Dementia Treatment Depends on Cause

DementiaBefore Alzheimer’s Disease became a household word, the combination of forgetfulness and agitation were typically categorized under the catch-all terms dementia, senior dementia or senility. Today, it is Alzheimer’s that has become the catchall despite the fact that dementia is caused by many diseases and proper treatment depends on identifying the cause.

Doctors use the term dementia to describe a cluster of symptoms. Along with forgetfulness, agitation and confusion, the cluster includes apathy, depression, poor judgment, and motor skill problems such as slurred speech, difficulty swallowing, and impaired balance. Patients with dementia may have all or some of these symptoms.

Alzheimer’s accounts for 60 to 80 percent of dementia, but dementia can also be caused by common problems such as strokes or exotic conditions such as frontotemporal dementia.

Strictly speaking, Alzheimer’s occurs when beta-amyloid proteins form plaque that damages and destroys brain cells. The disease also damages the system that feeds brain cells. Typical symptoms of Alzheimer’s are forgetfulness, confusion, problems talking and writing, and difficulty solving problems or making decisions. Emotionally, Alzheimer’s patients can be depressed, easily agitated, or suspicious bordering on paranoia.

Two classes of drugs are showing promise in Alzheimer’s treatment, cholinesterase inhibitors and Memantine. Neither cures the disease, but they can slow its progression.

The second-leading cause of dementia is the build-up of protein deposits called Lewy bodies in the regions of the brain that control thinking, memory and motor control. Lewy body dementia (LBD) can occur side-by-side with Alzheimer’s.

People with LBD can see hallucinations or hear, smell or feel things that are not real. They may have difficulties with blood pressure, heart rate, sweating and digestion. They may shuffle when they walk, experience tremors, or move slowly. Cognitively, they may be drowsy, stare into space, or have a hard time speaking coherently.

Cholinesterase inhibitors and levodopa (l-dopa) are used to treat LBD. Doctors may prescribe anti-psychotic medications, although these sometimes cause Parkinson’s-like symptoms.

Vascular dementia is caused when stroke, heart problems or circulatory problems affect the flow of blood to the brain. There is no clear-cut set of symptom because it can affect parts of the brain that control memory, cognition, sensation, motor skills or emotions. Treatment for vascular dementia depends on knowing which part of the brain was deprived of blood, how long and how severely blood flow was restricted, and what caused the circulatory problem to start with.

People tend to associate Parkinson’s Disease with physical symptoms such as tremors, muscle stiffness and speech problems. It occurs when neurons break down or die, depleting the supply of dopamine that brain cells need to communicate with each other. Sometimes, the brain begins to accumulate Lewy bodies. Patients may experience dementia if Parkinson’s affects parts of the brain that control cognitive functions, but that happens only about 20 percent of the time.

Huntington’s Disease is a genetic disorder that usually begins when people reach their 40s or 50s. Its most-noticeable physical symptoms are sudden, involuntary arm, leg or head movements, trouble walking or standing, and problems speaking and swallowing. Huntington’s patients can suffer loss of impulse control, loss of focus (or, conversely, fixation on a task or object) or learning problems. Patients may receive antidepressant, antipsychotic or mood-stabilizing drugs to treat their dementia.

Frontotemporal dementia is a rare condition caused by deterioration of cells in the front and side (temporal) lobes of the brain. It is characterized by major personality and behavioral changes and is sometimes misdiagnosed as a psychological problem. People with the condition may suddenly show poor judgment, act rashly, become rude, or stop paying attention to personal hygiene.

Researchers have not found a way to treat or retard the condition. Doctors may prescribe antidepressant and antipsychotic medications and order therapy to manage the symptoms. The condition slowly gets worse and patients may eventually require 24-hour supervision.

Because frontotemporal dementia resembles a major behavioral disorder, it demonstrates why it is essential to look beyond symptoms for the root problem. Treatment depends on knowing whether dementia is caused by physical disease, mental illness or some combination of the two.

By J.W. Huttig

Mayo Clinic
Stanford Medicine

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