Decoding Dementia: Understanding Alzheimer’s, Vascular and Lewy Body Dementia

Introduction to Dementia

When we hear the term "dementia," Alzheimer’s disease often comes to mind first. However, it’s important to clarify that dementia and Alzheimer’s are not synonymous. Dementia is not a specific disease but rather a general classification used to categorize symptoms associated with cognitive decline.¹ Often referred to as an “umbrella term,” dementia includes over 100 different conditions, with Alzheimer’s disease being the most prevalent and widely recognized.² Other significant forms include vascular dementia and Lewy Body Dementia. Although these conditions share similar symptoms, such as memory loss, confusion, and behavioral changes, their underlying causes and treatment approaches can differ greatly.³ Understanding these distinctions is crucial for accurate diagnosis, effective treatment, and providing the best possible care. Let’s take a closer look at these differences.

Alzheimer’s Disease: The Leading Type of Dementia

Alzheimer's disease affects an estimated 6.9 million people in the United States.⁴ This condition is driven by the buildup of harmful proteins—amyloid plaques and tau tangles—in the brain. Over time, these proteins cause brain tissue to shrink, particularly in areas responsible for memory and thinking. The hippocampus, often referred to as the brain’s control center, is one of the first regions to be affected, leading to the progressive worsening of symptoms.⁵

Alzheimer’s disease typically unfolds in three stages: early (mild), middle (moderate), and late (severe). During these stages, it’s common for symptoms to plateau temporarily, resulting in a gradual progression rather than an abrupt decline, which is often seen in vascular dementia. The majority of individuals affected by Alzhiemer’s are over the age of 65—a time when the signs of normal cognitive aging often emerge, closely mirroring many early-stage symptoms. This overlap can make early detection challenging, as mild memory lapses and difficulties with complex tasks are common in both normal aging and Alzheimer’s.⁶ However, by the middle stage of Alzheimer’s, cognitive decline, daily life disruption, and behavioral changes become far more pronounced than what is seen in typical aging.⁷

Detecting Alzheimer’s in its earliest stages requires proactive measures, such as requesting cognitive screenings during annual health check-ups and obtaining a baseline evaluation to monitor changes in cognitive function over time.

Vascular Dementia: Impact of Blood Flow to the Brain

Vascular dementia, the second most common form of dementia, arises when blood flow to the brain is restricted, causing irreversible damage. Unlike Alzheimer’s and Lewy Body Dementia, vascular dementia often follows a 'stepwise' pattern, characterized by sudden declines in cognitive and physical abilities. These abrupt changes, which are often closely linked to major vascular events like strokes, make diagnosing vascular dementia somewhat more straightforward compared to the other two.⁸ Cardiovascular issues—such as strokes, small vessel disease, and hypertension—are the leading risk factors.⁹ While maintaining a healthy lifestyle that includes regular exercise and a balanced diet cannot fully guarantee the prevention of vascular dementia, it significantly reduces the risk of cardiovascular diseases, thereby lowering the likelihood of developing this type of dementia. Post-stroke rehabilitation can also play a vital role in managing vascular dementia symptoms. Through targeted physical and occupational therapy, individuals with vascular dementia can work to retain some of their independence and improve their overall quality of life.¹⁰

Lewy Body Dementia: Distinctive Traits and Challenges

The third most common type of dementia, Lewy Body Dementia (LBD), is caused by the accumulation of abnormal proteins in the brain known as Lewy bodies. LBD shares symptoms with both Parkinson’s disease—such as tremors, muscle stiffness, and coordination difficulties—and Alzheimer’s, including memory loss and impaired judgment, which makes early diagnosis particularly challenging.¹¹ What typically distinguishes LBD from Parkinson’s disease and other dementias is the early onset of visual hallucinations and REM sleep behavior disorder in LBD patients.¹² Visual hallucinations affect approximately 80% of those with LBD. While they can occur in other types of dementia, they typically emerge much earlier in LBD compared to other types.¹³ REM sleep behavior disorder (RBD) is characterized by physical movements and reactions during REM sleep, a phase that is normally marked by muscle relaxation. RBD is a defining feature of Lewy body dementia and can be identified years before the onset of other symptoms. Recognizing these manifestations earlier on is not only essential for differentiating LBD from other types of dementia, but also critical for early detection, which allows for better management and planning.¹⁴

The Role of Social Interaction in Dementia Management

Until recent years, the impact of social interaction on brain health has been largely overlooked. However, emerging research has demonstrated that social engagement not only helps to prevent and delay the onset of dementia-related conditions but also plays a crucial role in managing symptoms after diagnosis.¹⁵ The value of a strong support network and active social life for individuals with dementia cannot be overstated. Social isolation, by contrast, often accelerates cognitive decline and exacerbates the progression of the disease. Fostering meaningful connections and maintaining regular social activities are vital strategies for enhancing quality of life and slowing the progression of dementia.¹⁶

Lowering Your Risks and Early Detection

While prevention of any type of dementia cannot be fully guaranteed, there are proactive steps one can take to lower the risks. Engaging in both physical and mental exercise (like word games and puzzles), adopting a diet low in sodium, refined sugars, and red meat—such as the DASH or Mediterranean diet—and managing stress levels are all effective strategies to reduce or delay the onset of Alzheimer’s, vascular dementia, or Lewy Body Dementia.¹⁷ Additionally, staying proactive with annual check-ups, advocating for cognitive screenings, and obtaining your cognitive baseline are crucial for early detection and better management.¹⁸ Dementia-related diseases are profoundly challenging for both those affected and their families. However, with ongoing advancements in technology and medicine, there is growing hope that we will see a future where these conditions no longer have the devastating impact they do today.

If you or a loved one is affected by dementia and would like to connect with others, consider joining our virtual support group, Caregiver Conversations. For more general information and resources, please visit Alzheimer’s Texas or call our 24/7 Helpline at (512) 241-0420.

Austin McKee, MSSW, is the Helpline Specialist and Content Creator at Alzheimer’s Texas. With a Master of Science in Social Work, Austin has extensive experience in geriatric care, including social support and engagement, end-of-life care, and caregiver support. She is passionate about bridging the gap between generations, fostering mutual understanding, and helping people recognize the inherent value and purpose in individuals of all ages, regardless of physical or cognitive changes.

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