Caregiver’s Corner: Understanding the Many Faces of Dementia: Symptoms, Causes, and Hope for Caregivers

When I ran my poll for what information the newsletter audience is looking for in the new year, the overwhelming response was “insights into symptoms, progression, and underlying causes.” Because of this, I’m leading off the year with a more technical Caregivers Corner than I usually write.

Below, I’m going to talk about exactly that: the symptoms, progression, and underlying causes of not just Alzheimer’s disease but of several other forms of dementia as well. Let me know what you think of this article by responding to this email: I read every single response personally and tailor the newsletter accordingly so I can offer the most help to the most people.

So, with no further ado…

When a loved one begins to forget names, repeat questions, or behave in confusing ways, it’s natural to fear dementia. And while Alzheimer’s disease is the most common cause, dementia is not a single illness—it’s an umbrella term for over 70 different conditions that affect memory, thinking, and behavior. Understanding the differences between these types can bring clarity, reduce fear, and guide better care.

As a caregiver, you’re not just managing symptoms—you’re navigating a complex landscape of medical conditions, each with its own rhythm and challenges. Some dementias progress slowly; others fluctuate day to day. Some are irreversible, while others can be reversed with proper treatment. Let’s explore the most common—and some lesser-known—forms of dementia, so you can better understand what your loved one may be experiencing.

Alzheimer’s Disease: The Most Common Cause

Alzheimer’s disease accounts for 60–80% of dementia cases and is characterized by the buildup of amyloid-beta plaques and tau tangles in the brain, which disrupt communication between neurons. Early symptoms often include forgetting recent events or conversations, misplacing items, and difficulty finding the right words.

As the disease progresses, people may experience:

• Confusion about time or place

• Trouble with familiar tasks (like cooking or managing finances)

• Personality and mood changes

• Wandering or getting lost

• Difficulty with judgment and decision-making

While there is no cure, treatments can help manage symptoms. Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and memantine are commonly prescribed to support cognitive function. Newer therapies, such as monoclonal antibodies that target amyloid, aim to slow disease progression.

Alzheimer’s is irreversible and progressive, but early diagnosis allows for better planning and access to support services.

Other Irreversible Dementias: Progressive but Manageable

Dementia with Lewy Bodies (DLB)

Dementia with Lewy bodies is one of the most common progressive dementias, caused by abnormal deposits of alpha-synuclein protein (Lewy bodies) in the brain. It often shares features with both Alzheimer’s and Parkinson’s disease.

Key symptoms include:

• Visual hallucinations

• Fluctuating alertness (lucid one moment, confused the next)

• Parkinsonian motor symptoms (tremors, stiffness)

• REM sleep behavior disorder (acting out dreams)

DLB is irreversible, and people with this condition are often highly sensitive to antipsychotic medications, which can worsen symptoms. Treatment focuses on cholinesterase inhibitors and non-drug strategies for sleep and behavior.

Parkinson’s Disease Dementia

Many people with Parkinson’s disease develop dementia as the condition advances. When cognitive decline appears more than a year after motor symptoms begin, it’s diagnosed as Parkinson’s disease dementia.

Symptoms include memory loss, slowed thinking, and impaired executive function. Like DLB, it involves Lewy bodies in the brain. There is no cure, but medications and supportive care can help manage symptoms.

Vascular Dementia (Multi-Infarct Dementia)

This type results from reduced blood flow to the brain, often due to a series of small strokes. Symptoms may appear suddenly or progress gradually and include difficulty planning, slowed thinking, and mood changes.

While the damage is irreversible, progression can be slowed by managing risk factors like high blood pressure, diabetes, and heart disease. Prevention is key.

Reversible Causes of Dementia-Like Symptoms

Not all cognitive decline is permanent. Some conditions mimic dementia but can be treated—and even reversed.

Infections: UTIs and Beyond

Urinary tract infections (UTIs) are a common cause of sudden confusion, especially in older adults. Symptoms may include agitation, delirium, or worsened memory—often mistaken for dementia progression. Once treated with antibiotics, mental clarity often returns.

Other infections, such as pneumonia or sepsis, can also trigger acute confusion and should be ruled out during any sudden cognitive change.

Medication Side Effects

Many medications—especially anticholinergics (found in some antihistamines, sleep aids, and bladder control drugs)—can impair memory and thinking. Sedatives, painkillers, and certain antidepressants may also contribute.

A medication review with a doctor or pharmacist can identify culprits. Adjusting or discontinuing these drugs often leads to noticeable improvement.

Normal Pressure Hydrocephalus (NPH)

NPH involves a buildup of cerebrospinal fluid in the brain, leading to gait problems, cognitive decline, and urinary incontinence. When diagnosed early, it can be treated with a shunt to drain excess fluid—sometimes resulting in significant improvement.

Early-Onset (Younger-Onset) Dementia

Dementia can affect people under 65. Early-onset Alzheimer’s, frontotemporal dementia, and vascular dementia can appear in the 40s or 50s. Symptoms may be mistaken for stress or depression, but early diagnosis is crucial for planning and support.

What This Means for You, the Caregiver

Understanding the type of dementia your loved one has—or whether symptoms might be reversible—can transform your caregiving journey. It helps you advocate for proper testing, avoid unnecessary medications, and choose the most effective care strategies.

You don’t need to be a doctor to make a difference. Simple steps—like tracking symptoms, reviewing medications, and noticing patterns—can provide vital clues to healthcare providers.