Dementia Is Not Dementia Is Not Dementia

I’ve been away for a week, and almost every day someone has asked me is Alzheimer’s Disease the same as dementia, even a registered nurse working in aged care. One taxi driver said he thought his mum was ‘soooooo lucky’ to have Alzhiemer’s Disease and not dementia like his father, although then went into a tirade (for the whole trip!) of how awful it is being a family carer… what a drag, what a terrible burden for him, how much he feels like he is on parole as he has to check in every day… For once, I kept my mouth firmly glued shut!

Although a little dated I am adding this journal article Dementia Is Not Dementia Is Not Dementia as explains it well. Teepa Snow also talks of dementia in terms of fruit. All fruits are fruit, but below that label there are different categories of fruit such as apples, pears, bananas and so on, and then within those categories there are different types of apples, pears, bananas and so on. It is a very simple analogy but one I use (thank you Teepa) often as it really helps people understand it better.

Dementia Is Not Dementia Is Not Dementia

Rita A. Jablonski, PhD, RN, ANP-BC, Journal of Gerontological Nursing January 2013 – Volume 39 · Issue 1: 3-5

 

Many clinicians use the terms dementia and Alzheimer’s disease (AD) interchangeably. This is incorrect; dementia is to AD as car is to Corvette. Dementia is a global term that describes chronic and permanent loss of cognitive function, whereas AD is a type of dementia. Nurses can provide better care when they are aware of which type of dementia is present in a patient, because the same nursing intervention may result in disparate patient responses. Differentiating the type of dementia is a clinical challenge, especially in situations where more than one type of dementia is present (i.e., mixed dementias). Certain behaviors are associated with specific types of dementia. The five most common types that nurses typically encounter are described below: AD, vascular dementia (VaD), frontotemporal dementia (FTD), Lewy body dementia (LBD), and Parkinson’s disease dementia (PDD).

Alzheimer’s Disease

The most commonly occurring type of dementia is AD, which is thought to be caused by the accumulation of beta-amyloid protein plaques in the brain due to some combination of genetics, environment insults, and lifestyle (Shagam, 2009). The hallmark of AD is progressive and irreversible loss of memory. More specifically, individuals with AD exhibit declines in executive functioning, visuospatial judgment, and language (Shagam, 2009). The clinical picture is that of a person who rapidly forgets new information while older memories simultaneously disappear over time (Levy & Chelune, 2007). When conversing with someone affected by AD, the nurse may note that the speech remains fluent and grammatically correct but the content is illogical (Levy & Chelune, 2007). Many individuals with early AD can appear superficially normal, retaining appropriate social etiquette behaviors until the disease progresses into the later stages (Levy & Chelune, 2007).

In the past, AD could only be diagnosed posthumously, by examining the brain tissue microscopically. Researchers at the University of Pittsburgh recently developed Pittsburgh Compound-B, which binds with beta-amyloid plaque and can be visualized using nuclear imaging (Shagam, 2009). By using Pittsburgh Compound-B with nuclear imaging, trained radiologists can identify AD in early stages and distinguish between AD and other forms of dementia (Shagam, 2009).

Vascular Dementia

The second most common type of dementia is VaD, accounting for 20% of all dementias (Black, 2011; Levy & Chelune, 2007). Cerebrovascular insults that interrupt blood flow to particular areas of the brain, resulting in hypoxia and tissue damage, cause VaD. The onset can be abrupt, in the case of an immediate reduction of blood flow to the brain from a myocardial infarction or cerebrovascular accident. VaD can also progress slowly, in the case of numerous small strokes that result in multiple-infarct dementia. Magnetic resonance imaging, which shows lacunar infarcts and changes in the white matter, can help distinguish VaD from AD (Shagam, 2009).

Although specific signs and symptoms of VaD are dependent on the affected areas of the brain, individuals with VaD share some common physical symptoms: shuffling gait, walking with small rapid steps, urinary incontinence, and unilateral limb weakness or paralysis (Black, 2011; Levy & Chelune, 2007). Family members may additionally relate that the older adult with VaD becomes lost in familiar environments, exhibits slurred speech, and has difficulty understanding and following directions (Shagam, 2009). Unlike those with AD, individuals with VaD are typically able to learn and retain new information (Levy & Chelune, 2007). They are also more likely to respond to cueing (Levy & Chelune, 2007). Another difference involves activities of daily living (ADLs). Individuals with AD gradually lose their abilities to perform ADLs; those with VaD usually maintain their abilities over long periods of time—or until another cerebral vascular event compromises additional brain tissue (Levy & Chelune, 2007). Nurses should recognize that individuals with VaD are typically aware of their own deficits, which contributes to depression, stubbornness, and apathy (Black, 2011).

