Identifying the Type of Dementia: Symptoms and Stages Explained

Which type of dementia does it belong to?

My grandfather is nearly 80 years old and has been experiencing a disrupted sleep-wake cycle in recent months, with increasing daytime sleepiness.
He has also lost a significant amount of weight and takes a long time to eat, needing to chew his food extensively.
He has very little strength, frequently falls, and has recently been experiencing urinary and fecal incontinence.
Additionally, he is showing some signs of memory loss.
Could this be indicative of a specific type of dementia, and is it in the mid to late stages of dementia?

Aru, 20~29 year old female. Ask Date: 2016/05/12

Dr. Shen Zhengnan reply Geriatrics

If an elderly person's forgetfulness reaches a level that affects daily life, it may indicate dementia.
Dementia is merely a clinical syndrome (a collection of symptoms) that requires further differentiation of its underlying causes.
The two most common causes of dementia are Alzheimer's disease, which involves the gradual death of brain cells and typically presents a continuous decline in function, and vascular dementia, which results from impaired blood flow to the brain, such as due to embolism, leading to brain cell death and typically presents a stepwise decline, where function remains stable for a period before suddenly deteriorating.
Alzheimer's dementia usually does not significantly affect gait, while vascular dementia may.
There are several other types of dementia that must be diagnosed through clinical examination.
Regarding the severity of dementia, two indicators can be assessed: daily living functions and orientation.
If there are issues with tasks such as taking medication, managing finances, or shopping, but the individual can still manage personal hygiene, bathing, and eating independently, it is considered mild dementia.
If there are noticeable problems with personal hygiene, bathing, and eating, it is classified as moderate dementia.
If the individual is completely unable to manage personal hygiene and experiences incontinence, it is classified as severe dementia.
In terms of orientation, confusion about dates and holidays indicates mild dementia; confusion about locations or floors indicates moderate dementia; and failure to recognize family members may indicate severe dementia.
Your grandfather appears to be unable to manage personal care, which suggests a more severe form of dementia.
However, you mentioned that he is just a bit forgetful, which seems inconsistent.
It is certain that your grandfather needs to see a doctor for an evaluation to determine the appropriate medical care or assistance he may require.

Reply Date: 2016/05/12

More Info

Identifying the type of dementia can be a complex process, especially as symptoms can overlap among different types of dementia. In your grandfather's case, the symptoms you describe—day-night reversal, excessive daytime sleepiness, significant weight loss, prolonged eating times, weakness, frequent falls, incontinence, and memory issues—are concerning and warrant further evaluation.

Dementia is generally characterized by a decline in cognitive function severe enough to interfere with daily life. The symptoms can vary widely depending on the type of dementia. For instance, Alzheimer's disease often begins with memory loss and progresses to include difficulties with language, problem-solving, and other cognitive functions. Vascular dementia, on the other hand, may present with sudden changes in function following a stroke, along with issues related to planning and organization.

In your grandfather's case, the combination of symptoms suggests a possible diagnosis of one of the following types of dementia:
1. Alzheimer's Disease: This is the most common form of dementia, typically characterized by memory loss, confusion, and changes in behavior. The later stages can include significant cognitive decline, difficulty with communication, and physical decline.

2. Lewy Body Dementia: This type can present with fluctuating cognition, visual hallucinations, and parkinsonian symptoms such as rigidity and bradykinesia (slowness of movement). The excessive daytime sleepiness and falls could also align with this type.

3. Vascular Dementia: This form is often associated with a history of cardiovascular issues and can present with sudden changes in cognitive function, particularly after strokes. Symptoms may include confusion, difficulty with attention, and physical symptoms like weakness.

4. Frontotemporal Dementia: This type primarily affects personality and behavior, but can also include language difficulties. It is less common in older adults but can occur.

Given your grandfather's age and the symptoms you've described, it is possible that he is in the middle to late stages of dementia, but a definitive diagnosis requires a thorough assessment by a healthcare professional. This typically includes a detailed medical history, cognitive testing, and possibly imaging studies like MRI or CT scans to rule out other causes of cognitive decline.

Recommended Steps:
1. Consult a Specialist: It is crucial to consult a neurologist or a geriatrician who specializes in dementia. They can conduct a comprehensive evaluation, including cognitive assessments and possibly neuroimaging.

2. Monitor Symptoms: Keep a detailed log of your grandfather's symptoms, including changes in behavior, sleep patterns, and any physical issues like falls or incontinence. This information can be invaluable for the healthcare provider.

3. Consider Support Services: Depending on the diagnosis, consider engaging with support services such as occupational therapy, physical therapy, or dementia care programs that can help manage daily living activities and improve quality of life.

4. Family Support: Dementia can be challenging for both the patient and the family. Consider joining support groups for caregivers, which can provide emotional support and practical advice.

In summary, while your grandfather's symptoms may suggest a type of dementia, a thorough evaluation by a healthcare professional is essential for an accurate diagnosis and appropriate management plan. Early intervention can significantly improve the quality of life for both the patient and their caregivers.

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