Learning the ABC’s of Dementia

Many developed countries around the world are facing the fact that their population is aging - Canada is no different.  An older population brings along its own challenges -  mental health concerns being one of them.

Statistics Canada had about 10 per cent of Canadians in 1981 aged 65 or older.  Fast forward 45 years and 2026 will have that number hitting the 25 per cent mark.  The older Canadians get, the higher the chance of developing dementia - about 8 per cent of people over the age of 65 have some form of the condition.

Dementia patients are confused, disoriented and intellectually impaired.  The symptoms can significantly impact thinking, and normal activities and relationships.  Research shows that one in five people with dementia will become aggressive and can pose a threat to himself/herself, caregivers or the people he/she lives with, either at home or in a residential facility.   

Therefore, it is important to become familiar with the different forms of dementia and what to look out for:

Alzheimer’s Disease

Alzheimer’s is the most common cause of dementia in people aged 65 and older.  Currently, about one in 20 or approximately 290,000 Canadians have the disease - this number increases to one in four over age 85.  Eventually, nearly all brain functions, including memory, language, judgement, behaviour, abstract thinking and movement is affected.

Binswanger’s Disease

Binswanger’s disease is a rare form of dementia which occurs when there is damage to the small blood vessels in the white matter of the brain.  The disease - also called subcortical vascular dementia - progresses with the hardening of the arteries to the brain, leading to brain lesions, disordered cognition, mood changes and loss of memory.  There is no cure for Binswanger’s disease.

Cortical Dementia

Cortical dementia patients are diagnosed with damage to the brain’s outer layer or cortex.  They show severe aphasia and memory impairment, the inability to recall words and understand everyday language.  Two commonly known cortical dementias are Alzheimer’s and Creutzfeldt-Jakob disease.  These are progressive diseases and eventually will lead to death.

Creutzfeldt-Jakob Disease

Creutzfeldt-Jakob disease (CJD) - also referred to as the human form of mad cow disease - is a rare degenerative, fatal brain disorder that may be linked to an abnormal form of a protein called prion.  CJD targets the elderly and kills an average of one person in a million every year.  The disease is transmitted through contact with infected people’s brains via insufficiently sterilized surgical instruments and electrodes applied directly to the brain.  There is also danger of transmission through a growth hormone created from infected corpses, along with eating meat contaminated by mad cow disease.

Dementia Puglistica

Dementia puglistica is also called Boxer’s syndrome or chronic traumatic encephalopathy.  It is caused by head trauma that is commonly experienced by boxers.  Many big names such as Muhammad Ali, Floyd Patterson, Jack Dempsey, Joe Louis, along with Jerry and Mike Quarry are all believed to have suffered from the ailment.  In boxers, the symptoms usually show up about 12 to 16 years after they have started their career.

Frontotemporal Dementias

Frontotemporal Dementias - originally called Pick’s disease -  are typified by degeneration of nerve cells, especially those in the frontal and temporal lobes of the brain.  People suffering from these dementias show symptoms similar to Alzheimer’s disease.  The disease advances quickly from two to ten years.  There is no known treatment to slow the progression and frontotemporal dementias patients will eventually require 24-hour care.

HIV-Associated Dementia

HIV-associated dementia typically occurs a few years after a person is infected with the human immunodeficiency virus that causes AIDS and is commonly seen as the onset of full-blown AIDS.  The disease causes destruction of vast amounts of the brain’s white matter.  Symptoms include tremors, poor balance, clumsiness, memory loss, difficulty in concentration, mental slowness, along with lethargy and apathy.

Huntington’s Disease

Huntington’s disease (HD) is caused by a faulty gene for a protein called huntington and is a degenerative hereditary disorder.  The disease attacks many regions of the brain and spinal cord, leading to loss of intellectual faculties, uncontrolled movements and emotional disturbance.  If one parent has the disease, the children have a 50-50 chance of developing HD.  Symptoms include trouble learning new things, depression, irritability, mood swings, making a decision or remembering facts.  The symptoms can be controlled through medication; however, there is no cure for HD.  People diagnosed with the disease can lead normal lives and continue for another 15 to 20 years after diagnosis, they usually do not die from Huntington’s.  

Lewy Body Dementia

Lewy body dementia accounts for approximately 20 percent of all dementia cases.  It is the second most common type of progressive dementia.  The disease is characterized by abnormal structures called Lewy bodies being present in the brain.  The symptoms - similar to Alzheimer’s - include changes in behaviour, mood and communication abilities along with loss of memory, judgement and reasoning.  Lewy body dementia can materialize on its own or in conjunction with Alzheimer’s or Parkinson’s disease.  There is no cure and the cause, so far, is unknown.

Multi-Infarct Dementia

Multi-infarct dementia occurs as a common cause of memory loss for the elderly.  It is a type of vascular dementia which can happen when several small strokes attack the brain.  These “silent” strokes are often not detected since there are no noticeable symptoms.  The brain damage that results cannot be reversed and the patient usually gets worse over time.  Occasionally the patient may seem to be improving slightly; however, they continue to decline after suffering more silent strokes.

Parkinson’s Dementia

Parkinson’s dementia sometimes manifests in people with advanced Parkinson’s disease, which is a movement disorder.  Those with the disorder will experience similar symptoms as Alzheimer’s patients, along with their Parkinson’s symptoms.  Its not clear what causes the dementia, although many of the Parkinson’s patients have the same amyloid plaques found in Alzheimer’s.  There is no clear indication if the diseases are linked.

Progressive Supranuclear Palsy

Progressive supranuclear palsy (PSP) is a rare degenerative brain disorder that impacts the person’s gait and balance.  It targets people over the age of 60 and approximately one in 100,000 are affected.  Common symptoms include unexplained falls, a stiffness and awkwardness in the gait, loss of balance while walking along with changes in personality, forgetfulness and irritability.  These patients often suffer from depression, apathy and mild dementia.

Currently there is no cure nor an effective treatment.  The disorder is not fatal, but patients are susceptible to serious secondary complications which include difficulty in swallowing and pneumonia which can be quite serious since it is the most common cause of death for PSP patients.

Post-Traumatic Dementia

Post-traumatic dementia occurs when a single traumatic brain injury happens.  It is uncommon and is like dementia pubilistica; however, it usually includes long-term memory problems.

Substance-Induced Persisting Dementia

Substance-induced persisting dementia is caused by regular abuse of alcohol and/or recreational drugs.  The symptoms can continue in people even after the substance abuse has ended.

The preceding list covers many of the common types of dementia; however, older people may show symptoms and not have dementia.  As we age, it is normal for some elders to show some decline in brain function.  Our brains may shrink and some nerve cells die resulting in mild memory impairment and slower information processing.  This is all normal in the aging process and not any indication of dementia.

Others may have symptoms that are more evident than those associated with normal aging and these people may develop mild cognitive impairment.  They still are not severe enough to be considered dementia; however some may develop dementia eventually.  

Through education and awareness of the symptoms of various dementia conditions, Canadians will be better prepared to face the challenges of getting older.  Something all of us will eventually have to deal with.

SOURCE: "The many forms of dementia" CBC News. 6 July 2009.