Frontotemporal Dementia

Originally called Pick’s disease, FTD may occur at earlier ages than other dementias and has been observed in people as young as 35 (Zanni & Wick, 2007). FTD is thought to have genetic origins, where the genes that code for tau or ubiquitin proteins are altered. The result is the formation of insoluble protein deposits in neurons, with resulting atrophy of the frontal and temporal lobes (Shagam, 2009). The frontal and temporal lobes are responsible for speech, personality, and inhibition of inappropriate behavior. When the frontal and temporal lobes are compromised, the following behaviors become evident: hesitant speech and word-finding difficulty, progressing to aphasia (the inability to connect words to their meaning or to speak fluently); personality changes, including the acquisition of new artistic or musical talents (rare); and lack of social awareness and inhibition, resulting in inappropriate behavior (Shagam, 2009). Individuals with FTD also lack accurate appraisal of their limitations, which exacerbate their inappropriate behavior (Massimo et al., 2012). It is the inappropriate behavior that often generates concerns and anxiety among family members and may result in the person with FTD becoming acquainted with the judicial system. A lawyer with whom I collaborate contacted me concerning his client, a woman in her mid-50s, who was arrested repeatedly for shoplifting. I suggested the possibility of FTD and advised a thorough neurological evaluation. Another unique feature of FTD is hyperorality, a condition where the individual places inanimate objects in his or her mouth and may exhibit gluttony (Zanni & Wick, 2007). This behavior can present special challenges in both tertiary and long-term care, where the older adult attempts to eat any unmonitored food tray or swallows plastic catheter plugs. Additionally, individuals with FTD may neglect personal hygiene as well as exhibit muscle weakness, muscle atrophy, muscle rigidity, and tremors (Zanni & Wick, 2007).

Lewy Body and Parkinson’s Disease Dementias

Another type of dementia is LBD. Lewy bodies are atypical masses of alpha-synuclein, ubiquitin alpha B-crystallin, and neurofilament proteins that accumulate in the brain stem and brain cortical cells. The presence of these proteins in brains results in LBD. Go to the full article to continue reading and for the full list of references.

16 thoughts on “Dementia Is Not Dementia Is Not Dementia

  1. yes Kate it’s astounding…even GPs don’t get it. I play a game of categories and lead in to the ‘category’ of dementia. It helps. The sooner we move away from the dreadful word dementia, the better. It’s old and outdated and why do we persist with something that means ‘madness/lunacy’ anyway? The American footballers have ‘chronic traumatic encephalophy” and Vascular dementia is now being referred to as “Vascular cognitive impairment”. Hope you are feeling well Kate!

    • Thanks Sharon… although I don’t think the word dementia is that dreadful, what I think is dreadful is the ignorance there is about it… we would be outraged if doctors and clinicians knew so little about cancer, diabetes, MND, asthma, etc… and yet they can still get away with knowing so little about dementia??? go figure!

  2. When I commenced working in an Aged Care Facility in their Dementia Specific Unit, I asked one of their doctors what types of dementia did his five residents have. He said “they all have dementia – why, what difference does it make?” I proceeded to attempt to explain the differences including the different paths the illness would take that carers need to know. He was affronted and said that ‘they’ were all old and have dementia and ‘ that is all we need to know’. Incidentally, when teaching I used the analogy of flowers in a garden – roses, poppies, pansies – all flowers, all different and all special in their own way.

    • Thanks for sharing this Wendy… it is still happening much of the time, disturbing for us all. The flower analogy is another good one too, thanks. Between fruit, cars (corvettes of course) and now flowers, we have some terrific and simply ways for others to understand it is not all memory loss, and AD is a form of dementia (fingers crossed!).

  3. Hi Kate
    While I fully support the fact that people, especially professionals, should be aware of the differences between AD and VaD my worry is that it hinders people being treated as individuals as I automatically pigeon-hole the person according to their diagnosis rather than their individual skills and abilities. Human nature is to categorise people and “lump” them together which automatically sets up an “Us & Them” scenario where typically the “them” group always come out of it much worse than the “us” group.
    Loving the blog Kate 🙂
    Regards
    Mark

    • Glad you like the blog Mark… and I think it is important care and nursing staff understand the different types or causes of dementia. As it is now, we are lumped in the same basket – memory loss, confusion, and it is already very much a case ‘them and us’

  4. Hi Kate, at present I am about to complete a course (MOOC), it is assembled by UTAS, relating with the brain, cells, dementia and the person. It is offered for free for anyone interested on understanding the disease of dementia. I have found it very educational and easy to study.
    I have added a link for anyone that may be interested on understanding dementia. I read your blog and was much moved.
    Courage.
    Regards
    Renato

    https://oer.utas.edu.au
    WICKING
    Dementia Research & Education Centre

    • Thanks Renato.
      I am really glad you are enjoying it, and getting a lot out of it. I have promoted the MOOC on myblog since it started a cople of years ago, and know many people how rad my blog have done it and found it very useful too.
      Keep on learning… that is the best gift all of us can give each other, and exspecially people with dementia as things definitely need to change for them.
      Regards, Kate

      • A colleague in ACAT recently asked me the same question. At least in the asking there is the opportunity to hear a response and learn (I say with my optimists hat on, however at the time the pessimist in me wondered if all the hard work is penetrating AT ALL!).

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