Dementia: Not a Normal Part of Aging, Pt. 1

Much like the term "heart disease", dementia covers an array of specific medical conditions. Disorders that are included under the term "dementia" are caused by abnormal changes in the brain that trigger a decline in cognitive ability and negatively impact behavior, feelings, and relationships. There are different types of dementia:

1. Alzheimer's dementia accounts for 60-80% of all dementia cases (Alzheimer's Association, 2022). Even though the majority of Alzheimer's patients are 65 and older, Alzheimer's is not a normal part of aging. Alzheimer's is a progressive disease, meaning it worsens over time. In the early stages, memory loss is mild, but in later stages, people lose the ability to hold a conversation and respond to their environments. With Alzheimer's, changes in the brain typically begin in the areas responsible for learning. As the disease spreads through the brain over several years, symptoms become increasingly more severe and include disorientation; behavior and mood changes; confusion about places, times, and events; unfounded suspicions family, friends, and caregivers; worsening memory loss and changes in behavior; and eventually, difficulty walking, speaking, and swallowing.

2. Vascular dementia, which develops as a result of microscopic bleeding and the blockage of blood vessels in the brain, is the second leading cause of dementia. Oftentimes vascular dementia will manifest soon after a stroke. Multiple small strokes can also damage blood vessels and nerve fibers in the brain, which can result in a more gradual onset of symptoms than a major stroke. Early signs of vascular dementia include impaired judgment and planning, uncontrollable crying and laughing, impaired ability to function in social situations, difficulty finding words, and a declining ability to pay attention.

3. Frontotemporal dementia is an uncommon type of dementia that causes problems with behavior and language. While most forms of dementia affect adults aged 65 or older, frontotemporal dementia tends to start earlier, with most cases occurring in individuals aged 45-65 years old. According to the National Institute of Neurological Disorders and Stroke, frontotemporal dementia progresses steadily and often rapidly, ranging from less than 2 years in some individuals to more than 10 years in others. Unfortunately, there are no known medical treatments that have been shown to slow the progression of frontotemporal dementia.

4. Dementia with Lewy Bodies (DLB) is a type of dementia that leads to a decline in thinking, reasoning, and ability to function independently. Features of DLB often include spontaneous changes in alertness and attention, recurring visual hallucinations, changes in REM sleep patterns, slow movement, and tremors or rigidity. In early DLB, it is common to experiences disruptions in the autonomic nervous system, such as a drop in blood pressure upon standing, dizziness, urinary incontinence, and falls.

5. Mixed dementia occurs when the changes in a person's brain resemble more than one type of dementia. The most common form of mixed dementia is when a person's brain has the abnormal protein deposits associated with Alzheimer's dementia along with blood vessel damage associated with vascular dementia. Alzheimer's brain changes also regularly coexist with Lewy bodies. In some cases, a person changes in his or her brain linked to all three of these conditions - Alzheimer's dementia, vascular dementia, and DLB.

Is Dementia Preventable?

Unfortunately, there is no certain way to prevent all types of dementia; however,  a healthy lifestyle has been shown to decrease the risk of developing dementia in a person's later years. A healthy lifestyle can help prevent cardiovascular diseases, such as heart attack and stroke, which are risk factors for Alzheimer's and vascular dementia, the two most common types of dementia. Other risk factors for dementia include:

• Age: The older a person is, the higher the likelihood of developing some form of dementia. However, it is important to note that dementia is not a normal part of aging.

• Lower levels of education: In a landmark study by the Mayo Clinic (pubmed.ncbi.nlm.nih.gov/25054282/), lifelong learning was associated with a delay in the onset of age-related cognitive decline. Education may play an important role in improving cognitive reserve, which is the brain's ability to cope with damage that would otherwise lead to dementia. Research suggests that education may help the brain build more synapses, which are the junctions between brain cells that relay information, and this may boost cognitive reserve, thus helping to prevent dementia.

• Loneliness and social isolation: The Centers for Disease Control and Prevention (CDC) reports that social isolation is associated with a nearly 50% increase in risk of dementia. The CDC also states that poor social relationships are also associated with a 29% increase in the risk of heart disease and a 32% increase in the risk of stroke.

• Weight: Being overweight or obese increases blood pressure and the risk for developing type 2 diabetes. Obesity and type 2 diabetes are linked to higher rates of Alzheimer's and vascular dementia.

• Smoking: Smoking cigarettes causes arteries to become narrower, which can raise blood pressure. This can increase the risk of cardiovascular disease, as well as several types of cancer. Cardiovascular diseases increase the risk of developing Alzheimer's dementia and vascular dementia.

References

Alzheimer's Association. (2022). What is Alzheimer's disease? https://www.alz.org/alzheimers-dementia/what-is-alzheimers

Centers for Disease Control and Prevention. (2021). Loneliness and social isolation linked to serious health conditions. 

Vemuri et al. (2014). Association of lifetime intellectual enrichment with cognitive decline in the older population. https://pubmed.ncbi.nlm.nih.gov/25054282/