If it's not Alzheimer's dementia, what is it?

by Dr. Pamela Tronetti for Rose Lamatt:There are more than 100 causes of dementia — the umbrella term that describes memory and judgment impairment, deficiencies in planning and organization, and the ability to live independently.Alzheimer's dementia accounts for 60 percent of dementias, but what about the rest?Vascular dementia accounts for 20 percent to 30 percent of dementias. The key features are tiny, sometimes microscopic, strokes causing cumulative damage to the brain.A stroke occurs when an artery becomes clogged and the brain cells that depend on its blood flow are damaged.Picture an area of the brain the size of the point on a ballpoint pen. Perhaps that miniscule area of the brain had a single purpose like paying the bill, turning on the oven or using a remote control.If the threadlike artery that feeds it becomes clogged and the cells are damaged, then that ability is lost.Now imagine hundreds, perhaps thousands, of these strokes occurring over time.VaD is treated with the same medication as Alzheimer's dementia.In fact, 30 percent of all patients who have Alzheimer's disease also have VaD. We call this a mixed dementia.So now we have 80 percent to 90 percent of all dementias accounted for by Alzheimer's and vascular dementia. What's left?Lewy body dementia causes symptoms of dementia and Parkinson's movement disorder — either simultaneously or sequentially. Hallucinations and word-finding difficulties are common early in this disease.Alcoholic dementia is caused from years of alcohol abuse. It is a cumulative effect, and any dementias are made worse with alcohol.Frontotemporal dementia (Pick's disease) presents with disinhibited behavior, impulsivity, distractibility, loss of insight, agitation and self-neglect. The cause of this is withering of the frontal and temporal lobes of the brain, where the "better angels of our nature" reside. Memory and spatial skills often remain intact.Primary Progressive Aphasia causes speech deficits and dementia. Initially, the patient may be diagnosed with a stroke because of the word-finding difficulty. The decrease in speech is called expressive aphasia. Eventually this gives way to receptive aphasia — the inability to understand words and their meanings. The patient becomes more dependent and loses the inability to care for himself.Traumatic brain injury. Head trauma is known to contribute to Alzheimer's dementia, but people with head trauma from accidents, attacks or abuse can have dementia with varying degrees of judgment impairment, social disinhibition and memory loss. Dementia pugilistica is the term for boxers or other athletes who suffered multiple concussions and now show signs of dementia.Normal Pressure Hydrocephalus. Patients with NPH present with a triad of memory loss, difficulty walking and urinary incontinence early in the disease. A workup may include invasive nuclear brain imaging and even a spinal tap. This treatment is surgical intervention.Infections such as Mad Cow disease, Creutzfeldt Jacob disease, meningitis, neurosyphilis and encephalitis can all result in dementia.Neurological diseases such as ALS (Lou Gehrig's disease), Huntington's chorea, etc., can cause dementia.Autoimmune diseases such as vasculitis and lupus can also result in dementia.If you or a loved one is having memory loss, judgment impairment, personality changes or other brain health concerns, ask your physician about an evaluation for memory loss, which will include formal memory testing, brain imaging, medication review and blood work.Early treatment can slow the progression of the disease and delay dependence.