4 Most Common Types of Dementia in Aging

Summary

في هذا النص المستخدم كنص تمثيلي، يتحدث الdoctor Leslie Kernisan، متخصصة في ال geriatria، عن أمراض النسيان الشائعة التي تؤثر على الأشخاص الذين يقلون من العمر 60 عامًا. تناقش الdoctor Kernisan أنواع النسيان المختلفة، بما في ذلك النزهة الدماغية، وأسبابها، وكيفية التعامل معها. وتشير إلى أن النزهة الدماغية هي السبب الأكثر شيوعًا للنسيان، ولكن هناك العديد من ال諸利亚 الأخرى التي يمكن أن تسبب النسيان. وتتحدث أيضًا عن أهمية التعرف على نوع النسيان، وتشير إلى أن التشخيص يتطلب وجود مجموعة معينة من الأعراض الذهنية المزمنة. وتطرق إلى أهمية التشخيص الدقيق لفهم أفضل كيفية التعامل مع المرض وتحسين نوعية الحياة للمرضى. وتشير الdoctor Kernisan إلى أن التشخيص يتطلب التحقق من عدة عوامل، بما في ذلك تراجع في القدرات الذهنية، وتأثير الأعراض على الوظائف اليومية، ولم يتمكن الMRI أو الCT الدماغية من الكشف عن أمراض النسيان بنفسه. وتشير إلى أن التشخيص النهائي يتطلب في بعض الأحيان التحليل العصبي بعد الوفاة. وتشير الdoctor Kernisan إلى أهمية التعلم أكثر عن النسيان وأنواعه، وتوصي بالتواصل مع الأطباء والدعم ال绫ocial للمساعدة في التعامل مع المرض.

Takeaways

• 👵老龄化人群中最常见的痴呆类型是混合型痴呆，尤其是阿尔茨海默病和脑血管病的混合。
• 🧠阿尔茨海默病是痴呆最常见的原因，约占60%到80%的痴呆病例。
• 📈脑血管病是痴呆的第二大常见原因，影响大脑中的血管，可能导致执行功能障碍和步态问题。
• 🌟路易体病是另一种导致痴呆的疾病，其特征是视觉幻觉、REM睡眠行为障碍、帕金森症状和认知波动。
• 🧬混合型痴呆的诊断通常依赖于临床评估，包括症状、病史、认知测试和功能评估。
• 🧪尽管实验室测试和影像学检查有助于排除其他疾病，但它们不能单独确定痴呆的原因。
• 👨‍⚕️老年医学专家可能会通过记忆诊所或专科诊所进行更深入的评估，以更好地猜测痴呆的类型。
• 📊根据2016年的健康和退休研究，随着年龄的增长，痴呆的患病率显著增加，90岁以上人群中有35%患有痴呆。
• 📉痴呆的临床表现具有高度变异性，即使大脑中有病理变化，也不一定会导致认知症状。
• 💊目前大多数痴呆的治疗是支持性的，旨在帮助患者管理症状和优化功能，而不是治愈疾病。
• 🏠家庭和护理人员学习更好的沟通策略和行为管理技巧，对于提高痴呆患者的生活质量至关重要。

Q & A

ما هي المرض الذاكروي؟

المرض الذاكروي، يُعرف أيضًا بـ "الاضطرابات ال認知 الكبرى"، هو مصطلح شامل يصف مجموعة من الأعراض التي نراها ويمكن أن تكون بسبب العديد من الأسباب الأساسية.

ما هي العوامل الرئيسية التي يجب أن تكون صحيحة لتشخيص المرض الذاكروي؟

لتشخيص المرض الذاكروي، يجب أن تكون صحيحة خمسة أشياء: صعوبة مزمنة في وظيفة ال認知، انخفاض من القدرات السابقة، وقوع صعوبات كبيرة بما يكفي ل妨害 الوظيفة اليومية، التأكد من أن المشاكل لا يمكن تفسيرها بحالة منerverous differentiable مثل الصرما أو مرض عقلي آخر.

ما هي النسبة المئوية لحالات المرض الذاكروي في عام 2016؟

في عام 2016، و conforme a la Encuesta de Salud y Jubilación, 3% من الأشخاص في سن الـ 60s中期 كان لديهم المرض الذاكروي، وهذا الرقم يزداد مع التقدم في العمر، حتى يصل إلى 35% من الأشخاص من 90 عامًا أو أكثر.

ما هي الأنواع الرئيسية من المرض الذاكروي التي نراها في كبار السن؟

الأنواع الرئيسية من المرض الذاكروي في كبار السن تشمل ال健忘症 المختلطة (mixed dementia)، المرض الzheimer، مرض السكتة الدماغية، ومرض لوي.

لماذا يعتبر ال健忘症 المختلطة (mixed dementia) أكثر شيوعًا في كبار السن؟

ال健忘症 المختلطة يعتبر الأكثر شيوعًا لأنه يشمل م搭傻傻 المرض الzheimer ومرض السكتة الدماغية، وهو ما يحدث بشكل شائع مع تقديم العمر.

ما هي العوامل التي يمكن أن تؤثر على التشخيص الداخلي للمرض الذاكروي؟

التشخيص الداخلي للمرض الذاكروي يعتمد عادةً على الدراسات البيولجيية التي تتم بعد الوفاة، حيث يمكن لطبيب الأمراض العصبية ال확اش على الخلايا العصبية والتحقق من ما يسبب تعطلها أو وفاةها.

ما هي العوامل التي يمكن أن تؤثر على التشخيص الخارجي للمرض الذاكروي؟

التشخيص الخارجي يشمل التقييم السري لأسباب القلق المتعلقة بالذاكرة أو التفكير، وإجراء اختبارات عقلانية في المكتب، وتقييم الوظائف الوظيفية، وإجراء اختبارات لمختبر للتحقق من وجود حالات طبية أخرى.

لماذا يشير التشخيص الداخلي للمرض الذاكروي إلى الautopsia؟

الautopsia يتيح للطبيب الأمراض العصبية التحقق بشكل دقيق على مستوى الخلايا العصبية في الدماغ، مما يتيح التعرف على السبب الحقيقي وراء الاضطرابات ال認知.

ما هي الأهمية من التعرف على نوع المرض الذاكروي؟

التعرف على نوع المرض الذاكروي يمكن أن يكون مفيدًا لفهم ال諸OrDefault الشخص وتوقع ما سيحدث، ولكن في حالات ال健忘症 المختلطة، قد لا يغير التشخيص الداخلي الإدارة الطبية.

ما هي العوامل الأساسية التي يجب مراعاتها عند التعامل مع المرضى الذاكروي؟

في حين التعامل مع المرضى الذاكروي، يجب التركيز على تطوير استراتيجيات التواصل المناسبة، وتعلم كيفية إدارة السلوكيات ال最具 تحدي، وإيجاد الدعم المناسب، وممارسة العناية الذاتية والقبول.

لماذا ينصح بممارسة العناية الذاتية والقبول من قبل العائلة؟

العناية الذاتية والقبول يساعد على تقليل الضغط النفسي على العائلة، ويتيح للأشخاص الذين يعانون من المرض الذاكروي ودعمهم العيش حياة أفضل وأكثر معنى.

