A Guide to Dementia Memory Care

Dementia vs. Alzheimer’s Disease

What is the difference between dementia and Alzheimer’s disease? These terms are often used interchangeably, but they are not the same. Dementia is not a specific disease but an umbrella term for different conditions that cause progressive problems with thinking or memory. Alzheimer’s disease is one type of dementia.

What Is Dementia?

Dementia is progressive problems with cognitive functioning that interfere with a person’s ability to handle tasks of everyday living. Symptoms may be subtle at first and develop over time before they get severe enough to interfere with functioning.

When symptoms are present but the person is still well enough to do all of their usual activities, they might have mild cognitive impairment, or mild neurocognitive disorder. When they begin to have difficulties with tasks such as working, managing their finances, or driving, they are considered to have crossed the threshold into dementia, which is also called major neurocognitive disorder. Cognitive functioning has multiple domains, such as these:

• Learning and retrieving information
• Storing and remembering information
• Planning and executing actions
• Speed of processing
• Motor/movement speed
• Language functioning
• Visual-spatial functioning

There are many causes of dementia. Alzheimer’s disease is the best-known and one of the most common. Other subtypes of dementia include vascular dementia, dementia with Lewy bodies, Parkinson’s disease dementia, corticobasal degeneration, and primary progressive aphasia.

While the treatments available for dementia are limited, and there is no way to cure these conditions, understanding the subtype(s) causing the symptoms is still helpful because it allows patients and their families to plan and get appropriate care. Doctors may perform different kinds of tests to diagnose the cause of dementia depending on the person’s symptoms. Sometimes a person has more than one type of disease-causing their dementia symptoms; in this situation, they have what’s called “mixed” dementia.

Some kinds of injuries, illnesses, or medical treatments can cause damage to the brain that affects cognitive functioning. When those changes occur at the time of the brain damage and stay stable afterward (do not get worse), they are not considered dementia, even if the changes are severe enough to interfere with daily function.

Diagnosing Dementia

While dementia is not reversible, some reversible conditions can show up with similar symptoms. Therefore, anyone with memory loss or changes in thinking should get evaluated for other causes of their symptoms. If the cause does turn out to be dementia, it is helpful to figure out which type of dementia so that the right treatments can be given. It can also help optimize quality of life and help patients and their families plan for senior care.

Doctor’s Visit

Someone experiencing changes in memory may talk to their primary care provider about seeking memory care, whether a general internal medicine doctor, a family practice doctor, or a geriatrician. They may also see a specialist in general neurology, behavioral neurology, memory disorders, geriatric psychiatry, or neuropsychiatry. The doctor will want to know about the details of the illness and perform an exam. Here is an overview of what to expect at this initial exam.

History

The doctor will likely ask about the following:

• Onset: When did the symptoms begin?
• Progression: Did they get gradually but steadily worse over time? Did they worsen suddenly and then plateau? Did they start recently or a long time ago?
• Cognitive domains affected: Is it just a memory problem? Or is the person having trouble with language and speaking, planning and carrying out tasks, or other aspects of thinking?
• Accompanying symptoms: Are there changes in movement or mood?
• HCP: Is someone chosen as a health care proxy?

Examination

The doctor may perform a general physical exam to look for changes that might signal a different medical cause. Then he or she will likely perform a neurological exam. This includes assessment of the following:

• Muscle strength and tone
• Movement of muscles in the body and face, including the eyes and tongue
• Rapidity of movements
• Tremors or twitching
• Walking: balance, stride, turning, and accompanying movements
• Balance at rest
• Sensation
• Reflexes
• Vision and visual perception
• Hearing
• Sense of smell
• Speech
• Orientation
• Memory
• Attention
• Mood and anxiety

Next Steps

At the end of the visit, the doctor will likely understand what could be wrong but will probably need you to complete some tests before diagnosis.

Laboratory Tests

Laboratory tests can help identify some common causes of cognitive changes. These might include blood tests, urine tests, and tests of the spinal fluid (cerebrospinal fluid, or CSF) to measure the following:

• Blood counts
• Electrolytes
• Glucose and hemoglobin A1C levels
• Presence of ammonia or heavy metals such as lead and arsenic
• Kidney tests (levels of BUN and creatinine)
• Liver function
• Thyroid-stimulating hormone level
• Vitamin levels
• Autoantibodies
• Urinalysis
• CSF cell counts and protein
• CSF amyloid and tau

Brain Imaging

Along with lab tests, brain scans can be informative. There are a few types of brain scans the doctor may recommend.

