Does It Matter Which Type of Dementia You Have?

 

When someone is told they have “dementia”, it can sound like one single illness.

In reality, dementia is an umbrella term for several different conditions that affect the brain in different ways.

 

This matters, because the type of dementia can change which treatments and approaches are helpful – and which might even be harmful.

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This question was particularly important to me. With Jackie displaying symptoms that were not typical of Alzheimer's (complete loss of speech, swallowing difficulties, bur reasonable cognition, fair short and long term memory, but confined to a wheelchair), I tried to find out which variation of dementia she had.  Research showed that there were different treatment regimes and in some instances Alzheimer's medications could be harmful.  But getting a diagnosis was almost impossible.  AI says that the average wait for diagnosis for FTP involving scans etc is 3.6 years.  In the end, in consultation with her GP, it was decided to take her off all medications.  I never noticed any bad effects from this decision.

 

However, this page explains why the diagnosis matters, as provided by AI.

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Dementia Is Not Just One Illness

 

Some of the most common types of dementia are:

 

• Alzheimer’s disease

• Vascular dementia

• Dementia with Lewy bodies

• Frontotemporal dementia (FTD)

• Mixed dementia (a combination, usually Alzheimer’s + vascular)

 

Each of these affects different parts of the brain, and this influences:

 

• Which medications may help

• What kind of support and therapies are most useful

• What risks or sensitivities to watch out for

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Alzheimer’s Disease – Medicines Often Help

 

Alzheimer’s is the most common form of dementia.

 

There are specific medications that can help some people with Alzheimer’s:

 

• Donepezil (Aricept)

• Rivastigmine

• Galantamine

• Memantine

 

These medicines:

 

• Do not cure dementia

• Can sometimes slow down decline or improve thinking and daily functioning for a time

• Can help with memory, concentration, and sometimes behaviour

 

Because of this, it’s important to know if Alzheimer’s disease is part of the diagnosis.

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Vascular Dementia – Treating the Blood Vessels

 

Vascular dementia is caused by reduced blood flow to the brain – often due to small strokes or damaged blood vessels.

 

For many people with pure vascular dementia:

 

• Alzheimer’s drugs usually don’t help very much

• Treatment focuses on protecting the blood vessels:

   

  • Controlling blood pressure

  • Managing diabetes

  • Reducing cholesterol

  • Stopping smoking

  • Preventing further strokes (if appropriate)

 

So here, the type of dementia changes the treatment strategy.

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Dementia with Lewy Bodies – Extra Care with Medication

 

Dementia with Lewy bodies can cause:

 

• Fluctuating confusion

• Visual hallucinations

• Parkinson’s-like movement problems

• Sleep disturbance

 

Some Alzheimer’s medicines (like Donepezil or Rivastigmine) may help with thinking and hallucinations.

 

But there is a very important caution:

 

People with Lewy body dementia can react very badly to certain antipsychotic drugs, which are sometimes used to treat agitation or hallucinations in other forms of dementia. In Lewy body dementia these drugs can:

 

• Cause extreme stiffness

• Worsen confusion

• In severe cases, be dangerous

 

Knowing that someone has Lewy body dementia is therefore essential for safe treatment.

 

 

Frontotemporal Dementia (FTD) – A Different Approach

 

Frontotemporal dementia often starts with changes in:

 

• Personality

• Behaviour

• Language

 

It usually affects younger people than Alzheimer’s.

 

For FTD:

 

• Alzheimer’s medicines typically do not help, and may sometimes worsen symptoms

• Treatment is more about:

   

  • Managing behaviour

  • Speech and language therapy

  • Psychological and practical support for the family

 

Again, the type of dementia makes a big difference.

 

 

Mixed Dementia – A Bit of Both

 

Many older people have mixed dementia, often:

 

• Alzheimer’s disease

• plus vascular damage

 

In this case:

 

• Alzheimer’s medicines may still help

• It is also important to treat vascular risk factors (blood pressure, diabetes, etc.)

 

The doctor or memory clinic team should explain if they suspect a mixture.

 

 

Treatments That Help Across All Types

 

Even though medicine choices differ, there are many non-drug treatments that can help everyone living with dementia:

 

• A regular daily routine

• Occupational therapy to make daily tasks easier and safer

• Cognitive stimulation (gentle activities for thinking and memory)

• Physical exercise, within the person’s ability

• Keeping hearing and vision as good as possible

• Adapting the home environment (lighting, clutter, clear signs)

• Speech and language therapy for communication or swallowing problems

• Support and training for carers

 

These remain important whatever the diagnosis.

 

 

Why the Right Diagnosis Matters

 

Knowing the type of dementia helps:

 

• Choose the right medicines (if any)

• Avoid drugs that might be unsafe in certain dementias

• Plan for likely changes in behaviour, memory, movement or communication

• Tailor support to the individual, not just the label “dementia”

 

If you’re not sure what type of dementia has been diagnosed, it is perfectly reasonable to ask:

 

“Can you tell me exactly what type of dementia you think this is, and how that affects treatment?”

 

 

Questions You Might Want to Ask the Doctor or Memory Clinic

 

You could take this list with you:

 

1. What type of dementia do you think this is?

2. Are there any medications that might help – or that should be avoided?

3. Is this more of an Alzheimer’s picture, a vascular picture, or mixed?

4. What changes should we expect over the next year or two?

5. What non-drug support is available locally (OT, day centres, carer support)?