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Types of Dementia
Human body has a various kind of organs. For example, heart, liver, lung, joints and brain. At certain age, the function of these organs starts to deteriorate. For example, cataract formation in the eyes, cardiovascular disease, arthritis and kidney failure etc. Brain is no different from any other organs in the body. With time, brain function also will deteriorate, such as forgetfulness in old age.Side view of the brain

Forgetfulness or memory impairment in the elderly is not a disease, but a natural phenomenon. The age starting forgetfulness and degree of forgetfulness vary from person to person. Unfortunately, forgetfulness also signals the beginning of one of the most feared diseases—Alzheimer’s disease.  The problem of severe Alzheimer’s disease is not only a medical but also a social problem. To a certain extent, Alzheimer’s disease is hereditary. That is why people are so concerned about their family members having Alzheimer’s disease, and this concern gives such a bad stigma to Alzheimer’s disease.

How do you know that you have Alzheimer’s disease?
If you can laugh at your own forgetfulness, you do not have Alzheimer’s disease. Let me give you an example. If you go upstairs to get something and forget what you wanted to get, then you go back to downstairs and suddenly remember what you wanted to get, you start laughing at yourself. Then you don’t have Alzheimer’s disease. On the other hand, if you start to worry and deny your forgetfulness, you may indeed have early Alzheimer’s disease. You should consult your family doctor.

There are many types of dementia
Aging—forgetfulness, no other behavior changes. This is not dementia.

Alzheimer dementia can be divided into stages

  • Forgetfulness. Mild Cognitive impairment.  
  • Especially recent memory loss
  • Unable to recall what he/she ate for breakfast that day before
  • Unable to name objects but able to describe what the object is used for
  • Unable to do calculation
  • Moderate cognitive impairment, behavioral problems and suspiciousness, some paranoid ideation
  • More forgetful—burns pots and pans
  • Unable to recognize distant family members or friends.
  • Difficult to do 3-step commands (for example, “take this book upstairs to your room, and come down to wash your hand”.) Patient becomes suspicious, for example, he/she hides the money and then forgets where he/she hides it.  The patient then accuses somebody of stealing the money.

Severe cognitive impairment, unable to recognize the closest kin or oneself. Extremely forgetful, unable to find his/her own home. Unable to recognize close friends or members of the family. Withdrawn. He/she may lost bowl control. He/she may wash he/her body with clothes on. Finally, he/she may not recognize him/herself.Papers blowing away

It is of interest to know that forgetfulness in Alzheimer’s disease has a distinct pattern. It is like a stack of paper. The top pages represent recent events, and the bottom pages represent past events. As the wind blows, the top pages will fly away.  This is like the forgetfulness in A.D. patients—the most recent events are forgotten most easily. The more the wind blows, the more pages are gone, and the memory is getting worse.

There are of course other signs and symptoms of Alzheimer’s disease
Multi-infarct dementia
Usually caused by many “silent strokes”. Each stroke will destroy certain cells in areas of the brain. Signs and symptoms of multi-infarct dementia depends which area of the brain is affected. So the memory loss does not have a distinct pattern such as AD. Of course there are clear signs and symptoms of stroke that make the diagnosis of MID much easier. Alzheimer’s Disease of the mixed type. This group consists of AD and Multi-infarct dementia. This diagnosis may be confusing. Often the Geriatrician will help with the diagnosis.

AD of lewy body. This is characterized by rapid onset and fast deterioration. It is the second most common cause of dementia. It presents with strong psychotic features, such as hallucination, and yet it is extremely sensitive to anti-psychotic medication. Day-to-day symptoms are variable. Patients with AD of lewy body should be referred to specialist ASAP. Alcoholic dementia. It is diagnosed by history. Excessive amount of alcohol will destroy brain cells and it will cause variety of signs and symptoms. Hypothyroidism, maybe known as pseudo dementia. This form of dementia is reversible by proper treatment of hypothyroid disease.

Traumatic dementia
Traumatic dementia is diagnosed by history. A professional boxer may end up with dementia of this type. It may cause Parkinsonism.  A differentiation of the two diseases should be carefully carried out. Under three conditions the patient should be referred to the specialist:

  • The family doctor is not sure of the diagnosis
  • Members of the family request the referral
  • AD with depression

By: Dr. Francis Ho