Dementia: Symptoms, Progression, and Treatment Options

Nearly 7 million Americans are living with dementia. This number is steadily rising as the population ages and people live longer. Researchers anticipate that almost 14 million adults will be affected by some form of dementia by 2060.

While there is no cure for dementia, research shows that some treatment and management options can slow its progression.

What is Dementia?

Dementia is an umbrella term for over 100 types of cognitive impairments. It refers to abnormal brain changes that lead to the loss of thinking, remembering, and reasoning skills.

There is more of a risk of developing dementia as we age, typically age 65 and older. But dementia is not a normal part of aging. Many people live well into their 90s without signs of dementia.

There are several different types of dementia, each affecting the brain differently. The most common types include:

• Alzheimer’s Dementia
• Vascular Dementia
• Frontotemporal Dementia
• Lewy Body Dementia

The causes and symptoms of each type vary, and someone can have more than one type of dementia.

Causes of Dementia

Alzheimer’s Disease (AD)

The cause of Alzheimer’s Disease isn’t fully understood, but research strongly suggests that changes in the brain, genetics, and lifestyle play a significant role.

• Brain changes: Alzheimer’s-related changes in the brain occur when two naturally occurring substances, amyloid and tau, begin to clump up, forming tangles and plaques in the brain. These structures make it hard for the brain to work properly, as essential chemicals and messages can no longer move around as needed. As a result, parts of the brain may shrink in size or become damaged.
• Genetics: Research shows that individuals who have a parent or sibling with a diagnosis of Alzheimer's are more at risk of developing the disease than those who do not have a first-degree relative with Alzheimer's.

Vascular Dementia (VD)

Vascular dementia is caused by damage to blood vessels in the brain, which disrupts the flow of blood and oxygen supply. Conditions such as strokes (minor or major), high blood pressure, diabetes, and hardening of the arteries can affect blood vessels in the brain and contribute to the disease.

Lifestyle factors can also increase the risk of developing vascular dementia. It is crucial to control these vascular risk factors as best as possible:

• Smoking
• Poor diet
• Lack of physical activity (sedentary lifestyle)
• Drinking alcohol
• Poor sleep habits
• Unmanaged health conditions, including high blood pressure, diabetes, high cholesterol, heart disease, mood disorders (such as depression/anxiety)
• Untreated hearing loss

Frontotemporal Dementia (FTD)

There are several different types of FTD. FTD occurs when nerve cells in the front and sides of the brain become damaged and die. While the exact cause of nerve death is unknown, the tangling or clumping of naturally occurring proteins such as tau or TDP43 in the brain are thought to contribute.

Symptoms can start between ages 40-65 and older. For about one-third of people with FTD, the cause is genetic. For many others, the cause is unknown.

Lewy Body Dementia (LBD)

LBD happens when tiny clumps of a protein called alphasynuclein build up inside brain cells. These clumps, referred to as Lewy bodies, prevent cells from functioning normally. Over time, the cells become damaged and die.

The exact reason the protein clumps is unknown. Age is the biggest risk factor, with most people developing LBD after age 50. A small number of cases appear to be linked to genetics, but most people do not have a strong family history. To date, no lifestyle causes have been identified.

Symptoms of Dementia

Because dementia affects everyone differently, it’s impossible to create a definitive list of symptoms. Even within a specific type of dementia, symptoms and even the timing of onset can vary dramatically.

To aid in diagnosis, it’s helpful to keep a record of developing symptoms, noting when and how they occur.

Alzheimer’s Disease (AD)

Symptoms of Alzheimer’s Disease tend to begin gradually but get progressively worse over time.

Problems with short-term memory, particularly new information. Additional early signs include:

• Poor recall of recent events or conversations
• Repeating stories or questions
• Relying heavily on memory aids such as notes and lists
• Word finding difficulties
• Difficulty planning and completing simple or familiar tasks
• Misplacing items

Symptoms that can occur with progression of disease:

• Poor judgment
• Challenges following or joining a conversation
• Increased agitation, anxiety, or confusion
• Paranoia, suspiciousness, anger, or delusions
• Changes in sleep patterns
• Inability to recall the names of even those closest to them
• Incontinence
• Difficulty swallowing
• Believing they are at an earlier stage in their life
• Inability to recognize family members and friends, or even their own reflection in a mirror

Vascular Dementia (VD)

Unlike Alzheimer’s Disease, which steadily progresses, symptoms of VD tend to stabilize for stretches of time, followed by marked decline or step down. The step-like declines occur after a vascular event, such as a stroke.

