Hello and welcome to Dementia Q&A. I’m Dr. Marc, internist and geriatrician.
This week’s question: What other diseases of the brain can resemble and sometimes be mistaken for dementia?
It’s a great question. We have to be careful to make sure that we tease apart dementia from other disorders of the brain for three main reasons.
- Dementia is a long and difficult journey for any patient and family member. Dementia is not a diagnosis to be thrown around lightly. We have to make sure we’ve ruled out other disorders of the brain before we tell someone they definitively have dementia.
- For people who have dementia and have other disorders that involve the brain, they can make the dementia symptoms worse, more severe. And so, by treating the other illnesses, we could reduce the severity of the dementia and we can improve quality of life for our patients and their families.
- Several of these other illnesses are actually treatable, manageable, some of them preventable from becoming worse and some are actually curable. In that sense, we really owe it to our patients to track them down and treat them.
The three main categories that I think of when I’m considering other disorders of the brain that can be confused and resemble dementia are:
- Delirium of any kind.
- Depression any other mood disorders.
Let’s start with delirium. Delirium results from when you have illnesses of the body that essentially impair the brain’s normal function. Typical causes are things like severe infections, drug overdoses, medication side effects, heart disease, liver disease, surgery can actually cause delirium and even for some, being hospitalized can induce delirium on its own.
Delirium and dementia come on very differently. Dementia, as we know, is a chronic disease. It takes months or even years for us to realize the symptoms are there. Delirium occurs quickly – hours, maybe a day. Delirium is a medical emergency because it’s a signal that something is awry in the body and we have to go chase it down and treat it.
Often when you do that and you treat the underlying problem, the delirium resolves – actually most of the time, the delirium resolves. Folks who have dementia are actually more susceptible to delirium. In illnesses that might not cause delirium in you or I, for example, a urinary tract infection or maybe a common cold or a minor drug side effect, in someone with dementia, those things might push them into a full-blown delirium really quickly, so we have to be alert for that.
Delirium patients tend to be inattentive, confused. They can often appear to be sort of with us one minute and not with us the next. So, in that sense, it can look a lot like dementia.
Depression and other mood disorders is our second category. These illnesses result from cells in the brain not being able to communicate and signal back and forth to each other correctly. Often, medications can treat that, like antidepressants and antipsychotics. A lot of the symptoms of these mood disorders – depression, manic depression, psychotic depression, schizoaffective disorder, schizophrenia even – these symptoms can resemble the symptoms of dementia that we’re always looking for. For example, somebody who’s depressed might appear very apathetic. They’ll lose interest in their activities of daily living and stop doing them. They can appear a little bit disorganized and often, they might have trouble with short-term memory, so in that sense, they look a lot like someone with early Alzheimer’s disease.
For people who have bipolar disorder or schizoid or schizoaffective type illnesses, they might become very disheveled, they might have incredibly disorganized and manic thinking and they can have visual hallucinations which reminds us of early symptoms of Lewy body dementia or some of the frontotemporal dementias as well. Luckily, all of these illnesses can be treated.
The last category are strokes. Of course, strokes can cause dementia later one, but strokes are their own disease. When strokes happen acutely, we might observe them in front of our very eyes if it’s in a large artery: facial droop, slurred speech, arms and legs that aren’t functioning. These are class warning signs that something is wrong and that’s a medical emergency. But when the strokes happen in smaller arteries spread throughout the brain and they block blood flow to the brain, which results in cells dying, we don’t always see it right before our very eyes. Sometimes it takes days, weeks, or even months to pick up on the symptoms. Even though that person may end up with a mild or moderate dementia, we have to treat the strokes as their own disease because having one stroke means you’re very likely to have more and we really want to stop that in its tracks if we can.
I hope that this discussion of other diseases of the brain that can resemble or be mistaken for dementia is useful to you as you think about diagnoses you’ve seen, either in a loved one or yourself.
If you have a question you’d like a geriatrician to try to answer, please put it in the comments section and if you’ve liked or shared or subscribed to the page, it’s greatly appreciated. Thank you so much for watching and I’ll see you all next week.