Written by E. Parsons, BSN, RN & Amanda Thornton, MSN, BSN, RN, CIC, VA-BC
If your physician has recently told you that you or your loved one has “dementia” you may be wondering what exactly the term means. So often on this blog we use this term to describe a set of symptoms that our mother exhibits, but we have yet to fully define the word for our readers. So today, we are going to talk about the word, “dementia.” What exactly does it mean when my loved one has dementia? Are there different types?
If you have ever asked any questions like these, then you’re in good company! The Alzheimer’s Association defines dementia as, “a general term for loss of memory and other mental abilities severe enough to interfere with daily life. It is caused by physical changes in the brain. Alzheimer's is the most common type of dementia, but there are many kinds” (Alzheimer’s, 2022). So what types of dementia are there and how do I tell the difference?
Dementia can often be misunderstood and lumped in as being all Alzheimer dementia related, however there are many forms of dementia. This visual below tries to help explain the most common diagnosis that can be found under the high level “umbrella” that we call dementia. Alzheimer's disease is the most common form of dementia accounting for 60-80% of cases, however there are also many other forms of dementia including Vascular dementia, Huntington’s disease, Parkinson’s dementia, and Lewy body dementia. Again, this is not an all inclusive list by any means, but includes just some of the most prevalent forms of dementia that are diagnosed.
As reported from the Alzheimer's association, an estimated 5.8 million Americans of all ages are living with Alzheimer’s dementia in 2020. Out of the total U.S. population the breakdown is as follows; 3% percent of people age 65-74, 17% percent of people age 75-84, and 32% percent of people age 85 and older have Alzheimer’s dementia. This is, to me, an astounding fact. This, combined with the numbers of aging persons we see on the population pyramid, means the healthcare system will be facing an avalanche of persons who will be presenting with this condition over the next ten to twenty years. Also of note, women tend to experience Alzheimer’s twice as much as men which may partly be due to the fact that women have a longer life expectancy. Interestingly, experts estimate that only 5-15% of cases are due to genetic predispositions but that about half of these cases will have an early onset, meaning that the person will develop the disease before the age of 65 (Huang, 2021).
Patients diagnosed with Alzheimer's dementia or another form of dementia also have specific physical changes that are happening to them which affect their ability to function. Alzheimer’s disease specifically is characterized by plaques that inhibit normal brain processes that alter cellular activities. The majority of research into the causative agent of Alzheimer’s has focused on the idea that clumps of amyloid proteins form plaques and tangles on the neurons in the brain, causing inflammation and cell death. These can fairly easily be seen on post mortem exams, and also on PET scans when patients are alive. However, the presence of such proteins does not always determine that a person will FOR SURE have dementia, and the actual REASON for the buildup of the proteins is still not clear…..there are lots of different theories around this (See out blog titled “Why is there still no cause and no cure for Alzheimer’s? And could it possibly be related to an infectious reason?”).
All of this leads to the conclusion that all the behaviors we see in Alzheimer’s as well as other dementia’s are for a very good reason- a scientifically backed reason. If you think upon human behaviors, these are mostly learned over time from a young age. We act appropriately within situations based on that learning. Patients with dementia diseases have specific changes within their brain that take away that learning, making them unable to continue to act normally as they would have in certain social situations. The accumulation of those plaques and protein's in the brain cannot be cleared causing chronic inflammation, atrophy, and the inability of the brain to use glucose- which is its main source of fuel. As the damage continues, cognitive decline, memory loss, confusion and behavioral symptoms such as depression, apathy, and personality changes begin to emerge. It is also important to note that Alzheimer’s dementia is not a normal part of aging, it is actually a disease, and older age alone is not sufficient to cause Alzheimer’s dementia.
So much more research needs to be done on the causative reason behind dementia, and with the knowledge that a huge amount of people will be suffering from this disease in the near future it cannot come soon enough.
Huang, Juebin (2021) Alzheimer disease. Merck Manual Professional Version. https://www.merckmanuals.com/professional/neurologic-disorders/delirium-and-dementia/alzheimer-disease
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