• Slight memory loss, slowed thinking, difficulty concentrating, trouble panning and organizing
• Walking, balance issues, incontinence
• Behavior changes and more obvious trouble with daily tasks (depression, irritability)
• Sudden mood changes (trouble with emotional control)
• Possible personality changes

Frontotemporal Dementia (FTD)

• Personality and behavioral changes, including being less patient or kind, quick to anger, decline in personal hygiene.
• Lack of filter and empathy and tendency to miss social cues
• Inappropriate behaviors, often sexualized
• Trouble naming things
• Tremors, rigidity, and poor coordination
• Trouble walking
• Compulsively tapping, clapping, smacking their lips, or putting things in their mouth

Lewy Body Dementia (LBD)

Onset of LBD typically occurs after age 50 with symptoms slowly worsening over time. The earliest symptoms are similar to Alzheimer’s Disease. Once differentiating symptoms appear a diagnosis can be made.

• Seeing shapes, animals, people that others don’t see
• Movement symptoms such as slowed movement, tremors, shuffling walk
• Issues with memory loss/confusion, poor attention
• Acting out dreams physically such as punching, kicking, yelling/screaming while asleep
• Varying alertness during the day, speech that doesn’t seem to make sense
• Mood changes (depression, apathy)

Risk Factors of Dementia

While everyone has a chance of developing dementia, researchers have identified certain risk factors that increase the likelihood of developing one or more kinds of dementia. Some risk factors cannot be avoided, but some can be reduced by lifestyle changes.

Alzheimer’s Disease (AD)

• Immediate family member with the disease
• Being female
• Lifestyle and uncontrolled conditions such as high blood pressure, diabetes, depression, smoking, lack of physical activity, poor sleep, social isolation, hearing loss, obesity, and excessive use of alcohol, untreated depression/anxiety can bring on Alzheimer’s earlier or can cause a co-existing vascular dementia.

Vascular Dementia (VD)

Vascular dementia risk factors can damage brain blood vessels per below. It is important to control these risks:

• High blood pressure
• Diabetes
• Smoking/drinking alcohol
• High cholesterol
• Obesity
• Heart disease
• Personal or family history of stroke or heart disease
• Sedentary lifestyle

Frontotemporal Dementia (FTD)

The only known risk factor for FTD is genetics. A history of traumatic brain injury, especially to the front of the brain, as well as repetitive head impacts, are also thought to contribute to early onset of the disease.

Lewy Body Disease (LBD)

• Family history of Parkinson’s Disease and/or Lewy Body Disease
• Being over the age of 50
• Being male
• High blood pressure
• Diabetes
• High cholesterol
• REM sleep behavior disorder (acting out dreams during sleep)

Diagnosing Dementia

Diagnosing dementia of any type is a multi-step process, including:

• Initial Assessment: personal and family history, lab tests to rule out reversible conditions (e.g., vitamin deficiencies, misuse of medication, or infections).
• Cognitive and Neurological Evaluation: check of balance, reflexes, senses, and movement; cognitive assessments of memory, reasoning, language, and problem solving; functional assessment of an individual’s ability to perform activities of daily activities and routines
• Brain Imaging: may be needed to assess physical changes in the brain using MRIs or PET scans.

Dementia Treatment

As there’s no cure for dementia, treatment focuses on managing a patient’s symptoms and maintaining the best possible quality of life. The first stage of treatment consists of non-pharmacological approaches treatments, with medical (i.e., medication) treatments introduced only if appropriate.

Non-Medical Treatments  

• Habilitation Therapy: focuses on strengthening an individual’s current abilities, simplifying tasks, improving functional independence, and encouraging the highest level of involvement in daily living and decision making. Habilitation Therapy emphasizes respecting and validating the emotions and experiences of those with dementia, even if it differs from reality.

Medical Treatments

Not all medication options are appropriate for every type of dementia. Though not all appropriate there are some treatment options, though have varied benefits/potential side effects:

• Cholinesterase Inhibitors: (brand names: Donepezil, Galantamine, Rivastigmine) Increase brain chemicals for memory; help with thinking, behavior (modest benefit in some).
• Memantine: Regulates brain signals, often used with inhibitors for moderate to severe stages, or when others aren't tolerated.
• Anti-Amyloid Therapies: (brand names: Lecanemab, Donanemab) Generally given in the early stages of Alzheimer’s to remove brain plaques and slow the progression of disease and decline.
• Other medications: Behavioral symptoms can often be managed with antidepressant and anti-psychotic medication.