Outlines

00:00

👋 Introduction to Dementia and Alzheimer's

Dr. Leslie Kernisan introduces herself as a geriatrician and the founder of Better Health While Aging. She discusses the focus of her video podcast, which is to address common health issues in people over age 60, including dementia. Dr. Kernisan emphasizes the importance of understanding different types of dementia, particularly in the elderly, and mentions her mixed feelings about the necessity of identifying the specific type, especially in those over 80. She provides an overview of dementia as a clinical syndrome with a set of symptoms due to various causes and outlines the criteria for its diagnosis.

05:00

🧠 Understanding Dementia Prevalence and Causes

The script covers the prevalence of dementia based on the 2016 Health and Retirement Study, highlighting the increase in cases with age. It explains that dementia is caused by brain cells becoming damaged over time, often due to neurodegenerative processes. The most common cause of dementia is Alzheimer's disease, but the script also mentions other causes. The process of identifying dementia causes is explored, including clinical evaluations, cognitive testing, functional assessments, lab tests, and imaging techniques.

10:02

📈 Diagnostic Methods and Autopsy Studies

The paragraph discusses the limitations of brain scans like CT or MRI in identifying the causes of dementia. It explains that while these scans can rule out other conditions, they cannot by themselves diagnose dementia. The gold standard for identifying dementia causes is through autopsy and neuropathology evaluations. The script also mentions specialty clinical care and research studies that help in identifying dementia types.

15:05

📊 Common Types of Dementia in Older Adults

Dr. Kernisan outlines the four most common types of dementia found in older adults, particularly those over 80: mixed dementia, Alzheimer's disease, cerebral vascular disease, and Lewy body disease. She provides insights into the characteristics and symptoms associated with each type, emphasizing that mixed dementia is the most common. The paragraph also touches on the importance of understanding Alzheimer's disease and its early symptoms.

20:06

👁️‍🗨️ Symptoms and Diagnosis of Lewy Body Dementia

The script delves into Lewy body dementia, discussing its core clinical features necessary for diagnosis, which include visual hallucinations, REM sleep behavior disorder, Parkinsonism, and cognitive fluctuations. It differentiates Lewy body dementia from other forms of dementia and Parkinson's disease, noting the presence of Lewy bodies in the brain and their impact on neurons.

25:09

🧪 Neuropathology and Additional Causes of Dementia

The paragraph explores the neuropathology of Lewy body disease, along with other less common causes of dementia like Parkinson's disease dementia, alcohol-related dementia, chronic subdural hematomas, and normal pressure hydrocephalus. It explains the potential for treatment of some of these conditions and the importance of considering them in the differential diagnosis of dementia.

30:09

🛠️ Treatable Conditions and Dementia Care

The focus shifts to the potential treatments available for certain types of dementia, such as chronic subdural hematoma, alcohol-related dementia, and normal pressure hydrocephalus. The script acknowledges the rarity of curative treatments for most dementias and emphasizes supportive care to manage symptoms and optimize function. It also introduces newer findings in dementia pathology, including limbic predominant age-related TDP-43 encephalopathy, hippocampal sclerosis, and cerebral amyloid angiopathy.

35:09

🧬 Autopsy Studies and the Prevalence of Mixed Dementia

The paragraph discusses findings from long-term studies and autopsies that have shed light on the prevalence of mixed dementia, particularly in older adults. It highlights that while Alzheimer's pathology is common, it rarely exists in isolation, especially in those over 80. The variability in how dementia presents and progresses is attributed to the numerous potential combinations of neuropathologies.

40:09

🤔 The Relevance of Identifying Dementia Types

Dr. Kernisan shares her perspective on the importance of identifying the specific type of dementia. She questions the common advice to identify dementia types for targeted treatment, given the lack of specific treatments for most dementias. She discusses the use of oral dementia medications and new anti-amyloid antibody treatments, noting their limitations and side effects.

45:10

🏥 Approach to Dementia Care and Support

The final paragraph emphasizes the importance of non-medical forms of dementia care, which are crucial for quality of life and well-being. Dr. Kernisan stresses the value of learning dementia communication strategies, managing challenging behaviors, finding support groups, and practicing self-care and acceptance. She also encourages seeking educational resources and support to better cope with the condition, regardless of the specific type of dementia.

Keywords

💡Dementia

Dementia, also known as major neurocognitive disorder, is a clinical syndrome characterized by a decline in cognitive function severe enough to affect daily life. It is a central theme in the video as it discusses various types, causes, and management strategies. The video mentions that dementia can involve memory, language, executive function, complex attention, perceptual motor function, and social cognition.

💡Alzheimer's Disease

Alzheimer's disease is identified as the most common cause of dementia. It is characterized by the presence of amyloid plaques and neurofibrillary tangles in the brain. The video discusses Alzheimer's as a subset of dementia, emphasizing its prevalence and typical symptoms like short-term memory loss and executive dysfunction.

💡Cerebral Vascular Disease

Cerebral vascular disease, or vascular cognitive impairment, is the second most common cause of dementia discussed in the video. It involves problems with the blood vessels in the brain, which can lead to symptoms like impaired executive function and slower processing speed. The video highlights its contribution to dementia cases and its neuropathology.

💡Lewy Body Disease

Lewy body disease is a type of dementia characterized by the presence of Lewy bodies, which are protein aggregates in the brain. The video describes its core clinical features, such as visual hallucinations, REM sleep behavior disorder, Parkinsonism, and cognitive fluctuations. It is significant because it can affect medication sensitivities.

💡Mixed Dementia

Mixed dementia is a condition where more than one type of dementia is present simultaneously. The video emphasizes that mixed dementia is very common, especially in people over the age of 80, and often involves a combination of Alzheimer's disease and cerebral vascular disease.

💡Neuropathology

Neuropathology refers to the examination of the nervous system, including the brain and nerves, to identify the cause of neuronal dysfunction or death. The video discusses how neuropathology is used to understand the different types of dementia through autopsy studies and the concept that neuropathology is not always synonymous with clinical symptoms.

💡Mild Cognitive Impairment (MCI)

Mild cognitive impairment (MCI) is a condition that represents a decline in cognitive function but is not severe enough to affect daily life activities. The video contrasts MCI with dementia, noting that dementia involves a more significant impairment that affects independence in daily life.

💡Delirium

Delirium is a state of acute brain dysfunction that can occur when people are very sick, particularly older individuals in a hospital setting. The video mentions delirium as a condition that can cause confusion and must be ruled out when diagnosing dementia.

💡Neurodegenerative Process

The neurodegenerative process refers to the gradual degeneration or damage to neurons in the brain, which can lead to dementia. The video explains that dementia usually develops over time due to this process and is often caused by one or more underlying diseases or conditions.

💡Cognitive Assessment Protocol Project

The Cognitive Assessment Protocol Project is a subset of the Health and Retirement Study that assesses people for mild cognitive impairment and dementia. The video cites this project as a source for prevalence statistics on dementia, highlighting its importance in understanding the condition's impact.

💡Supportive Treatment

Supportive treatment in the context of the video refers to the management of symptoms and optimization of function for individuals with dementia. Since most causes of dementia are considered uncurable, the focus shifts to supporting the person to maintain the best quality of life possible, which includes managing cognitive and physical symptoms.

Highlights

Dr. Leslie Kernisan, a board-certified geriatrician, discusses common health problems affecting people over age 60 and ways to manage them.

