When Dementia ISN’T Alzheimer’s: Vascular and Lewy Body Dementias

When Dementia ISN’T Alzheimer’s: Vascular and Lewy Body Dementias

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50 million people worldwide have dementia, and 60-70% of those have Alzheimer’s.

Meaning…. Do the math.

30-40% have something else.

As we discussed in defining Alzheimer’s, dementia and Alzheimer’s are not synonymous. Dementia is the animal, and Alzheimer’s is one breed.

So what’s the rest?

The Types of Dementia—Separating the Poodles from the Chihuahuas

“My husband is leaving me. No dramas, no slammed doors—well, OK, a few slammed doors—and no suitcase in the hall, but there is another woman involved. Her name is dementia. (Laurie Graham)

Dementia can be scary—both in bark and bite—no matter what the species, for both the person who has it and the ones who love him.

So why does it matter if you know what kind it is?

  • Because treatment can be different.
  • Prognoses can change.
  • Even knowing what to expect for symptoms isn’t always the same.

Either way, remember. Dementia isn’t just a normal part of aging.

So if you see symptoms, write them down and call the doctor.

Read on for what to look for in dementia types that aren’t Alzheimer’s.

Vascular Dementia—A Real Blood Vessel Stumbling Block

“Those with dementia are still people and they still have stories and they still have character and they are all individuals and they are all unique. And they just need to be interacted with on a human level.” (Carey Mulligan)

While Alzheimer’s is the first most common type of dementia, Vascular Dementia—meaning dealing with the blood vessels—is the second.

When Do Vascular Dementia Symptoms Start?

Alzheimer’s can actually start years before symptoms show up. But Vascular Dementia? It tends to be sudden, seemingly overnight, like they’re taking giant steps downhill.

Change can happen slowly, but it’s often dramatic.

Either way,

  • It rarely happens before age 65, and
  • Chances escalate significantly as Grandma reaches her 90’s.

To complicate diagnosis? Vascular Dementia and Alzheimer’s often occur together.

What Are the Symptoms?

It all depends on what part of the brain is affected.

While Alzheimer’s tangles and plaque tend to start building in the hippocampus (the area deep inside the temporal lobe [above your ears]) and gradually moves to the frontal lobe (by your forehead) …

Vascular Dementia can hit anywhere you have blood vessels in the brain.

Which means anywhere.

And different parts of the brain control different things.

But the most common symptoms are:

  • Confusion
  • Difficulty problem solving, analyzing, and communicating a plan
  • Slowed thinking
  • Lack of focus and a struggle to pay attention
  • and Trouble organizing, both in thoughts, actions, and what’s the “next step.”

In fact, with Vascular Dementia, those symptoms are often much more noticeable than memory loss.

You might also see physical symptoms:

  • Restlessness, agitation
  • An unsteady walk
  • A sudden inability to control urination or needing to go all the time
  • Depression and apathy

What Causes Vascular Dementia?

The long and short? Reduced circulation to the brain.

  • Maybe from a stroke that blocks an artery.
  • Maybe from other conditions that damage blood vessels

As the blood struggles to get through, that spot of the brain can’t get oxygen and nutrients.

It’s damaged.

Whatever that part of the brain did, it can’t do as well anymore. Hence the frequent suddenness of symptoms.

Identifying dementia as vascular is most clear-cut when you know there’s been a major stroke— “post-stroke dementia.” But it can also happen after a series of strokes or mini-strokes.

Either way, the risk increases with each stroke.

So what could cause strokes and damage to blood vessels?

  • Anything that narrows the path for blood, like deposits of cholesterol and other “roadblocks” in the arteries. (Atherosclerosis)
  • Bleeding from a ruptured blood vessel
  • History of heart attacks
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Smoking
  • Diabetes
  • A-Fib

It’s why doctors always warn us to

  • Prevent or control diabetes,
  • Quit smoking—or never start in the first place,
  • Get physical exercise, and
  • Keep cholesterol down

What Happens to the Brain in Vascular Dementia?

While Alzheimer’s has a connection to “tangles” and “plaques” within and between the brain’s nerve cells, vascular dementia is all about the blood vessels that feed those cells.

The brain requires constant food—oxygen and nutrients—to work. If it can’t get those?

Brain cells die. Those functions erode.

  • It can be a slow cell death, like in the case of a deposit build-up in blood vessels (confusingly also called “plaque,” but not the same as the Alzheimer’s kind). Blood trickles through, but maybe not enough.
  • It can also be quick, like in the case of a stroke or a brain bleed.

Vascular dementia is generally not considered progressive, meaning it might not get worse over time.

But—if more strokes happen, more blood vessels bleed out, more vessels are blocked…the brain continues to starve, more brain cells die, more function dies with it, and more symptoms increase.

How Long Does Someone with Vascular Dementia Survive?

