's Place. It's a place where we will talk about grief, dementia, and caregiving. I'm your host, Lisa. I dedicated this uh podcast in honor of my mom, Pat, who passed away from dementia about two years ago. And so I want this to be a place where we can talk about these things and you'll not feel like you're alone in all this because it is very overwhelming. So pull up your cup of tea, your cup of coffee, or if you're having a really bad day, that glass of wine. And I thought today we would talk about, we haven't talked about this in a little while, but the difference between understanding Alzheimer's and dementia, because it is very um, you know, we use the terms interchangeably, but they're not interchangeable. And especially if you watch a lot of TV and stuff, they they use they use them interchangeably, and they're not. So if you uh the Alzheimer's Association website has a lot of very, very good information on it. So Alzheimer's is the most common cause of dementia, and it's a general term for memory loss and cognitive abilities, seriously enough to interfere with daily life. So Alzheimer's disease accounts for 60 to 80 percent of dementia cases. So what's the difference, right? The difference between dementia and Alzheimer's. So dementia is a general term for symptoms like decline in memory, reasoning, or other thinking skills. So it's an umbrella term if you look at it like that. And it also encompasses a collection of different symptoms. So like your cognitive, functional, and behavioral, and they're caused by specific diseases. Alzheimer's is the disease most the most common disease that causes dementia. But there's also frontal temporal degeneration. That's one of the diseases that, like, say Bruce Willis has. He has several other ones, but that is one of his diseases that they that he has. Uh Lewy body disease. That's another one that is what they said Robin Williams had. There's also vascular disease, can also cause symptoms of dementia. Um, they think my mom had some of that uh with it, but not all cognitive decline is considered dementia. So dementia is driven by an underlying progressive neurogenerative disease. So as you start to learn about the two terms and the differences between them, it's important because when you are dealing with somebody who you think might have Alzheimer's dementia with their with your family and your caregivers, you have to understand the difference with it. And you'll come to find out that a lot of people don't. It is a learning curve, it's an experience because it's very overwhelming. So look at it like this. So we'll start with dementia. Dementia describes a group of symptoms, it's usually associated with your decline in memory, your reasoning or thinking skills. And there's many different types of dementia, as I just mentioned, uh, with it. So usually like it's the umbrella of dementia with it. Uh, and many different conditions can cause it. They don't really have that one thing that says, oh, you have this, this causes dementia. And that's part of why this disease is so overwhelming and you feel so helpless and frustrated because they really don't completely know what causes it. A lot of times people will have what's called mixed dementia, and that's a condition in which the brain changes, and there's more than one type of dementia dementia that occurs simultaneously with the Alzheimer's disease. That's what I was referencing that uh the report say Bruce Willis has a couple different types of dementia, and sometimes people do, it's a mix of them. So, like I said, Alzheimer's is the most common for it. Now, here's the thing dementia is not a normal part of aging. Okay. You know, we say that and we joke about that, but when you are actually dealing with somebody who has it, it is completely different. So, what it does is what dementia does is it it is caused by damage to brain cells that affects their ability to communicate, which then of course affects your thinking, your behavior, and your feelings with it. So, what are some of the symptoms? So it could be some of the examples would include problems with your short-term memory. So, your short-term memory is what did you do yesterday? What did you do a few hours ago? You know, we joke sometimes, people say, Where were you on such and such date? And you're like, I'm lucky I remember what I had for lunch yesterday. A lot of times with dementia patients, they can remember what they did 20, 30, 40 years ago. And sometimes they think that's where they are, but they truly can't remember what they just did five minutes ago. So maybe it's also keeping track of a purse or a wallet or your keys. You know, sometimes people will joke like, oh my God, I lose my phone all the time, or I lose my keys. That's a normal thing. But if it's like consistent, like they cannot keep track of it. They, you know, they lose things all the time. And a lot of times then they find in um they f you'll find the item in like the weirdest places. Um when with my mom, uh, my mom was never a big cell phone user. She only had a flip phone and and we only did it for emergencies. But when we you know, she had to go into memory care, and my dad was cleaning out the house, and he found her cell phone. It was wrapped in paper towels, wrapped in a sock, in the back of a box, in a in the back of a cabinet. Like it was ridiculous. Or she had those dis you know how you buy the the disposable, the the wands to clean your toilet bowl. I cannot tell you how many of those my dad and I found in my mom's dresser. It's like those types of things. Paying bills. They can't pay the bills anymore. They think they paid them, but they didn't. Or maybe they start signing it, say uh a a woman may sign it with her married name uh, I'm sorry, her maiden name instead of her married name, those types of things. So that so all of a sudden you realize, wait a minute, they didn't pay the bills. And this might have been somebody who was always on top of things, planning and preparing meals. My mom was a wonderful cook, and she started where she she just couldn't do it. I I think I've told the