MRI

The first scan the doctor will recommend to evaluate cognitive changes is often an MRI (magnetic resonance imaging), which looks at the brain’s structure. If there are abnormal changes in the brain’s shape, such as certain regions being thinner or smaller than expected, this can help identify the likely problem, especially in combination with the symptoms. Brain MRIs can also rule out the possibility of another cause for the changes, such as a tumor or stroke.

PET Scans

Some people getting evaluated for brain changes will also get a PET scan (positron emission tomography). PET scans use radioactive molecules to stick to something that will go into the brain, and then the picture can be taken with a special camera. There are different types of PET scans.

In FDG-PET, radioactive fluorine is attached to a special sugar that is taken in by brain cells. By looking at where the radioactive sugar shows up in the brain, doctors can tell which parts of the brain are active. PET scans can also be done using Pittsburgh compound B, which attaches to amyloid in the brain and can help identify Alzheimer’s disease. However, this is not yet widely available.

Other Scans

A SPECT scan, or single-photon emission computerized tomography, uses radioactive compounds to measure brain blood flow. DaT scans, or dopamine transporter scans, are used to identify Parkinson’s disease.

EEG (electroencephalogram)

If any abnormal movement symptoms are repetitive, or there are any repetitive changes in awareness, an EEG may be performed to see if seizures are occurring. Seizures can be a cause of changes in cognitive functioning, but they can also occur alongside the onset of dementia.

Neuropsychological Assessment

Often, people with cognitive changes will undergo a comprehensive evaluation of their thinking and memory. This is called a neuropsychological assessment or neuropsychological evaluation, and a neuropsychologist usually performs it. Tests may be done with paper and pencil or a computer. These measure executive function, learning, memory, language, visuospatial function, and motor function. These tests can take a long time, often two to three hours.

Putting It All Together

None of the tests described here are diagnostic by themselves. Instead, doctors look at all of the tests and symptoms together to figure out the cause of the problems.

Symptoms of Dementia

The symptoms of dementia develop as different parts of the brain stop working properly. As a result, dementia symptoms can vary greatly, depending on which parts of the brain are affected and not working properly. These are some common early symptoms:

• Impaired memory
• Difficulty staying organized, planning, or handling multiple streams of information
• More trouble learning new information and pulling it out when needed

These are some common later symptoms of dementia:

• Decline in everyday living skills
• Difficulties with cognitive domains not affected earlier on
• Disorientation

Cognitive Symptoms of Dementia

• Memory loss: can be rapid forgetting, trouble learning new things, or forgetting things previously known
• Trouble remembering words or speaking in normal patterns
• Inability to recognize familiar people, places, and things
• Trouble following instructions
• Difficulty navigating familiar routes
• Disorientation

Behavioral and Emotional Symptoms of Dementia

• Impulsivity
• Depression
• Anxiety
• Irritability
• Paranoia: can be increased by not recognizing others or not remembering where things are and believing they have been stolen
• Hallucinations
• Restlessness
• Wandering

Motor Symptoms of Dementia

• Poor balance
• Falls
• Gait changes
• Abnormal uncontrolled movements
• Muscle jerks or twitches
• Poor bladder or bowel control
• Trouble speaking or swallowing
• Tremor or shaking
• Poor coordination of intentional movements

Watch the video with geropsychologist Abby Altman, Ph.D below for more information on the symptoms and the warning signs of dementia.

Dementia Care Overview

In general, people with dementia do better in familiar environments with familiar people. These are a few ways to help create consistency and familiarity for those with dementia.

• Location and caregivers: Have a consistent home base and consistent caregivers for the person with dementia.
• Cues from the environment: Dementia patients can become more confused if they do not have cues from their environment that orient them. Therefore, it helps to make sure they see daylight during the daytime and have a dark sleep environment at night.
• Time: It can be helpful to hang a calendar or sign near them that identifies the year, month, and date.
• Sleep: Good sleep is essential, so removing sources of light or noise from the bedroom can help.
• Health: People with dementia are vulnerable to more confusion if they get sick, so it’s essential to avoid contact with people who are ill and promptly treat any infections (such as pneumonia or urinary tract infections).
• Medications: Avoiding anticholinergic medications is very important in dementia care. It’s also important to take advantage of tools like a medication dispenser to ensure the person with dementia takes the right medication at the right time.

Dementia Subtypes

There are several types of dementia, each with its own set of symptoms. The main dementia subtypes are covered in more detail below.

Other Subtypes of Dementia

There are more types of dementia than are described here. For information on other subtypes of dementia, consult your doctor or reputable websites such as the Alzheimer’s Association.

Need Help Accessing Dementia Care?

If you are looking for dementia care, call our dementia helpline or search our expansive directory of dementia care facilities.