Dementia’s Many Faces

Dementia has many faces, many ways to teach us how terrible oblivion is. Traditionally, the best known type of dementia is Alzheimer’s disease, but it is not the only form in the world. However, it is the most common.

Contrary to popular belief, not all types of dementia are irreversible. In some cases, if the cause is found out, it can be treated and even corrected. These cases include e.g. Dementias due to vitamin B12 deficiency, vasculitis, hypothyroidism, or hydrocephalus.

Today, all types of dementia belong to the neurocognitive disorders classified by DSM-5. They have been classified together with ringing, amnestic disorders, and other neurocognitive disorders. In these disorders, no cognitive loss or effect has occurred since childbirth or early childhood. Therefore, they exhibit a setback that is evident when comparing the current level of performance to the previous level.

Alzheimer’s type dementia

This type is a degenerative brain disease with unknown causes. Its onset is gradual and means continuous, slow, and progressive deterioration. The average duration of this dementia is often 8-10 years. There is currently no cure for the disease. Three different stages in the development of the disease can be distinguished:

Early stage (about 2-4 years):

The onset of the disease is usually sudden and its main feature is impaired local memory. This is the part of memory that refers to what is happening in the present. In other words, sick people  have difficulty remembering daily chores as well as learning things.

A person with the disease usually loses his or her vocabulary. Because they have a hard time finding words (anomie), they try to solve the situation by using circular expressions, talking around the topic, and telling things in their own words. Telling things in your own words means replacing a word with another word that has pretty much the same meaning.

Changes in personality can also occur, such as apathy (general laziness or lack of interest), irritability, aggression, stiffness, etc. Stiffness is understood as an inability to think flexibly. In other words, the thoughts are obsessive for them. It doesn’t matter how much you try to make sense of things for them, the idea doesn’t change.

Affective changes such as anxiety or depression may also be involved,  as sometimes they are aware of the onset of the disease, especially because they notice their own memory problems. In these cases,  patients and their family members have to adapt to a new lifestyle. And it is a challenge that causes stress and a great deal of pain.

Second phase (about 3-5 years):

Intellectual degeneration continues when aphasic-apraxic-agnostic syndrome appears. This leads to repeated forgetfulness and difficulty in performing simple tasks such as dressing or washing and identifying family members and objects. This syndrome makes monitoring necessary.

Retrograde amnesia also occurs. It means the inability to remember the events of the past. Such individuals often try to cover up the matter by chatting. It consists of inventing events that have never happened but that allow them to fill in the gaps in their memory. However, they do it with no intention of lying.

Their judgment is impaired. They become more impulsive and are unable to distinguish right from wrong or what kind of behavior is acceptable publicly or privately, etc.  Their ability to think abstractly also weakens and results in a lack of problem-solving ability as well as task planning.

Other symptoms worsen and psychotic symptoms can occur, such as hallucinations where an individual says they have spent time with their mother who has been dead for years. Or delusions where they say something has been stolen from them even though they have actually lost it or put it in the wrong place.

At this point, they can no longer be oriented to the time  (hour, day, month, or year where they live) or place (where they live, different rooms in the house, etc.). A person suffering from this stage of Alzheimer’s dementia is unable to survive without supervision. They need supervision even if they are able to perform basic daily tasks on their own. 

Third stage (variable duration):

During this stage, the individual does not identify himself in the mirror  because he thinks he is younger than the person he sees in his mirror image. Nor do they recognize the people closest to their lives. Their speech becomes constantly slower and they gradually become dumb.

Difficult changes appear in their walking. For example, they walk in very short steps and mixing or pulling their legs is the most characteristic feature. This can lead to stumbles and falls, followed by walking apraxia (inability to walk because they have forgotten how to do so). At this point, the patient needs help to do virtually everything, and it usually leads to bed rest. 

Lewy body dementia

Lewy body dementia is one of the most difficult types to distinguish. In addition, it is found at the most recent stage. This is because this type of dementia has some of the same symptoms as Alzheimer’s disease and Parkinson’s disease and is therefore usually confused with either of these. Lewy body dementia is now considered the second most common type of dementia.

The symptoms of this type are mainly as follows:

• Aphasic-apraxic-agnostic syndrome: this syndrome is typical of Alzheimer’s disease and includes repeated forgetfulness, difficulty performing simple tasks, and identifying family members or objects. In this case, it is characterized by significant variations in attention and alertness.
• Repetitive and complex visual hallucinations  as well as auditory hallucinations and delusions. Symptoms associated with REM sleep disorders are very common (which may be an early manifestation), in addition to other hallucinations such as modal senses, depression, and delusions.

• Symptoms of Parkinson’s disease. As with Parkinson’s disease, these include tremor and extreme stiffness.

Spontaneous Parkinson’s symptoms usually begin when cognitive decline begins. Larger neurocognitive impairments appear at least one year before motor symptoms. They should also be distinguished from extrapyramidal symptoms produced by neuroleptics. These are motor symptoms caused by a drug used to treat hallucinations and confusion. As many as 50% of people with NCD in Lewy songs have a significant susceptibility to these drugs.

They often suffer from repeated falls and syncopations which are temporary losses of consciousness. These are accompanied by a momentary paralysis in heart movements and breathing. These are due to a lack of cerebral circulation as well as unexplained loss of consciousness.

Vascular dementia

Vascular dementia is caused by a series of small strokes that occur over a longer period of time. These vascular strokes are blockages or interruptions in blood circulation to a specific part of the brain and cause the death of nerve cells in that area.

It is characterized by a decline in phases whose symptoms are difficult to predict because they depend on the area of ​​brain activity to which they are directed. Nevertheless, in the early stages of the disease, a person is characterized by recurrent forgetfulness and orientation problems. Personality changes or difficulty speaking may also occur.

Parkinson’s dementia

This type of dementia, Parkinson’s dementia, is a different matter from Parkinson’s disease. Parkinson’s disease is associated with tremors in the hands, feet, chin, and face; stiffness of hands, feet and body; slowing down of movements and problems of balance and coordination.

This type of dementia is characterized by the typical tremor of Parkinson’s disease as well as cognitive slowing of upper functions and very important mental changes.  These patients often have severe depressive states.

This type of dementia differs from other types in that the aphasia-apraxia-agnostic syndrome does not appear as it does in Alzheimer’s disease. Nor are hallucinations and delusions as significant or common as in Lewy body dementia. However, cognitive slowing and body tremor are accentuated.

This article describes the most common types of irreversible dementia. However, there are other types of dementia, such as frontotemporal types, of which Pick’s dementia is one of the most common, Huntington’s disease, HIV-related dementia, and prion-induced dementia.