Dementia Series: Terms Used & Common Dementias
There is a lot of misunderstanding and misuse of the word dementia… and a misconception that everyone who has dementia has Alzheimer’s.
A diagnosis of dementia is only made when cognitive decline becomes so pronounced that it affects the adult’s ability to manage their day-to-day lives. And there are a dozen or more causes of dementia, each with different symptoms and treatments.
This is a guide to the terms used to describe the dementia journey.
Capability
When we make our own life and health decisions, we are ‘capable.’ In the legal and financial world, this is called ‘competence.’
There are serious and acute reasons that we might lose the ability to make our own health care decisions:
We are seriously injured, affecting our brain function, or we are receiving high doses of opioids, or we are unconscious, on life-support.
Or, we have a life-altering or life-ending disease where we are receiving medications that alter our thinking.
Very few of us will ever experience one of these sudden and acute events. When they occur, it is often apparent that we can’t make our own decisions, even temporarily.
With cognitive decline and advancing dementia, capability too often becomes a murky concept – and we are often unaware or in denial at the time when we can no longer make safe and appropriate decisions for ourselves – making the moment our loved ones can and need to step in and take over as a time of tremendous stress.
Under the law, you are presumed capable. You can continue to make decisions until you are incapable of making these decisions. ~Public Guardian and Trustee
We think of dementia as being short-term memory issues. But loss of executive function and cognitive decline nearly always come before that.
The inability to manage our day-to-day lives often comes on slowly, is difficult to spot, and may take years to diagnose correctly. Denial, covering up glitches in memory (sometimes known as ‘confabulation’), and paranoia can muddy and slow seeking appropriate medical testing. Families try to protect the adult’s dignity by not pointing out concerning behaviours or avoiding confrontation in suggesting testing.
Confabulation is defined as the spontaneous production of false memories: either memories of events that never occurred or memories of actual events which are displaced in space or time. They are not intentional, and they are not the same as a delusion.
Too often, a diagnosis of dementia is not made until there is a crisis or a tipping point. Until that time, an adult has been managing in their own home. But there is a sudden event that triggers intervention: the power goes off because the hydro bill was not paid, or a pot is left on a hot stove, and there is a fire, the adult gets lost in their neighbourhood, or worse, there is a medical crisis such as sepsis from an untreated infection, or a broken hip from a fall.
The adult suddenly requires extensive home support or transfer to residential care in these cases.
Mild Cognitive Impairment is the state between normal function and dementia. It is more than just memory loss and can involve slower thinking and information processing. This is seen as a normal part of aging.
Executive impairment, or an executive function disorder, involves impaired executive functioning and decision-making. This is often referred to as "brain fog." It might not involve memory loss. It can be caused by many things (fatigue and sleep disorders, physical illness and disease, chemotherapy) and is not necessarily a sign of future dementia.
Executive functioning involves the ability to organize, plan and carry out a set of tasks efficiently. It also includes the ability to self-monitor and control our behaviours and multiple other cognitive functions and to perform goal-directed behaviour. It can be described as high-level thinking skills that control and direct lower levels of cognitive functioning.
Signs of an executive function disorder can include:
Failure to do essential tasks such as paying bills
Forgetting important facts and appointments
Difficulty concentrating
The inability to recognize or use familiar objects
Getting lost in familiar areas
Mood changes, withdrawal and paranoia.
Dementia is diagnosed when:
Impairment is sufficient enough to interfere with day-to-day activities and independence.
There has been a mild to significant decline in function as reported by the adult, a reliable informant, or a clinician.
Is not explained by another mental health disorder.
Delirium (severe confusion) and hallucinations may or may not be present.
Common Dementias
Alzheimer’s disease is the most common form of dementia. It is thought to be caused by the abnormal build-up of proteins in and around brain cells. One of the proteins involved is called amyloid, deposits of which form plaques around brain cells. The other protein is called tau, deposits of which form tangles within brain cells. The first symptom is generally memory loss. There is no cure, but some medications have been shown to slow the progression.
Vascular Dementia is caused by damage to the brain from insufficient blood flow or brain damage due to minor to major strokes. How quickly it progresses depends on the damage that has and continues to occur. It can happen alone or with Alzheimer’s Disease. There is no cure, but there is a solid link to other cardiovascular diseases, so slowing or managing heart disease can slow the progression of brain disease.
Lewy Body Dementia (LBD) is a disease associated with abnormal deposits of alpha-synuclein deposits in the brain. It can lead to significant thinking, movement, behaviour and mood issues. It can be rapidly or slowly progressive (2 to 20 years). There is no cure, but there are medications that have been shown to slow down the progression. Those with Parkinson Disease have a greater chance of developing it.
Frontotemporal Lobar Degeneration (Frontotemporal Neurocognitive Disorder) is a progressive decline in behaviour or language associated with degeneration of frontal and anterior temporal lobes. There is evidence of future treatment for this disease.
Parkinson Disease. Not all people with PD will develop dementia. As brain changes caused by PD progress, the adult may experience changes to mental function, including memory and the ability to focus, make sound judgements, and exercise executive functioning.
Other forms of dementia:
Other medical conditions
Sources & Resources
Tender Rose Dementia Care Specialists: Confabulation in Dementia
Very Well Health: Executive Disorder
National Library of Medicine: Dementia and Cognitive Impairment
HealthLink BC: Alzheimer’s Disease
National Health Service: Alzheimer’s Disease
National Institute on Aging: Vascular Dementia
National Institute on Aging: What is Lewy Body Dementia
National Institute on Health: Frontotemporal Lobar Degeneration
Alzheimer’s Association: Parkinson Disease Dementia