Alzheimer's disease is the most common cause of dementia, but other conditions can also cause it, collectively referred to as different types of dementia.

The importance of identifying the specific type of dementia, especially in people over age 80, is a topic of mixed feelings among experts.

Dementia, also known as major neurocognitive disorder, is a clinical syndrome defining a collection of symptoms due to various underlying causes.

Five criteria must be met for a dementia diagnosis, including chronic difficulty with cognitive function and a decline from prior abilities.

Dementia prevalence increases with age, affecting 3% of people in their mid to late sixties and 35% of those 90 and older.

Dementia usually develops as brain cells become damaged over time due to neurodegenerative processes.

Diagnosing dementia involves clinical evaluation, cognitive testing, functional assessments, lab tests, and imaging to rule out other conditions.

The most common causes of dementia in older adults are mixed dementia, Alzheimer's disease, cerebral vascular disease, and Lewy body disease.

Mixed dementia, involving a combination of different types, is the most common type seen in people Dr. Kernisan works with.

Identifying dementia types can be challenging and often requires autopsy studies for definitive answers.

Lewy body dementia is associated with specific clinical features like visual hallucinations and Parkinsonism.

Cerebral vascular disease can cause dementia through problems with the brain's blood vessels, often manifesting as impaired executive function.

Alzheimer's disease is characterized by amyloid plaques and tau tangles in the brain.

Frontotemporal degeneration and other rarer causes of dementia are less common in people over 80.

Most dementia causes are considered uncurable, and treatment focuses on managing symptoms and optimizing function.

Newer types of dementia neuropathology, such as limbic predominant age-related TDP-43 encephalopathy (LATE), hippocampal sclerosis, and cerebral amyloid angiopathy (CAA), are being researched.

Autopsy studies reveal that mixed dementia increases with age and is prevalent in people over 85, often with Alzheimer's and vascular disease combined.

Identifying the type of dementia may not significantly impact treatment options, especially in older adults, where mixed dementia is common.

The most effective dementia care involves non-medical strategies, focusing on quality of life and well-being, regardless of the dementia type.

Transcripts

Well, hello there everyone.

I'm Dr.

Leslie Kernisan,

board certified geriatrician and the founder of the website,

Better Health While Aging dot net.

And this is the Better Health While Aging video podcast where

we discuss common health problems that affect people over age 60

and the best ways to prevent and manage those problems.

We also often address common concerns and dilemmas that come up

with aging parents and other older loved ones like what to

do if you're worried about falls or safety or memory or

even the quality of an older person's healthcare.

In this episode,

I'm gonna talk about something that I'm often asked about,

which is common causes and types of dementia.

Now, you probably have already heard of Alzheimer's disease.

It is in fact the most common cause of dementia,

but there are many other conditions that can cause dementia,

and these are sometimes referred to as different types of dementia.

So if you've been dealing with a diagnosis of dementia or

have heard about Alzheimer's,

or have been concerned about memory or thinking problems in an

older adult,

it's possible that you've been wondering what type of dementia you

might be dealing with.

Or maybe someone has told you that it might not be

Alzheimer's and that it's important to find out what type of

dementia it's now.

I actually have mixed feelings about how important it is to

identify the specific type of dementia,

especially in people over age 80.

And in this video I'll be telling you a little bit

more about why and what is my approach to types of

dementia. But if you are dealing with dementia or even a

diagnosis of Alzheimer's,

I think it's a really good idea to learn more about

this condition and to familiarize yourself with the most common types

of dementia.

So in this video specifically,

I'll be covering the main types of dementia that we see

in older adults,

especially when it comes to people over the age of 80.

And then I'm also gonna talk about some other types of

dementia that you might hear about or read about if you

go Googling about dementia online.

I'm also gonna spend some time talking about mixed dementia.

This is actually the most common type of dementia in people

that I see and that I work with.

And I'm gonna talk about when it might be important to

find out what type of dementia you are dealing with.

And again,

I'll share more about my usual approach to using dementia type

to help families.

But before I go into dementia types,

just a few words about what is dementia to make sure

that that's clear to you if you're watching this video.

So dementia is also known as major neurocognitive disorder.

And it's essentially an umbrella term and a clinical syndrome.

So that means it kind of defines a,

a collection of symptoms that we see and it can be

due to many underlying causes.

So to diagnose dementia,

these five things have to be true.

So first of all,

a person has to be having chronic difficulty with a cognitive

function. And in the DSM five,

which is the Diagnostic and Statistical Manual,

what doctors use for the diagnosis of any conditions that affect

the mind or mental health,

the DSM five defines six types of cognitive function that can

be affected.

And they are memory and learning language,

executive function,

complex attention,

perceptual motor function,

which includes visual spatial processing and or social cognition.

Next, the difficulties have to be a decline from prior abilities

from the way the person was in their adulthood.

Third, the difficulties have to be bad enough to impair a

daily life function.

So that means they have to be bad enough that the

person is no longer independent in some kind of task or

activity that they used to do independently as an adult.

And so this could be something like some aspect of their

work, it could be planning and cooking a meal,

it could be doing their finances,

but in that case,

the person has to have been able to do their finances

previously. So that's a really important criteria to diagnose dementia.

And it is one of the criteria that distinguishes dementia from

something like mild cognitive impairment,

which by definition is not bad enough to affect independence in

daily life activities.

And if you wanna learn more about the difference between MCI,

my cognitive impairment and dementia,

I have a video that goes into that in depth.

So also the diagnosed dementia,

the cognitive problems.

So the problems with memory or thinking can't be due to

delirium or some other reversible illness.

And delirium is that state of worse than usual mental function

that we see happen when people are very sick,

especially older people in the hospital.

So if you've ever heard,

sometimes people even call it,

you know,

hospital associate dementia,

but if it happened in the hospital or while somebody was

ill in the context of being sick,

it would probably be delirium.

And then lastly,

for it to be dementia,

the problems with memory or thinking can't be better explained by

another mental disorder.

So for instance,

they can't be better explained by a condition such as schizophrenia,

major depression,

bipolar disorder,

or another significant mental illness.

Now you might be wondering,

is dementia common?

And we got a really good answer to that question recently

in the 2016 health and retirement study survey.

So the health and retirement study is an ongoing longitudinal nationally

representative study,

and in 2016 they added on a special subset called the

Cognitive Assessment Protocol Project.

And so that mean that they assessed lots and lots of

people for mild cognitive impairment and for dementia.

And what they found as the prevalence was that when people

were in their mid to late sixties,

3% of them had dementia.

And that kept going up as people got older,

especially once people got into their eighties and nineties.

So for people 90 plus,

it was 35% of them who had dementia.

So it does become common,

especially as people get in their eighties and now what actually

causes dementia?

So in a moment,

I'm going to go through the different types,

but you know,

at a bigger level,

dementia usually develops over time as brain cells become damaged and

malfunction and die due to some kind of condition or problem

affecting them.

So this is often referred to as a neurodegenerative process because

it takes time for the neurons to get sick and degenerate.

And again,

it's usually caused by one or often more than one underlying

diseases or conditions.

And those kind of relate to the types of dementia that

we are going to talk about.

Now, Alzheimer's disease is the most common cause of dementia.

So we can say that Alzheimer's disease is a a subset

of dementia,

but there are many other causes which I'm going to talk

about in this episode.