story before where she was making pizzas and they should have been on a round pizza pan, and she she couldn't find them. And so what she did was is she flipped the square pans and she put the crust uh on the flipped square pan. Well, obviously it started um it dripped, and so then the oven started to smoke and everything, and well, obviously we didn't have pizza that night, the homemade pizzas, we ordered pizza, but what was in her mind was that my dad had hid the pans and he did it on purpose to her, and well, he he didn't. So it's those types of things, or you know, things that they normally make all the time and they can't do it anymore. Like it, or it doesn't turn out. It's those types of things, not like, oh my god, they forgot to buy, you know, milk for the for the one recipe. Remembering appointments or remembering dates. My mom was always really good with birthdays and in appointments and stuff, and she didn't remember people's birthdays anymore. Like I had to tell her, hey, this is an important date, or this is so-and-so's birthday. It just didn't mean anything to her. Uh, traveling out of the neighborhood, that's a big one too, where all of a sudden people who my mom was never good with directions, but she knew how to get to the places she wanted to go to. So it's a common one, especially when they're driving, and you have to really pay attention to these things because they get lost easily, you know, and it's it's not just they got lost to someplace they'd never been before. It's they got lost coming from the store that they go to all the time. Or my mom would be the library. I think that's what happened to my mom. She never said it, but that's when she stopped driving. She blamed it on my dad. She blamed it that he bought the this car that she didn't like and it was too big. But I I think looking back, she probably got turned around and it scared her. So she just said she was never driving again. So it's those types of things, but they're progressive. It's not just something that happens right away. Um you have to kind of slowly pay attention. So it means that their cognitive impairment starts out slowly and it gradually gets worse over time. That leads to the dementia. It's all of a sudden maybe they can't follow watching a TV show. You know, something may be very simple and they can't follow it anymore with it. So, like I said, they don't really know what causes it with it. Now, like there are some different there's different types, the different types of dementia with it. Uh, with that. So those are the different symptoms of them. So we'll kind of talk a little bit about the different types for it in case you're wondering, because it does worsen over time with it for it. Um now early symptoms are things you need to kind of pay attention to with it. And again, there with the different types, sometimes they sometimes you don't exactly know what the different types are until later, and sometimes they're able to figure it out based on what it is. So again, when you want to think about this, is their memory loss is it disrupts their daily life. Okay, it isn't just that, like I said, you misplaced your phone. Uh for my mom, she couldn't figure out how to do the phone anymore. And like I said, she had a flip phone. And I I had to explain to her, I don't know how many times, how to dial a number and it was already stored in there. So it's those types of things, forgetting names, appointments, you know, challenges and planning or solving problems, especially if there were somebody, somebody that they were always good at those things, completing familiar tasks, those types of things. And they get confused with time and place with that. They might might also have trouble understanding visual images and spatial relationships, or they have problems with words or speaking and writing. I know for my mom, uh, the one time I noticed when we went, uh, I believe it was for her MRI, and she had a hard time signing her name anymore. Those types of things for it. Alzheimer's, like I said, is one type of dementia for it. So we'll start with the mixed dementia. So mixed dementia is the most common form for it. It's uh they think it's their abnormal protein deposits associated with the Alzheimer's disease, and it also coexists with blood vessel problems linked to vascular dementia. So Alzheimer's brain changes can also coexist with Lewy body. In some cases, a person may have brain changes linked to all three conditions Alzheimer's, vascular, and dementia with Lewy body. So, vascular dementia. So you're like, okay, that's nice. What is that? So vascular dementia is a decline in your thinking skills caused by a condition that blocks or reduces blood flow to various regions of the brain. So it deprives them of oxygen and nutrients. So an inadequate blood flow can damage and eventually kill cells anywhere in the body, but the brain is especially vulnerable. So in vascular dementia, changes in thinking skills sometimes occur suddenly. It could be after a stroke, which could block blood vessels in the brain. Thinking difficulties may also begin as mild changes, and then they gradually worsen as a result of multiple minor strokes or another condition that affects smaller blood vessels. A lot of experts prefer the term vascular cognitive impairment or VCI to vascular dementia because they feel it better expresses the concept. So the vascular brain changes, it often coexists with changes linked to other types of dementia, which again could be Alzheimer's, could be Lewy body. So a lot of times they've done some studies and they found that vascular changes and other brain abnormalities may interact in ways that might increase the likelihood of dementia diagnosis. So they think about 5 to 10% of people with dementia may have vascular dementia alone. It's more common as part of a mixed dementia. Many experts believe that vascular dementia remains undiagnosed, like Alzheimer's disease, even though it's recognized as the most common. Now, on my mom's death certificate, they listed vascular dementia. So hers could have been obviously that's what the