Differentiating Between Dementia Disorders

August 01, 2017

On July 25, Shore celebrated the opening of the Flora Baker Center for Alzheimer’s Disease and Related Disorders, a resource that previously had not been available in South Jersey. While Alzheimer's disease is the most common form of dementia, what makes this center unique is that many forms of dementia are treated in this comprehensive program.

Neurologist David Roeltgen, MD, who serves as the center's medical director, explains, "In major cities, there are specialized clinics for each form of dementia. Many centers at these hospitals are Alzheimer's only, but people can have Alzheimer's without dementia. If the diagnosis is frontal temporal dementia, they would be directed to go to that type of center. Diagnoses such as multi-system atrophy fall into a 'no man’s land,'"

"It also just is not feasible or cost effective for many people who are suffering from dementia to be able to travel to Philadelphia or New York or hop on a plane and travel cross country for treatment at a specialized clinic. The Flora Baker Center for Alzheimer’s Disease and Related Disorders was designed to be as inclusive as possible, and that is why it was vital to include 'related disorders' in our program."

Dementia is a broad category, while Alzheimer's disease is a specific type, and the most common cause, of dementia. The textbook definition of dementia is an impairment in brain functioning. It can include thought processes, judgment, reasoning, memory, communication and behavior. "To me, dementia is an impairment of functional capability," says Roeltgen.

There are a variety of patients Dr. Roeltgen sees with varying degrees of concern regarding dementia. The first two are those who are feeling the effects of normal aging, and then those "Worry Wells," who are feeling the normal effects of aging, but are anxious about it.

"I explain to people that just like your knee or hip ages with time, so does your brain. Some memory loss is just something that happens to all of us as we get older."

Dementia can take many forms, at varying degrees of debilitation. The following are disorders of memory that are treated at Shore's new center:

Mild Cognitive Impairment. This term describes impairment of cognitive function in absence of functional impairment. It can be based on criteria. For example, take two 75-year-old former full-time physics professors. The first teaches part-time, and the second is retired and now enjoys playing golf and relaxing. One day, the part-time professor has trouble doing his normal task of grading papers. That person is diagnosed as having mild dementia. The retired professor, when asked to grade the same paper, has the same difficulty, but because she is no longer an active teacher, is not considered to have dementia. The outcome for those with Mild Cognitive Impairment is split evenly three ways:

  1. Develop full dementia in a year
  2. Stays the same
  3. Improved

Multiple System Atrophy (MSA) - a rare neurological disorder that impairs your body's involuntary (autonomic) functions, including blood pressure, heart rate, bladder function and digestion. Formerly called Shy-Drager syndrome, the condition shares many Parkinson's disease-like symptoms, such as slowness of movement, muscle rigidity and poor balance. MSA is a degenerative disease that develops in adulthood, usually in the 50s or 60s. Treatment for MSA includes medications and lifestyle changes to help manage symptoms. The condition progresses gradually and eventually leads to death.

Multi-infarct Dementia - Dementia resulting from multiple small strokes. Unlike Alzheimer’s disease, which develops insidiously, the cognitive deficits of multi-infarct dementia appear suddenly, in stepwise fashion. For these patients, we can address vascular risk factors, and try and slow down progress.

Frontal-Temporal Dementia - Any of several degenerative conditions of the frontal and anterior temporal lobes that cause personality and behavioral changes sometimes mistaken for those of Alzheimer's disease, and may eventually progress to immobility and loss of speech. This typically occurs between ages 50 and 70. The frontal dementia affects change in behavior, while the temporal impairs language and affects memory. There is an emptiness to their speech and can often have trouble in discussions. This type of dementia progresses rapidly.

Lewy Body Dementia - This is the second most common type of dementia, with an estimated 1.3 million Americans diagnosed. The patient suffers from memory loss and displays Parkinson's disease-like features. Occurring in people over 65, it results in REM sleep disorder, and causes people to act out their dreams, often violently, while sleeping. This behavior can begin years before Parkinson's or dementia sets in. Patients with this diagnosis are treated for their sleep disorder and checked for their health, including blood pressure, blood sugar, nutrition and more.

Dr. Roeltgen currently provides cognitive diagnostic evaluations at the Flora Baker Center for Alzheimer’s Disease and Related Disorders, located at Shore Physicians Group’s Marmora office in the ShopRite Plaza at 4 Roosevelt Blvd. To schedule an appointment, call 609-365-6226.  For more information, visit www.shorephysiciansgroup.com.