And it's important to know that damage to brain cells has

almost always started years and years before mild symptoms become apparent.

So people really usually need to have a lot of brain

cells affected before their memory and thinking is affected.

And that's because otherwise the brain tends to recruit from other

healthier neurons to do the work that it's trying to do.

Now, how are dementia causes identified?

So this is kind of interesting because we have sort of

like a clinical outside version for dementia diagnosis and identifying the

causes and a sort of inside version.

So the outside version is the one that most of you'll

encounter in routine medical care and the one that I'm usually

involved in.

So in clinical medical care,

we start to evaluate somebody because there have been concerns about

their memory or thinking,

and we're kind of looking at it from the outside of

the brain.

So to do an evaluation,

we ask about symptoms like is it memory or are there

other forms of cognitive change that are worrisome?

If you wanna know more about sort of signs that might

be Alzheimer's or another form of dementia,

I have a video about that 21 signs we ask about

the history.

So when did the symptoms start?

How have they evolved over time?

We also do cognitive testing in the office.

It can be a pretty short office-based cognitive test,

or sometimes there's more involved neuropsychological testing.

So that's to get an objective kind of evaluation of how

well the person's memory and thinking processes are working.

And then especially in geriatrics,

we do functional assessments.

So that means asking questions to find out how well people

can do their activities of daily living and especially their instrumental

activities of daily living.

So daily life tasks that we learn usually as teenagers and

that are important to being independent as an adult,

like finances driving,

managing your email and correspondence,

managing your grocery shopping meal and meal preparation,

home maintenance.

And we also ask just what else is the person having

difficulty with because that's very important.

Then we'll usually do lab tests in part to help rule

out medical conditions that our dementia mimics.

So for the types of dementia that I'm going to talk

about, they usually cannot be identified on a regular lab test.

And so the lab testing is really more to rule out

other things that might be affecting memory and thinking.

If you wanna learn more about that,

I have a video about 10 common causes of cognitive impairment

in older adults,

and that goes through the things that doctors are supposed to

check to sort of identify common medical conditions that might be

contributing. And then there's the role of imaging.

So a ct,

a CAT scan of the brain or an MRI.

So this is often useful again for ruling out other things

that might be affecting memory and thinking.

So on a scan,

we can first of all make sure that the person doesn't

have a tumor,

that they don't have a big hematoma or blood clots,

but that might be affecting their thinking.

So an MRI could be helpful for that purpose.

Sometimes it also shows which parts of the brains have shrunk,

and it can also show small scars in the tissue.

These are called white matter hyperintensities that are often associated with

vascular cognitive impairment.

What's important to know though is that a brain CT or

MRI cannot by itself identify dementia causes and it can't even

definitively identify dementia.

I have people tell me this,

that they got an MRI and the MRI showed they had

dementia. Well,

to diagnose dementia,

we have to establish that there is enough change to memory

and thinking processes that independence in activities is impaired.

So you can have a terrible looking MRI,

but if you are still well enough with your memory and

thinking to be independent in your activities,

it doesn't meet the criteria for dementia.

So that's what I'm often explaining to people.

So that's the sort of clinical from the outside evaluation of

dementia. And then there's another way to do it,

which is from the inside.

So if we wanna really know what made those neurons get

sick, malfunction die,

we really have to look at the neurons themselves.

And because we don't routinely biopsy brains,

the way this is usually done is through autopsy studies after

people have died,

because in an autopsy we can do what's called a neuropathology

evaluation. So pathology basically is the,

you know,

science of what is going wrong with organs,

with human bodies,

or potentially with human cells or non-human cells.

And neuropathology means examining aspects of the nervous system like the

neurons in your brain or sometimes the nerves outside your brain

and taking a good look to see what is causing them

to not work well or what caused them to die.

So that is the most definitive way to evaluate dementia causes.

Now, it's also possible to come close and make a good

guess through specialty clinical care such as a memory clinic.

So these clinics are staffed by healthcare providers who have lots

and lots of experience evaluating potential dementia,

and they're often able to make a good guess based on

symptoms and history.

These clinics also usually are able to have a much longer

interview with a patient and with the family to learn a

lot about what's been going on.

They also usually include in-depth neuropsychological testing,

and they might do a more detailed MRI of the brain,

something called a volumetric MRI,

that can really drill down into which parts of the brain

specifically might be more shrunken than expected.

And that often helps the experts hazard a guess about what

type of dementia they are working with.

And then there are research studies and kind of newer special

tests that look for certain proteins associated with certain types of

dementia or other signs.

So there can be special scans that look for this,

like special scans that identify amyloid in the brain.

And as I'll explain,

amyloid is associated with Alzheimer's disease or there can be other

biomarkers either in spinal fluid or sometimes that are being experimentally

used in the blood.

Given that,

let me now talk about what are the most common types

of dementia,

because there are actually many conditions that can cause dementia,

but when it comes to older adults,

so most cases of dementia are affecting people who are age

80 and older,

and in most cases they really seem to fall into these

four types of dementia that I'm gonna share with you right

now based on autopsy studies.

The most common causes of dementia are number one,

mixed dementia.

Number two,

Alzheimer's disease numbers three,

cerebral vascular disease,

and number four,

Lewy body disease.

So let me now take you through a little bit more

about each of those types of dementia.

We're gonna come back to mixed dementia in a bit.

Let me start with Alzheimer's disease.

So this is the type of dementia that you know is

best known.

It is based on autopsy studies seems to be involved in

60 to 80% of dementia cases.

And the typical early symptoms are especially short-term memory loss.

Now, not all short-term memory loss is Alzheimer's disease or even

dementia, but it is pretty typical if somebody is developing Alzheimer's

disease that has progressed to the point where they're getting symptoms.

And again,

by that point they've usually had the signs of Alzheimer's slowly

progressing in their brain for at least 10 years.

But typical early symptoms include short-term memory loss,

executive dysfunction,

reduced insight into one's problems,

so kind of unawareness that one is having difficulty with some

aspect of memory or thinking.

And then other early symptoms might also include problems with visual

spatial processing.

That's an early sign for some people.

Language problems can be an early sign.

It's not uncommon for people to start having delusions,

false beliefs,

maybe falsely accusing other people.

They might be become quite paranoid.

Or another common early symptom is apathy and kind of losing

motivation. And so what is the neuropathology of Alzheimer's?

So really broadly,

it basically involves what they see on autopsies and studies is

they see that the brain develops these plaques of amyloid.

So amyloid is a protein that is produced by the body,

but in Alzheimer's disease it ends up clumping together and making

a lot of it that makes these plaques.

And there are also tangles of something that is called tau.

And then there is cerebral vascular disease.

So this is estimated to contribute to 50% of dementia cases

and cerebral vascular disease,

vascular means of the blood vessels and cerebral means of the

brain. So this means some kind of problem with the blood

vessels that are in the brain.

Now this can happen from a very large blood vessel in

the brain being affected when that happens,

that's generally a major stroke and people can have dementia after

a major stroke.

But often what's especially common is for the very small blood

vessels of the brain to be affected.

And so that tends to cause first of all,

people can have a lot of that being affected and not

show symptoms.

And then when they show symptoms,

they can start off as fairly subtle.