doctor said. My mom had some heart problems growing up. So, and she always and she had a heart murmur for the rest of her life. And at one point they thought she might have had to have valve surgery on her heart. She didn't end up having that. So it is quite possible that is what led to my mom's. I don't really know, but that's what the heart certificate said. So it is always something to look at too. Like it, like I said, when they say what strokes or heart attacks or things like that, because if the brain isn't getting enough oxygen, that can cause it as well. So think about it like this. So here are some of the symptoms. So the impact of the vascular conditions on your thinking skills, it kind of varies, you know, on it. So it really depends on the severity of the blood vessel damage and the part of the brain it affects. So the memory loss may or may not be significant, uh depending on the specific brain areas where the blood flow is reduced. And that's kind of the fascinating part about dementia. Everybody is different because it all depends on what part of the brain it affects and when for it. So vascular damage that starts in the brain area, they also can play a key role in storing and retrieving information, and it may cause memory loss that's similar to Alzheimer's disease. So some of the symptoms that are the most obvious when it happens could be after a major stroke or sudden post-stroke changes in thinking and perception may include. This can also include, you know, sometimes people have mini strokes and they don't know that they had mini strokes, but then they start to notice the different changes. So there could be confusion with them, a disorientation, trouble speaking or understanding speech. Obviously, uh, you know, if they have a physical stroke symptom such as the sudden headache or that, they might have difficulty walking or they might have poor balance. Obviously, they may have a numbness or paralysis on one side of the face. Uh, and like I was saying, they may have multiple small strokes or other conditions that affect the blood vessels and the nerve fibers deep inside the brain. So a lot of times the common early signs may widespread with small vessel diseases. And again, that could include impaired planning and judgment. Maybe they have uncontrollable laughing and crying, uh, and they maybe just stop paying attention. Like you notice they're in a social situation and you could just tell they're zoned out, they're not paying attention, they're not participating, and they might have been somebody who always did. So they have impaired function in social situations and they have difficulty finding the right words. So there are diagnostic guidelines for vascular dementia for it. So, again, obviously it's hard to diagnose because it's something that people are like, oh, it's just old age, but it's not. So diagnose of the dementia or the mild cognitive impairment is usually confirmed with they call it neurocognitive testing, and that is with a neurologist. And they might do MRIs, they do sometimes hour-long uh memory tests and things like that. A lot of times the vascular dementia goes unrecognized, and many experts recommend professional cognitive screening for everyone considered to be at high risk. So that would be anybody that has a stroke or those TIAs, those are the transient ischemic attacks with that. So they really don't know what causes it either. A lot has to do with obviously your heart for that. So now there's also so you're so you might have dementia with Lewy body. Uh dementia with Lewy body is a type of progressive dementia that leads to decline in thinking, reasoning, and independent function. And it features, it may include spontaneous changes in attention and alertness, uh, recurrent visual hallucinations, your REM sleep behavior disorder, and slow movement tremors or rigid might happen with Lewy body. So if they're diagnosed with dementia with Lewy bodies is one of the causes of dementia, it's also alongside types of dementia like the Alzheimer's and vascular. So they kind of say, according to Alzheimer's website, uh, Alzheimer's Association website, Lewy body dementia is a broad term that includes both dementia with Lewy bodies and Parkinson's disease, dementia. So we're just going to talk about dementia with Lewy body. So they said that the hallmark brain and abnormalities linked to the Lewy body are named after a doctor, Dr. Lewy. He was the neurologist who discovered them while he was working with Dr. Alzheimer's. That's how we got the that's how we got the name of the disease. So in the early 1900s, so they figured out that alpha cynocline protein is the chief component of Lewy bodies. It's found widely in the brain, but its normal function, they still don't know. And that's one of the other fascinating things about dementia, Alzheimer's, and all of these different types is that as much as they study the brain, there's still so much they don't know with it. And that's why there is no cure for it, and there's really no, they don't really know what causes it. There isn't this one thing where like, oh, eat this and this will help this and things like that. And that's what's so you feel so helpless and you feel so frustrated with it. I mean, they're studying it, they're making a lot of progress, but it's still not there. So a lot of times they say the overlap in symptoms and other evidence suggests that dementia with Lewy bodies or Parkinson's too, uh Parkinson's disease dementia can be linked to some underlying abnormalities and how the brain processes the protein. Uh, a lot of times they think that they have uh plaque entangles, which is a hallmark brain changes leaked to Alzheimer's disease. They know that there's this certain type of plaque that comes on the brain. Um, so a lot of times people have brain changes of more than one type of dementia, and they're said to have mixed dementia. So some of the symptoms of dementia with Louis body would include changes in your thinking and reasoning, fluctuating cognition that is delirium-like, recurrent well-formed visual hallucinations, the