Frequently Asked Questions
Are dementia and Alzheimer's the same?
Dementia itself is not a disease. It's actually simply a description that indicates that someone has significant impairment in their thinking abilities such as memory or language, and that these deficiencies cause them difficulties in their real-life functioning. For example, someone with dementia may have memory difficulties that make them forget to feed themselves or take their medications appropriately. Dementia is simply a category of functioning and there are several different disorders than can cause dementia. For instance, Alzheimer's Disease is a disorder in which the cells in someone's brain break down. In the early stages of Alzheimer's disease, someone may function quite well, but as time goes on, they will inevitably reach the point of dementia, where their memory loss and other cognitive difficulties cause them to no longer live a successful life. Aside from Alzheimer's Disease, there are a variety of other disorders that can cause someone to have dementia such as: Parkinson's Disease, stroke, traumatic brain injury, or issues with the blood vessels of the brain. Dementia can also be called "major neurocognitive disorder". When someone has cognitive impairment that is not yet significantly impacting their life, we call that "mild cognitive impairment" or "minor neurocognitive disorder". Both levels of impairment are worth looking into with your doctor.
Do all people get dementia when they are older?
All people have some changes to their cognitive ability as they age, but not all people get dementia. As you age, it is normal to slow down in the speed of your thinking and have some mild memory changes, but for a normally aging person, we would not expect these changes to significantly reduce their ability to live a successful life. When doing assessments for dementia, a person's scores on tests are compared to the average scores for their age range. It is normal to have some decline as a person gets older, but when that decline is beyond the norm for their age, that is when a diagnosis of dementia is considered.
Will my loved one with dementia forget who I am?
In movies and the media, people with dementia are often depicted in situations where they do not remember their family or loved ones. There are some types of dementia in which this can occur, but this does not happen in every type of dementia. Typically this type of issue happens in the later stages of dementia caused by Alzheimer's disease or Fronto-temporal Dementia. These types of dementia cause significant memory impairment that may cause someone to forget their loved ones in the later stages. Other types of dementia, such as that caused by Parkinson's disease are not as likely to cause the person to forget or mix up their close family members. Even if someone does have a condition that creates significant memory loss, the rate of progression is different from person to person and some people never have difficulty remembering their close family members regardless of their impaired memory.
What age does dementia start?
Technically dementia can begin at any age. For example, if a young adult gets into a car accident and acquires a traumatic brain injury, their impairment could be severe enough to qualify for dementia. However, most types of dementia are related to aging and are most common in people over 65 years of age.
Which doctor can diagnose dementia?
Depending on how impaired a person is and how clear their personal history is, there are a variety of doctors that may be involved in the diagnosis process. Most people begin with their general practitioner. In many cases, their doctor will then send them to a specialist such as a neurologist and/or a neuropsychologist. A neurologist is a medical doctor that focuses on the functioning of the brain. They will have the person undergo brain imaging (MRI, CT scan etc.), lab work, and other diagnostic tests and then they will work with the person to identify and treat neurological conditions (issues with the brain). A neuropsychologist has a doctorate in psychology and they provide assessment of the brain's functioning. They assess someone's memory and other thinking skills to determine whether they are on track for normal aging, or if there are additional difficulties present. Often neurologists and neuropsychologists work hand in hand to examine the individual from different perspectives in order to find an accurate diagnosis.
Can dementia be cured?
Certain types of cognitive impairment can be cured or reduced. Other forms of dementia current have no known cure. This is the primary reason that it is important to obtain an accurate diagnosis rather than resigning to the fact that someone is declining in their thinking abilities.
What should I do if I'm worried that a loved ones has dementia?
Express these concerns to a primary care doctor. They will likely ask some questions to determine whether there are any physical health or medication changes that could be contributing to the decline in thinking abilities. They may also run some basic tests to rule out other possibilities. From there, the doctor might conduct a "mini mental state exam", which is a short screening test that involves things like identifying the current date and remembering a few words. It is a brief test that will not result in a diagnosis, but will help to identify any obvious difficulties that would require the doctor to enlist the help of a specialist.
Once a concern has been identified by the primary care doctor, they may send a person to specialists such as a neurologist or a neuropsychologist. A neurologist is a medical doctor that focuses on the functioning of the brain. They will likely send the person for brain imaging like an MRI or CT scan, run lab work, and conduct some brief screening measures in the office to determine the likely cause of their impairment. A neuropsychologist is a psychologist with special training in the brain. They will conduct a thorough interview with the person and their family members (if needed) and perform a series of specialized tests to determine whether the person is showing impairment in their thinking skills beyond what would be expected for their age.
The process of diagnosis will be a bit different for everyone. Sometimes people go straight to a neurologist or a neuropsychologist when they have concerns rather than waiting for a referral from their primary doctor. When in doubt, start with primary care and they can help to get the process started.
Why is it important to know what type of dementia someone has?
Since there are many different types of dementia, the outlook and treatment options will be different depending on the source of dementia. For instance, someone who has dementia due to a stroke or brain injury will be expected to recover some functioning and improve over the 1-2 years following the injury and then remain relatively stable in their functioning after that. In contrast, someone with dementia due to Parkinson’s disease of Alzheimer’s disease would be expected to gradually get worse over time. There are also certain issues that can be treated, such as severe vitamin deficiencies or temporary states of delirium due to medication side effects. Getting an accurate diagnosis can help to determine whether treatments are available.
Are people with dementia aware of their condition?
It is common for people with dementia to be unaware of their condition. When memory loss is a prominent symptom in someone’s dementia, they will likely also have what is referred to as “lack of insight” into their condition. Importantly, this is different than denial or being unwilling to admit their difficulties. In the early stages of dementia, it is common for someone to be in denial and blame their difficulties on normal aging or simply being retired. However, as someone moves into the more advanced stages of dementia, they lose the ability to recognize that they have cognitive problems. You might ask them if they have any memory problems and they say, “Nope. Perfectly fine!” but if you ask them what year it is, they will be off by 20 years. This can be very frustrating for family members because it becomes very difficult to help the person understand their own limitations and it is also frustrating for the person with dementia because they do not understand why everyone is making such a fuss.
Does dementia cause hallucinations?
Certain forms of dementia can cause psychosis, which refers to delusions and/or hallucinations. Delusions are firmly held thoughts or beliefs that are not rooted in objective reality. Common delusions are the belief that people are stealing from the person or that their spouse is cheating on them when there is very little actual possibility of that being true. Hallucinations are sensory experiences that are not rooted in reality. In other words, seeing something, hearing something, or smelling something that is not actually there. Someone might have hallucinations of people in their home that are not there or hear voices coming from the walls.
Hallucinations may happen in the later stages of Alzheimer’s disease of Frontotemporal dementia. They are also common in Lewy Body disease and sometimes occur in dementia due to Parkinson’s disease.
Why are people with dementia sometimes mean?
Not only does dementia affect someone’s ability to think, but it also often impacts the way that someone behaves. Certain types of dementia affect the frontal lobe of the brain, which has a huge impact on personality. When a person’s frontal lobe is impacted, they might change from a shy, reserved person to someone with no filter that says offensive or inappropriate things. Other types of dementia may also cause general agitation. As someone’s abilities decline, they may not be able to express themselves as well and will act out with their behavior as a means to communicate (similar to the way a small child will cry when hungry or upset). It is important to not take agitation or irritability personally. Having dementia is a confusing and difficult experience.