So the typical early symptoms for cerebral vascular disease,

and this is called initially vascular cognitive impairment,

if it gets bad enough,

it can be vascular dementia.

Typical early symptoms are impaired executive function.

So executive function is the front of the brain that kind

of does planning,

processing, prioritizing,

weighing decisions.

We can also see slower processing speed and we can sometimes

see short-term memory issues.

Other early symptoms might include problems with walking or walking more

slowly or being a little bit off balance.

Another potential early symptom is depression.

There have been some studies that have identified that,

especially if it's the person's first time ever getting depression in

later life,

that seems to sometimes be associated with vascular cognitive impairment.

We can also see apathy,

loss of motivation,

and in some cases we can also see some delusions or

paranoia. And in terms of the neuropathology for cerebral vascular disease,

what's very common is to see signs of cerebral small vessel

disease. So on an MRI,

this shows up as little kind of white spots.

They can be called white matter hyperintensities or small vessel ischemia

in the radiology report,

or there might be small hemorrhages or there can be just

another form of damage to the brain's blood vessels.

Now what you should know is that it is extremely common

for people to develop white matter hyperintensities.

They're basically like little scars in the brain where little blood

vessels have had a problem.

So most older adults,

especially once they get into their eighties,

have at least some signs of this on MRI.

And so it's only if there's a lot of it or

if there are other symptoms that we would consider it very

concerning. I mean,

it is a sign of suboptimal vascular health,

right? It's often associated with having had high blood pressure or

maybe diabetes or smoking.

All those things that are bad for heart health are also

bad for the health of blood vessels in the brain.

So if you find out that you or somebody you care

about on their MR,

I had some signs of these white matter hyperintensities,

please don't panic.

And if you wanna learn more about how to think about

that kind of MRI finding,

I explain that in more depth in an article on Better

Health, While Aging about cerebral small vessel disease.

Now let's talk a little bit about Lewy body disease.

So Lewy body disease,

which can lead to Lewy body dementia seems to be involved

in probably about 20%,

maybe up to 30.

But the newer studies I saw seemed to think it was

closer to 20% of dementia cases.

And what's interesting about Lewy body dementia is that to make

a clinical diagnosis of that,

this is a form of dementia that actually is associated with

a few pretty specific signs that we don't see so often

in other forms of dementia.

So they're called core clinical features of Lewy body dementia.

So diagnosis requires at least two of these four core features.

And the features are one visual hallucinations.

So stereotypically it can be small children or animals in in

the home and sometimes adults.

And then there's some people who just see colors or shapes.

But visual hallucinations is one of those core features.

Another one is REM,

sleep behavior disorder.

So people moving more when they're in dreaming and in REM

sleep, because otherwise,

normally the way the brain is designed is that when you're

dreaming, the rest of your body is actually kind of paralyzed.

Then another core feature is to show Parkinsonism.

So Parkinsonism is related to Parkinson's disease but is not entirely

the same thing.

Parkinsonism refers to a collection of movements or motor symptoms that

is very classic in Parkinson's disease,

but can also be caused by some other conditions that affect

the brain and the nervous system.

So the sort of key symptoms of Parkinsonism are slowed movements,

resting tremor.

So that means when you know,

especially in the arms or hands,

when the person just rests it,

if it's like moving when they're not doing anything,

that would be a resting tremor,

stiffness. So if we try to move their arm kind of

back and forth this way,

they feel kind of stiff.

And then there's balance or gait issues.

And then the last core feature is cognitive fluctuations,

which basically refers to people having,

you know,

a significant change in their level of alertness or arousal or

cognition. So they,

they might seem at times very zoned out or very confused

or seem to be falling asleep.

And then other times they might seem almost normal.

This can come on fairly quickly or sometimes it comes on

more slowly,

it can last just briefly or it can last for a

longer period of time.

And it's really supposed to be more than people with dementia

often have kind of good days and bad days,

good moments,

bad moments.

They tend to be better early in the day when they

have more energy and as they get tired in the afternoon

they get worse.

So the cognitive fluctuations of Lewy body disease are really supposed

to feel like more than the kind of good moment,

bad moment that we otherwise see in other forms of dementia.

And so the neuropathology of Lewy body disease involves Lewy bodies.

These are accumulations of something called alphas and nucle protein and

they start to accumulate in neurons throughout sort of the brain.

The cortex is kind of like the main outer part of

the brain.

Now, Lewy body disease is related to Parkinson's.

There's kind of debate about how exactly to connect them,

but Parkinson's disease also involves Lewy bodies.

But in Parkinson's,

it's this part of the brain back here that regulates movements

and motor function that is initially affected.

And so with Parkinson's,

it's really that part that's affected.

You have,

you know, a lot of the typical Parkinsonian Parkinsonism signs,

but you don't see as much.

You don't see the other,

first of all,

clinical core features as much of of Lewy body and the

significant cognitive problems tend to come much later in Parkinson's disease.

So those are,

you know,

really the main types of dementia that we see among older

adults, especially the ones who are 80 and older.

Now, there are a few other causes that I might consider

in an older person.

So there is Parkinson's disease,

dementia. Now this one we kind of see it because it

tends to happen after people have had Parkinson's for several years,

often about 10 years.

So we wouldn't be thinking about Parkinson's disease dementia if the

person has developed cognitive problems just over the last few years

and gotten worse.

This is really for somebody who,

you know,

had preexisting Parkinson's.

But there are a few other causes.

So there's alcohol related dementia,

which is another kind of umbrella term for problems,

chronic problems with memory and thinking that are related to years

of alcohol abuse.

And there's something called cor cough syndrome that is associated with

this. And there may be some other forms of alcohol related

dementia as well.

Usually if we,

if we ask or inquire either asking the older person or

asking family members,

knowledgeable people,

we might find out that the person has been drinking fairly

heavily for,

for quite a while.

And then there's chronic subdural hematomas.

So a hematoma is a collection of blood and when people

fall and hit their head,

they can bleed and develop a big blood clot kind of

on the surface of the brain under the lining of the

brain and under the skull.

And because the skull is hard,

if you get a big enough blood clot,

it's pressing down on the brain and that can cause dementia

symptoms. And so every now and then some,

an older person who has gotten confused or cognitively declined,

if we scan them,

we find that they actually have a pretty significant collection of

blood and,

and that big collection can stay for for weeks for quite

a while and sometimes it makes them even sicker and we

find it faster.

So, but that is a known phenomenon,

chronic subdural hematoma.

And so we might consider that as well for an older

person who seems to have dementia.

And then there's a condition called normal pressure hydrocephalus.

So in this condition,

so in the very center of the brain inside there is

something that is called the ventricles of the brain.

And it's kind of like a space in the middle of

the brain that makes the cerebral spinal fluid that ends up

going down around the spine and kind of ends up coming

out and sort of soaking around the brain.

So in normal pressure hydrocephalus,

that drainage of that space gets blocked.

And so the,

that space in the middle of the brain starts to expand

because it has all this fluid building up in it with

nowhere to go and that can cause dementia symptoms.

The sort of classic symptoms are triad of dementia,

urinary incontinence,

and a change in gait as as well.

So this condition can be treated and symptoms can improve if

doctors place what's called a shunt.

So a kind of passageway,

sort of a drain in a way that goes from that

space in the brain that needs to drain into the belly.