Most research suggests five years once symptoms show.

But some say it might be shorter if vascular dementia is actually caused by a stroke. Then, you’re looking at closer to three years.

Again, since vascular dementia often occurs with Alzheimer’s, timing may vary.

Lewy Body Dementia (DLB)—When the Heffalumps and Woozles Look Real

Those with dementia may have a brain that works much differently than ours. But if we link our hands together, we can overcome anything. (Teepa Snow)

Alzheimer’s is the most common dementia. And overall, Vascular Dementia is the second most common. But Dementia with Lewy Bodies (DLB) is the second most common degenerative (or progressive)dementia.

What makes it distinctive? The visual hallucinations.

When Do Lewy Body Dementia Symptoms Start?

  • It’s more likely after 60.
  • It’s more likely in men than women.
  • And it’s more likely if you have a family history of it.

What Are the Symptoms of Lewy Body Dementia?

Recurring hallucinations tend to show up first.

  • Often they involve shapes, animals, people. But it’s not just something they see.
  • Sufferers can hear, smell, even touch illusions.
  • Grappling with what’s real and what’s not leads to struggles in being alert to what’s actually going on around them.

As the disease progresses, so do symptoms.

  • Muscles become rigid, movement slows, tremors start, walking looks like a shuffle. (Yep, it looks like Parkinson’s Disease.)
  • The body struggles to regulate normal nervous system functions, leading to issues with
    • blood pressure, pulse, sweating
    • digestion, constipation
    • falls, dizziness
  • Cognition (thinking) becomes harder, with memory loss, visual spatial problems, confusion, and increased poor attention. (Yep, like Alzheimer’s)
  • Sleep becomes difficult. They physically act out their dreams, often called “REM sleep behavior disorder.”
  • They fluctuate between drowsiness, staring into space, long naps, and disorganized speech.
  • With all the symptoms compounding, depression and apathy often set in

What Causes Lewy Body Dementia?

In a nutshell? Lewy bodies.

These are protein deposits that cluster in nerve cells in the parts of the brain that control thinking, memory, and motor control.

Why do they grow? No one knows. Yet. Again, there seems to be an increased risk with family history.

But new research may have found a way to stop the molecule that protects the clusters from being destroyed. Disable that, and they can remove the clusters.

What Happens to the Brain in Lewy Body Dementia?

Just like with Alzheimer’s, Lewy Body Dementia causes damage to nerve cells.

But while Alzheimer’s has

  • tangles (protein that breaks down, build back up improperly, and make the inside of the nerve cell look wrinkly) and
  • plaques (old amino acids that don’t break down correctly, build up between nerve cells, and make the brain look like it’s filled with those prickly “hitchhiker” cockleburs),

Lewy Bodies are like sacks inside of the nerve cells. They take over other parts of the cell and kill it.

  • Why the hallucinations? Because damage often starts in the visual pathways (and sometimes the frontal lobes).
  • The thinking, memory, movement problems? Lewy bodies next show up in the cerebral cortex, the limbic system, and the brain stem.

But it all gets even more complicated as Dementia with Lewy Bodies progresses.

  • Those plaques and tangles most often signifying Alzheimer’s can also show up in DLB.
  • And Lewy Bodies can show up in Alzheimer’s.

Making them all hard to tell apart.

Often, the deciding factor is the timing of symptoms.

  • Those hallucinations.
  • Then the motor system struggles.
  • And the fact that with DLB, memory loss is probably not the first—or even the second—problem you notice.

How Long Does Someone with Lewy Body Dementia Survive?

Approximately 8 years after first symptoms.

The difficulty during those years with DLB is that treatment needs to be different. Medication for Alzheimer’s can make symptoms worse for DLB.

Meaning a correct diagnosis is important.

It can’t be done officially without an autopsy, meaning after it’s over. Lewy Bodies are super tiny—only seen in microscope.

But keeping track of symptoms can really help.

If Grandma or Grandpa start talking to those heffalumps and woozles, make a call for your doctor to run some cognitive tests.

Unwrapping the Puzzle of Dementia

Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.” (Leo Buscaglia)

As heartbreaking as dementia can be, it is far from cut and dry.

So much research has been done, and we know so much more today than yesterday. For one, again, the fact that it isn’t just what happens as we get older.

But other diseases can cause it. Read about those here

(A huge thank you to Renate Vanaga and Unsplash for the featured image.)

Elizabeth Daghfal
• 6 min read

Elizabeth Daghfal is a writer, teacher, speaker, and community volunteer. When she isn't teaching or writing-- Who are we kidding? Her husband and five kids say she's ALWAYS teaching and writing. She has a passion to help people who are struggling and is happy to say her shoulders are drip-dry. Born and raised in the South, she now lives in Wisconsin and loves it--except for the fifteen months of winter. Read more about her at elizabethdaghfal.com.