REM sleep behavior disorder that involves acting out dreams, spontaneous Parkinsonisms, that one's hard to say, with slowness of movement, the rest tremor, or rigidity for it. Other symptoms could be they have trouble interpreting visual information. So that might be they could be looking right at you or looking at a picture or looking at something visual, and they just it's not comprehending. They just they they don't know how to interpret it. Uh, other malfunctions of the automatic nervous system, which controls the automatic functions of the body, which would be sweating, blood pressure, heart rate, digestion, they they might have malfunctions with that. Uh, the memory loss might be more significant, but it's less prominent than in Alzheimer's. So, as you see, a lot of these symptoms overlap. So that's why a lot of times they say it's a mixed dementia with it, because they're they're very similar with it. As with all the other dementia, there's really no single test that can conclusively diagnose dementia with Lewy bodies. Uh, it's a the dementia with Lewy body is a clinical diagnosis, which means it represents a doctor's best professional judgment about the reason for a person's symptoms. Obviously, the only way they can conclusively know is through an autopsy. That's actually a lot too with uh the Alzheimer's diagnosis, and that is uh the autopsy of the brain. Uh, we thought about doing that with my mom, but in the end we didn't uh with it. Uh so that's always something, I mean, if something if you really want it to know that you you can have that. Um, a lot of experts believe that dementia with Lewy bodies and Parkinson's disease dementia are two different expressions of the same underlying problem with brain processing of the protein. Alpha C. Sinocline, if I'm saying this correctly. So they they recommend continuing to diagnose the Lewy body and Parkinson's disease as separate disorders. So the diagnosis with Lewy body is when a person experiences dementia either before or at the same time or with one year of the onset of symptoms of Parkinson's disease. In some cases, the dementia with Lewy body has symptoms of Parkinson's disease, like changes in movement, but may never occur. The diagnosis in Parkinson's disease dementia is when a person experiences dementia at least one year and usually several years after the onset of Parkinson's disease. And obviously, Parkinson's disease symptoms may include changes in movement, like tremors. So you see, like you look at this and you feel very overwhelmed. You're like, oh my God. And a lot of it is they overlap with it. And at some point, I mean, I always feel like knowledge is power and to understand and to know what you're dealing with as best as you can. But in the end, you still need to know how to deal with any of the different types of dementia and look at it from that the person who's sick point of view and kind of step into their and try to step into their world. And they may not they're in the beginning, some may understand what's going on with them and some may not. And it's important not to get angry with the person who doesn't understand what's going on with them. They're never gonna understand it. They're not trying to be difficult, they're not in denial. It's just the way their brain is functioning. So the information is important for the caregiver to understand and to know and to learn how to deal with it and also to know that they're never gonna get better. And that's really hard to deal with, especially when you're reading all this and you're finding this information and you're like, oh my God. So try to do it in little snippets. Like I know I gave you a lot of information right now, and all of this you can find on the Alzheimer's Association website and look into more information for yourself. It's also good to look at this and go ask questions when you're dealing, you know, when you're gonna go with your loved one to their doctor's appointment to go ahead and ask those questions to the doctor with it because maybe you can get those tests. Now, my mom was difficult. She refused to go for testing. And you might have somebody that is like my mom and doesn't do it until eventually it's pretty obvious and you get her diagnosed through the emergency room with it. But no matter how you do it, you have to have that information and you have to look into who they are and think about how you would want to be treated for it. And it has to be so scary and so difficult when your brain starts to do this to yourself. I mean, think about it like that. How would that feel? That you just don't have control anymore of your brain with it. So if you can kind of think about it like that, when you're learning about these symptoms and knowing what's gonna happen, and think about how would you feel with this? Because it is overwhelming, whether it's dementia, it's vascular dementia, it's Alzheimer's, it's dementia with Louis Body, or it's dementia with Parkinson's. All of it is a lot to deal with and to handle. So just try to take it a little bit at a time, learn what you can. And in the end, like I said, if you look at it, a lot of the symptoms are very similar. So it's just important to learn about it and to understand it and to treat that person, no matter what type of dementia they have, with some dignity and care and think about how would you want to be treated if your brain did that to you for it. And then depending on what parts of the brain shuts off at what time, they also may not be able to, you know, their physical movements stop too, where they can't walk on their own or things like that as well. So hopefully this has been helpful for you today. I know it was a lot of information. Like I said, you can always go back to the Alzheimer's Association website. And hopefully, like I said, you find some comfort in this and knowledge because knowledge is power. So hopefully you will join us next time. So hope you enjoyed your cup of tea, your cup of coffee, or if it was that really bad day, your glass of wine, and you will join us next time on another episode of Caddy's Place.