The thing about normal pressure hydrocephalus is that first of all,

it's not all that common.

So in one study of people who had been referred for

neuropsychiatric testing and gotten detailed MRIs in people who were in

their seventies,

only 0.2%

of 'em were judged to have likely normal pressure hydrocephalus.

And in people who were 80 and older,

the percentage was higher,

it was five or 6%,

but that's still not most of them.

The other thing that has also been noted is that a

lot of older adults,

especially if they're in their eighties,

who have normal pressure hydrocephalus also if they are studied in

depth, have signs of Alzheimer's disease or another form of dementia.

And so that means putting in the shun shunt may not

entirely resolve all the symptoms and problems.

So those are the most common causes of dementia in older

adults. But if you Google to learn more about dementia,

you will probably hear about lots of other causes of dementia

that are out there.

So let me take you through some of these.

These mostly affect people under age 80,

and some of them are even,

you know, more focused on people younger than that.

They include frontotemporal degeneration.

So this is a condition where either the front or the

sides of the brain start degenerating.

There are two main variants,

behavioral variant and primary progressive aphasia.

So behavioral variant people start off by,

you know, almost developing a personality change and becoming kind of inappropriate,

saying inappropriate things.

Whereas with primary progressive aphasia,

they start off by really having difficulties with language,

either with creating language or understanding language.

And that is apparently the variant that Bruce Willis was diagnosed

with. The thing about frontotemporal degeneration is that experts estimate that,

you know,

over 60% of cases are in people who are age 40

to 64.

So you can have people in their sixties and seventies diagnosed

with an S well,

but it becomes like relatively uncommon as people get older and

older. So then there are some other causes of dementia.

These are relatively rare.

There are three conditions,

progressive supra,

nuclear palsy,

corticobasal degeneration,

and multisystem atrophy.

These three conditions are fairly rare.

They are associated with Parkinsonism like symptoms,

but they have some other unusual features that show up either

in symptoms or on neurological exam.

And they again,

you know,

are less common in people over the age of 80.

There's a cause of dementia that's called Huntington disease,

that's a genetic disorder that often starts to affect people when

they're in their thirties or forties,

sometimes later.

Then there's chronic traumatic encephalopathy.

So this is dementia that occurs kind of as a result

of lots of concussions earlier in life.

So it's been explored especially as something that has affected some

former professional football players.

It might also affect combat veterans if they experience a lot

of concussions or a lot of blast exposure.

And then there's something called roitfeld yako disease,

which is a PreOn disease.

It's pretty rare,

but you might read about that as well.

And then there's HIV associated dementia,

which comes on especially in people who have HIV who weren't

able to get good,

highly active antiretroviral treatment to keep their HIV under control.

And so there again,

it's not something that we see a lot in geriatrics.

So those are common causes of dementia and you know,

they can have different neuropathology,

but in general,

you know,

a sad but true fact is that most causes of dementia

are actually considered uncurable.

The various processes that cause these diseases and that end up

causing dementia are things that we don't have ways to reverse

or stop.

So that means that most of the time when it comes

to dementia,

regardless of the underlying cause,

the treatment is usually supportive and focus on helping the person

manage symptoms.

Whether those are uncomfortable symptoms or just cognitive symptoms that are

making their life difficult,

we want to help them manage that and we wanna help

them optimize their function.

So help them be as able as possible to do what

they can still do to participate in meaningful activities to them

and to otherwise try to give them the best quality of

life possible.

So that's true of most causes of dementia.

Now again,

there are a few causes that might be potentially treatable.

So in older adults,

those you know,

might include chronic subdural hematoma.

They can either resolve slowly over time or sometimes they can

be drained in a neurosurgery procedure.

Alcohol related dementia.

Some people,

especially if they stop drinking and get treatment for thymine deficiency,

some people can improve and stabilize,

but it's not the case for everyone.

Normal pressure hydrocephalus,

again, sometimes can be treated with a shunt,

and HIV associated dementia sometimes gets better if the person does

start good antiretroviral treatment.

So let me now talk about some newer information that we

have about types of dementia pathology.

There's been some really interesting research done over the last 10,

20 years on the brains of older people with dementia.

And what people have realized scientists is that there are some

newer types of dementia neuropathology that are actually quite common in

older adults who die in their eighties and nineties.

So you might hear about these and I wanna tell you

a little bit about them right now.

So one is called limbic predominant age-related TDP 43 encephalopathy.

What a mouthful,

right? So it's abbreviated late for short,

it involves abnormal amounts of T TDP 43 protein.

This is a protein that can also be involved in frontotemporal

degeneration, but in late it sort of seems to be a

little bit of a a different process.

And what's interesting is how it's quite common and on autopsy

it's been found in roughly half of brains of people with

clinical dementia.

Another form of dementia neuropathology is called hippocampal sclerosis.

So the hippocampus is a little part of the brain that

is involved in memory and learning.

And in hippocampal sclerosis that part,

the neurons kind of get damaged and stop functioning.

So it involves a loss of neurons in the hippocampus and

they see it become fairly common as people reach age 90

or over.

And then there's a third type that I wanna mention,

which is cerebral amyloid angiopathy,

sometimes abbreviated CAA.

So this also seems to be fairly common.

So in this condition,

the body for some reason starts to deposit amyloid protein in

the walls of small blood vessels and that keeps them from

working properly and often contributes to micro hemorrhages.

And what they found is that many people with Alzheimer's disease

also have CAA.

So researchers are still trying to work out how these conditions

often seem to kind of synergize in unfortunately a bad way

for the the brain.

So as of now,

none of these three conditions,

first of all are routinely diagnosed in regular clinical care and

we don't really have a known treatment or way to stop

or reverse these conditions.

However, there's,

you know,

interesting research happening to try to see can we identify these

conditions earlier,

is there a way to change the trajectory of these conditions

because they do all three seem to affect the cognitive health

and wellbeing of older adults.

So as I mentioned,

we've really learned so much from these autopsy studies of people

with dementia or of older adults.

And so now I wanna share,

you know,

more of what has been learned.

There have been some really wonderful long-term studies that were done

of older adults who some of them were in religious orders,

monks or nuns,

others were just people who participated in a memory and aging

project. And as part of these studies,

participants agreed to come in regularly for cognitive testing to have

their health history really closely followed.

And then because they were followed closely,

the researchers notice if they've developed dementia.

And then when they died,

their brains were examined during autopsy.

What we learned from an autopsy analysis of 2,695

decedents, they were aged 80 plus,

was that 91% of them had more than one of six

key neuro pathologies,

and 41% had three or more.

So this is part of how we know that it's mixed

dementia that is really,

really common as people get older.

And the most common mix that is seen is Alzheimer's pathology

with cerebral vascular disease.

But we also sometimes see people who have Alzheimer's vascular disease

and also Lewy body or we see kind of other permutations

and in fact in ROM map.

So that's the acronym for the combination of the religious order

study and rush memory and aging project.

In one study of a thousand decedents,

they were able to identify over 230 unique combinations of neuro

pathologies. And they found that mixed dementia does increase with age

and is quite prevalent in people who are over the age

of 85.

However, most of those people had been diagnosed just with a

single specific dementia.

So more of what we've learned from autopsy studies.

Another thing that has been really fascinating to find out from

these long studies where people get autopsied at the end is

that neuropathology is not destiny.

