DEMENTIA VERSUS PSEUDODEMENTIA

As the population ages, the incidence of dementia in the U.S. will become an even more common problem

Dementia is a category of degenerative diseases that affect important brain functions. Alzheimer’s disease is the most prevalent type of dementia, but there are several others. Many of the dementia diseases have a number of symptoms in common, including:

  • Memory loss
  • Cognitive impairment
  • Personality and behavior changes

Science now knows that dementia processes start in the brain decades before symptoms appear. Early detection with SPECT gives people the opportunity to address these diseases in the early stages—when treatment will be most effective.

Although they often have similar looking symptoms – at least in the early stages, each of the different types of dementia includes a “signature” blood flow pattern in the brain that is revealed with SPECT imaging. Identifying the type of dementia a person has is so important because the treatment that works best for one type may not be effective for another type.

Alzheimer’s disease

Alzheimer’s disease accounts for 60-80% of dementia cases. Its signature brain pattern is low activity (blood flow) in the posterior cingulate gyrus, parietal lobes and temporal lobes. In later stages of Alzheimer’s, the low activity often extends into other areas of the brain, including the frontal lobes.

SPECT imaging can identify the abnormally low activity patterns of Alzheimer’s disease up to 9 years before the onset of noticeable symptoms. This capacity of SPECT imaging is particularly valuable for people with a family history of the Alzheimer’s disease.

Common Symptoms in Alzheimer’s Disease:

  • Memory loss
  • Problems with numbers
  • Difficulty performing familiar tasks
  • Problems constructing things
  • Difficulty following directions
  • Getting lost
  • Confusion with time or date
  • Difficulty interpreting what is seen
  • Struggling with vocabulary or verbal expression
  • Judgment problems
  • Changes in mood or personality


Frontal-Temporal Lobe Dementia

Frontal-temporal lobe dementia is a group of neurodegenerative diseases that affect the function of the frontal and temporal lobes. This disease causes decreased blood flow and low activity in these important lobes of the brain that are in charge of thinking and memory. It’s estimated that 10-15% of people with dementia have this type. People with frontal-temporal lobe dementia often develop it in their 50s and 60s—although earlier onset is possible.

Common Symptoms in Frontal-Temporal Lobe Dementia:

  • Inappropriate behavior
  • Loss of restraint/increased impulsivity
  • Problems with language or speech
  • Memory loss
  • Cognitive difficulties
  • Apathy
  • Personality changes
  • Language problems

Vascular Dementia

It is estimated that 10% of dementia patients are suffering from vascular dementia. This type of dementia occurs as a result of diseases and conditions that inflame or damage blood vessels and consequently restrict blood flow in the brain. These include:

  • High blood pressure
  • Arthrosclerosis (hardening of the arteries
  • High cholesterol
  • Diabetes
  • Obesity
  • Cerebral vascular (blood vessel) disease and stroke
  • Lupus erythematosus
  • Untreated obstructive sleep apnea
  • Brain infections
  • Traumatic brain injury
  • Untreated depression
  • Cigarette smoking

Symptoms of vascular dementia can vary depending on which areas of the brain are most affected by the disease and may include several of the following:

  • Thinking problems
  • Confusion
  • Poor reasoning and planning skills
  • Difficulty with decision making
  • Memory problems
  • Poor concentration
  • Difficulty with word finding
  • Difficulty in social situations
  • Uncontrollable laughing or crying
  • Restlessness or agitation
  • Difficulty walking
  • Urinary urgency or incontinence

On SPECT images, vascular dementia will reveal multiple areas of low blood flow, with the specific pattern for each patient reflecting the parts of the brain that have been adversely affected by disease.

Alcohol Related Dementia

Alcohol Related Dementia is caused by excessive use or abuse of alcohol. Alcohol is toxic to the brain, thus heavy long-term use impairs brain function over time, making the brain vulnerable to a degenerative process. It is also thought that vitamin deficiencies (especially a lack of thiamine), which are commonly found in alcoholics, play an important role in Alcohol Related Dementia. Damage from this disease can be widespread in the brain.

Common Symptoms of Alcohol Related Dementia:

  • Balance problems
  • Memory problems
  • Difficulty learning new things
  • Clouded thinking
  • Disorganization
  • Social problems
  • Loss of motivation or initiative
  • Hallucinations
  • Confabulation (making things up)
  • Language problems
  • Moodiness
  • Personality changes

Normal Pressure Hydrocephalus

Normal Pressure Hydrocephalus (NPH) is caused by an abnormal build-up of fluid in the brain, causing the ventricles to enlarge and press on the brain affecting the areas involved with walking, bladder control and cognitive processes.

NPH causes symptoms that can mimic those seen in Alzheimer’s disease and Parkinson’s disease, so people suffering with NPH are often misdiagnosed. SPECT scans have proven to be extremely helpful in differentiating NPH from dementia, so a person can get the appropriate medical attention and correct treatment needed for this potentially debilitating condition. If identified and treated early (before brain damage has occurred), the dementia symptoms of NPH can be reversed.

Common Symptoms of Normal Pressure Hydrocephalus:

  • Difficulty with walking
  • Slowed movements
  • Loss of bladder control
  • Memory problems
  • Difficulty making decisions and planning
  • Personality changes
  • Behavior problems
  • Apathy

There is decreased function in several areas of this patient’s brain from NPH, including the frontal lobes (thinking problems), temporal lobes (memory problems) and cerebellum (affecting walking and bladder control).

Pseudodementia

Pseudodementia is a condition in which a patient has another disorder—such as depression—yet has symptoms that mimic dementia (i.e. memory problems and behavior changes), but does not actually have dementia. The role of SPECT imaging is so important to reveal the underlying cause of symptoms since the treatment for depression, in this case, is vastly different than that for dementia.

Case Study: Pseudodementia

68-year-old Margaret lived alone. She appeared ragged and unkempt. She often forgot the names of her own children and frequently got lost when driving her car. Her family worried because she appeared to have the symptoms of serious dementia, and they were ready to put her into a supervised living arrangement.

While at first glance it may have appeared that Margaret was suffering from Alzheimer’s disease, the results of her SPECT study showed full activity in her frontal, parietal and temporal lobes—essentially mitigating against the diagnosis of Alzheimer’s. Instead, the only abnormal activity on Margaret’s SPECT scan was overactivity in her limbic system. This finding is commonly found in people suffering from depression.

Sometimes with the elderly, it can be difficult to distinguish between Alzheimer’s disease and depression because the symptoms can be similar. In this case of pseudodementia, depression was masquerading as Alzheimer’s.

SPECT imaging was critically important in making the distinction between the two disorders so that we could get Margaret on the right kind of medication, which ultimately helped her symptoms improve.

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