So in particular,

they noticed that many participants had Alzheimer's pathology in their brain

but did not have mild cognitive impairment or dementia.

They basically did not have significant problems with their memory or

thinking. And so they found that the amount of disease we

could say in the brain,

you know,

had a correlation with symptoms but is imperfect.

And there were some people who seemed to have quite a

lot of change to their brain and were still functioning okay,

and there would be other people who had had less change

to their brain,

but were having cognitive symptoms.

So what this means is that,

you know, when people have neuropathology,

the impact on cognition is highly variable.

And this is why some experts,

including many geriatricians,

feel a little squeamish about the idea of everybody now getting

a special scan to find very early if they have signs

of Alzheimer's pathology because we don't know who's actually going to

develop symptoms and when at this time.

So also what we learned from the autopsy studies is that

Alzheimer's pathology is really,

really common,

but it's rare,

especially when people are above age 80 for them to have

only that.

So in one rom map study and the average age of

people at death was like pretty far up there,

it was 89.7.

So you know,

essentially 90 65 of them had Alzheimer's pathology,

but only 9% had isolated Alzheimer's disease.

So in short,

when it comes to older adults and their brains,

especially if they have developed dementia,

it's mixed dementia that is the most common type of dementia,

especially a mix of Alzheimer's and cerebral vascular disease.

And we also know that lots of people have neuropathology changes

if we look in their brains,

but many of them do not develop symptoms.

And when people do have dementia,

it's important to realize that there can be so much variability

under there and it's gonna be really difficult to detect with

just clinical care,

even if you go to a memory and aging center because

it could be,

there are so many combinations that are possible.

And so this might explain why,

you know, when people have dementia,

it can be so variable how their dementia manifests or progresses.

It's partly because all kinds of things can be going on

in the brain from a neuropathological perspective.

So given all this does identifying the type of dementia matter

and what I would say is it really depends who you

ask. Certain types of experts,

especially the ones who work in memory and aging centers,

they're often doing research on a lot of these types of

dementia. There are lots of people who feel like it matters,

we should try to find out.

And then there are others,

you know, maybe like myself who think,

well it kind of depends a little bit on the circumstances

of the person.

So I would say that it depends on the age of

the person and on their symptoms.

I have been working online for a while and I have

seen so many expert resources say that,

oh, if there's dementia you should get the type identified so

you can get appropriate specific treatment,

you know,

or it's really going to make a difference.

But the truth is it's very rare for us to have

an effective specific treatment available for a cause of dementia.

So when I read this,

you know,

get an appropriate specific treatment,

I think what treatment are they talking about?

Because what treatments do we have for dementia right now?

So the most commonly used treatment is oral dementia medications.

We've had some FDA approved for many years right now.

So one class of them is called cholinesterase inhibitors.

This includes medications like the Napole,

Rivastigmine, Glanine,

the brand names for those are Aricept,

Exelon, and Rasine.

And then there's a different type of dementia medication called Memantine.

The brand name for that is nanda.

And the thing about these is that they're not really specific

to any dementia type.

When they were studied for FDA approval,

the researchers did not have a way to try to really

identify the dementia subtype.

It was,

you know,

dementia presumed Alzheimer's usually either mild to moderate or moderate to

severe in severity.

And for what it's worth,

memantine was not FDA approved for mild to moderate,

it's supposed to be for moderate to severe.

And all of these medications failed the phase three trials for

making a difference in mono cognitive impairment too.

But anyway,

these medications are not specific to any dementia type and they

usually also only have a small effect on cognition,

if any.

And then just in the last few years,

as of you know,

20 21,

20 22,

we have some new anti-amyloid antibody Alzheimer's treatments such as the

drug Le Cambi.

Now these are specific for Alzheimer's because they help the brain

not create amyloid plaques.

So they definitely slow the accumulation of amyloid plaques.

However, it's not yet clear how clinically significant this will be

in the phase three trial for embi,

people who were on the drug still declined cognitively over 18

months, just less than people who got the placebo drug.

And these drugs also have some pretty significant side effects that

require monitoring.

So it's true potentially if you can confirm that you are

dealing with Alzheimer's disease,

you could be eligible to try something like che be.

But otherwise,

most of our dementia treatment options are not really specific to

a type of dementia.

And also when it comes to like can be,

we don't really know how effective it'll be when people are

into their eighties and nineties,

especially because those are people who probably along with their Alzheimer's

have other forms of dementia going on as well.

And then very briefly,

I do wanna acknowledge that as I mentioned,

there are,

you know,

a few less common types of dementia that you know could

potentially be treated.

So normal pressure hydrocephalus can sometimes be treated by placing the

shunt to drain the cerebral spinal fluid into the abdomen.

But this is not very common.

Often coexist with Alzheimer's pathology,

alcohol related dementia sometimes gets better if people stop drinking,

if we treat thymine deficiency.

And then chronic subdural hematoma can potentially get better either with

time or with drainage.

So given all this,

let me share with you now what is my approach to

types of dementia.

So being a geriatrician and having tried to follow the research

and literature on this,

I know that most older adults,

especially if they're age 80 or older,

have mixed dementia.

And I know that all the common forms of dementia,

so the most common forms in older adults,

you know, Alzheimer's disease,

cerebral vascular disease,

you know,

and Lewy body can have a lot of variability in how

they manifest in different people and they can have a lot

of overlap between each other,

right? So you know,

both Alzheimer's and cerebral vascular disease can cause short-term memory loss

or possibly,

you know, strange beliefs.

So because of this,

I don't particularly try to get too,

too much into which type of dementia it is.

What I do think is important to do is to check

for symptoms of Lewy body dementia.

And the main reason for this is because people who are

having signs of Lewy body that can make them very sensitive

to drugs that block dopamine.

So the Lewy bodies are often involved in dopamine management in

the brain and people who have Lewy body can be very

sensitive to anything that that blocks dopamine.

And that includes many antipsychotics,

which are,

you know, sometimes prescribed to manage difficult Alzheimer's behaviors or sundowning or dementia

behaviors. Otherwise I focus on assisting with symptoms supporting family and

improving the quality of life.

And let me also say that,

you know, with this approach,

this is presuming I have already done,

you know,

an evaluation to check for dementia mimics.

And I've usually also already thought about,

well, you know,

have I checked for alcohol use?

Do we need to consider normal pressure hydrocephalus?

You know,

and making sure that there's been an MRI or scan to

make sure we're not dealing with chronic subdural hematomas as well.

So in terms of,

you know,

what I think of as thinking like a geriatrician,

as geriatricians,

we often consider these kinds of questions when it comes to,

you know,

do we wanna do more for diagnosis or evaluation?

And that is,

is this going to change medical management,

right? Will this make a difference in what we prescribe or

don't prescribe or,

you know, other aspects of medical care,

will this enable us to better help our patients and will

this information help the patient or the family?

So sometimes getting an evaluation,

you know, if somebody has worrisome signs that correspond to one of those

more rare types of dementia,

it's not curable.

But sometimes getting that information can help people do a certain

type of preparation or planning.

But otherwise it's so kind of variable the way,

especially when people are in their eighties and nineties,

the way their dementia might progress.

And it's mixed dementia often that I find trying to figure

out the types doesn't help me so much with these things.

So if you are dealing with memory or thinking problems,

possible dementia of some type and you're thinking,

but I think I might wanna know,

I think that's okay.

I just want you to be informed as you consider pursuing

that further.

So here's what I would say are the pros and cons.

So the pros of trying to find this out,

in my experience,

many families seem to find this really meaningful and helpful.

It's not even often clear to me whether I guess the

the basis for the diagnosis,

but I work a lot with families online in kind of

a coaching capability.

And families will tell me that they want and saw a

neurologist or sometimes a memory center,

you know, and we're told it's,

you know,

Lewy body for somebody in their nineties.

And I kind of think to myself,

well I don't know.

'cause the autopsy studies show that just isolated Lewy body is

really rare and people like that.

But families seem to often find it helpful.

So I do wanna acknowledge that.

And it's possible that getting that additional information might help you

better understand whatever symptoms you are seeing in your loved one

and what to expect.

Or if you are the person who has the dementia diagnosis,

you might find this information helpful in some way.

But there are some downsides to pursuing this.

So one of them is that it often takes a lot

of time and effort to get into a memory clinic for

a detailed evaluation.

So especially if you are dealing with somebody who is reluctant

to see the doctor doesn't like to go in is denying

they have a problem,

you know,

is it,

is it worth doing all of this?

And you know,

it might not be because again,

especially once people are in their eighties and nineties,

I personally find that it doesn't change management all that much.

And again,

in people over age 85,

the the answer is that what they have is likely to

be mixed dementia and there's going to be variability in that

dementia trajectory.

Whether or not it's mixed,

there is a lot of variability in people's dementia trajectories.

And that's in part because you know which part of the

brain is affected by the pathology first.

And also because many of them,

if we actually get an opportunity to look under the hood

and look at the brain tissue,

they have multiple processes going on.

And then lastly,

there's no particular medicine or treatment available for the most common

types of dementia that affect older adults.

And so if you're still thinking you wanna go ahead with

this, I do think it's most likely to be useful in

people who are,

there's a,

you know, there's a small group of people,

people who unfortunately develop dementia symptoms in midlife or before age

65. So I think,

you know, exploring the dementia type is more likely to be useful in

that group or in what we call a young old adults.

So people who are age 65 to 75 ish,

right? You might need to find a special memory clinic.

Your average primary care provider,

I mean, the average primary care provider seems to have difficulty just diagnosing

dementia in the first place,

nevermind getting into detailed types.

And neurologists,

I think vary in their comfort and doing it.

And also when it's not a very detailed evaluation,

the autopsy studies show that people often don't,

you know, get the type of dementia,

right? So you,

you would wanna look to,

for a special memory clinic,

another option would be to consider looking for a trial.

There are lots of trials related to Alzheimer's and other forms

of dementia listed at alzheimer's dot gov.

And the good thing about a trial is that as part

of the trial,

you can get a more in-depth evaluation,

and then you might also be able to access a newer

treatment and you're both furthering the science and it might even

be helpful to you or your family member.

So about better dementia care.

I, I think in the end,

what we all want is for a person who has dementia,

regardless of what type of dementia to get,

you know, the best care possible.

And I know that initially what people want and,

and I want this for them too,

you know,

I think what people want is they want a cure,

right? They want something that makes the dementia stop that ideally

reverses it and makes them the way that they were before.

And I really wish we had this available right now,

especially for people who are in their eighties and nineties.

And we mostly don't for,

for now.

So if we want better dementia care,

you know, what are our options?

And these are the things that I believe make the biggest

difference to the lives of people who are living with Alzheimer's

or another form of dementia.

So one is for them and their family,

especially their family and care circle,

to learn better dementia communication strategies.

It's to learn to focus on what can be done to

help the person make the best of their remaining abilities,

or maybe tap into some other abilities that they haven't used

so much before.

So for instance,

a lot of people with early Alzheimer's find that they're still

able to be very creative and engage in art and in

music. And these might be things that they never took time

to do before,

but that might be accessible to them.

There can be ways to help people still leverage the abilities

that they still have to work around whatever limitations that they

are developing.

And there are usually lots of ways that we can try

to help optimize the quality of their life so that they

can have the best possible life given the circumstances now and

for the future.

I think it's also really useful to learn strategies to manage

any challenging behaviors or difficulties that are coming up in your

situation. Whether that's,

you know, false accusations,

being unaware of their difficulties.

There are strategies out there,

they do,

you know, require some coaching,

some practicing,

they require patience,

a lot of patience.

There's no like magic pill,

but those,

those can be taught.

And when families learn that that can,

you know, really reduce the stress in the household and I think makes

an important quality of life difference,

both for the person with dementia and for their family support

groups. I can't say enough about the importance of finding support

groups. There are support groups for people who have dementia where

you can connect with other people going through this experience.

There are support groups for people whose spouse has dementia or

whose parents have dementia.

And it's just so,

so valuable to be able to process the feelings with people

who understand and also learn,

you know,

some practical information or strategies from others who are in this.

So I just really recommend looking to talk to experts and

fellow travelers to learn more about not just what's going on

now, but what to expect and if you have the bandwidth

to do so,

to plan appropriately when you can,

because that does make things easier down the line when the

situation has evolved and progressed and,

you know, care needs to change or maybe the goals of,

you know, medical care need to be revised.

And then there's practicing self-care and acceptance,

again, important for the person with dementia and important for their

family and their care circle.

So this is what I believe makes the big biggest difference.

And for all of this,

you don't really need to know the type of dementia.

What you do need to do is tap into a place

to, to learn this and to get this type of support.

So I do run online programs,

helping older parents,

and we have one that's for helping parents with memory loss.

And then you can also look around and find other programs

either online or locally is often great.

Just call your local Alzheimer's association chapter.

They should be a really good resource.

So you can look on family caregiver alliance's website online as

well. So to recap about types of dementia.

So in short,

in older adults,

it's mixed dementia that is the most common type of dementia.

So if,

if you are,

you know,

are in your nineties or caring for somebody in your nineties

and you're told it's this specific type of dementia,

I just want you to remember that statistically that's like not

super likely to be that dementia and nothing,

but it's usually mixed dementia,

especially Alzheimer's disease and cerebral vascular disease.

I do think it's useful to check for Lewy body dementia

symptoms, you know,

especially hallucinations,

REM, sleep behavior disorder,

cognitive fluctuations or signs of Parkinsonism,

slowing resting tremor,

you know,

gait instability,

stiffness. And that's because if people have signs of Lewy body

dementia, this can affect medication sensitivities,

especially if you're considering using antipsychotics for behavior management.

And then unless there are unusual symptoms,

I find that an extensive evaluation to identify the type often

doesn't change management all that much.

So if you really wanna pursue that,

go ahead.

I just wanna make sure you have,

you know, good information as you go into that.

And then last but not least,

the most important forms of dementia care when it comes to

quality of life and wellbeing are non-medical.

So always remember that,

and these for the most part are not going to depend

much on the type of dementia.

And for these,

it's really a matter of figuring out how to get support

in learning those aspects of care and in finding,

you know,

resources that can help you provide that.

And I hope you'll be able to do that.

That said,

I do think it's important to be educated about dementia and

different types.

And so I hope this episode explaining types of dementia will

be useful to you.

And with that,

thank you so much for watching or listening if you found

this video podcast helpful.

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