Neurology Insights

Understanding Dementia: A Look into Cognitive Decline and Impairment

Dementia. It’s a word that carries emotional weight, age-old stigmas, and a personal story for millions of families today. Whether you struggle with cognitive challenges or support a family member or friend experiencing changes, know that you are not alone. Nearly 1 in 10 Americans over the age of 65 currently live with some form of dementia, and while most symptoms are irreversible, with support, successful management is possible.

What is Dementia?

Throughout the ages, dementia has earned a negative reputation for its unpredictable nature. Often feared as a mental illness, there has been an association with madness and insanity. Its origin originates from the word “demens” in Latin, meaning “madness” or “without the mind”.

Today, we know better. While dementia syndrome may affect mental health and mood, dementia itself is not a mental illness but rather a brain condition that results in cognitive limitations.

In the medical field, dementia is an umbrella term to describe brain impairment, a decline in cognitive abilities ranging from memory loss to difficulty with language, motor skills, and more. I often explain to patients and families that dementia simply means a waxing and waning of thinking ability. I use the example of an eight-cylinder car, and with dementia, patients often are driving with six or seven cylinders firing. They can get around, just not as efficiently, as if all eight cylinders were working correctly.

How does dementia develop?

While we still need more research to find the absolute root cause of dementia, what we do know is that dementia most commonly develops as a result of disease or brain injury.

For many today, Alzheimer’s disease is the first thing that comes to mind when referring to dementia. And while Alzheimer’s Disease accounts for many dementia cases, the two are not interchangeable.

While all Alzheimer’s disease patients have dementia, not all dementia patients have Alzheimer’s Disease.  

Alzheimer’s disease and Huntington’s disease are currently the two most common diseases that promote dementia.

Dementia, outside of disease, generally forms as a result of repeated brain injuries, most often due to repeated strokes, falls, TBI, and more.

A Deeper Look into the Most Common Forms of Dementia

Alzheimer’s disease is currently the most known and common form of dementia syndrome, accounting for 60-75% of cases. However, that is not all. The next most common variations of dementia that follow are vascular dementia, followed by Lewy Body, Frontotemporal, and more.

Alzheimer’s Disease

The hallmark symptom of Alzheimer’s disease is memory loss, the most known and common form of dementia. Caused by an abnormal accumulation of amyloid proteins in the brain, these proteins form large clumps that stick together and form plaques in the brain over time. The aggressive nature of this plaque formation and disease destroys neural connections and brain cells responsible for memory retention, resulting in progressive and irreversible brain damage.

This form of dementia is often associated with behavior changes, which can be alarming for family members. We often see “sundowning,” which describes the worsening of cognitive and behavioral function during evening and night hours.

For more information about Alzheimer’s, please read: Alzheimer’s Disease: A Guide For Patients and Families

Vascular Dementia (also known as multi-infarct dementia) 

The most common symptoms of vascular dementia are a decline in critical thinking and the onset of confusion that interferes with daily life. This type of dementia develops due to impaired blood flow to the brain, particularly in areas responsible for cognitive reasoning. The lack of blood flow and oxygen to these areas of the brain is often a result of multiple stroke events.

With this form of dementia, we often see a stepwise decline in cognitive ability. That is because every stroke causes a little more brain damage.

Lewy Body Dementia 

In this form of dementia, patients experience changes in perception often associated with visual hallucinations, a decline in motor abilities, and more. In advanced cases, REM sleep disorder is present in which a patient may “act out” while dreaming. Protein deposits called “Lewy bodies” accumulate in brain regions, disrupting neurological functioning.

Frontotemporal Dementia

Not exclusively affecting senior patients, this type of dementia affects the frontal and temporal lobes of the brain, resulting in abnormal behavioral changes such as socially inappropriate behavior, mood changes, and more. With the unknown direct cause, current research shows a correlation between genetic mutations and a type of “Pick bodies” protein found in dementia patients.


Less common but occurring forms of dementia include mild cognitive impairment, young onset dementia, mixed dementia (multiple forms of dementia occurring together), pseudo dementia (depression that has its clinical presentation as cognitive impairment which can mimic dementia), and more.

Early Onset Signs & Symptoms of Dementia

Are you worried about a loved one who may be experiencing changes?

Early onset symptoms affect everything from mood to motor skills. Oftentimes, changes in behavior are the earliest warning signs of memory loss to come.

The following symptoms are generally associated with cognitive decline and impairment. An official diagnosis can only be made possible through proper medical evaluation.

Changes in Behavior 

  • Increasing bouts of frustration and irritability
  • Inconsistent memory patterns
  • Visible personality changes

Changes in Cognition & Communication

  • Loss of sense of navigation
  • General confusion with time and space
  • Dulled problem-solving skills
  • Difficulty finding words or explaining

Changes in Memory 

  • Frequent forgetfulness, i.e., keys misplaced, forgetting tasks
  • Inability to recall recent events  
  • Unfamiliarity with frequented places & activities
  • Difficulty with name and facial recognition

The Most Common Risk Factors in Dementia

Most of my patients ask, is dementia an inevitable part of aging? I tell them that while dementia most commonly affects adults 65+, dementia is not solely a senior person’s disorder. Research shows that the risk of dementia increases in the following groups and diagnoses:

  • 50+ individuals of Black and Hispanic ethnicities
  • Female sex (women are twice as likely to develop Alzheimer’s disease)
  • Hypertension
  • Obesity
  • Diabetes
  • Social isolation
  • Poor lifestyle habits, i.e., smoking, drinking, nutritionally deficient diet

Dementia Risk Reduction

It’s never too late to make a change. Although reducing one’s risk of dementia cannot be guaranteed, research has shown that lowering one’s risk of prerequisite conditions such as the ones listed above can considerably reduce one’s chance of preventable dementia.

The earlier, the better!

Lifestyle changes such as consuming a healthy diet (the Mediterranean diet is particularly helpful with this disorder) and engaging in exercise can promote healthy blood flow, blood sugar stabilization, and blood pressure stabilization, all of which prevent stroke, diabetes, and obesity.

Furthermore, in an increasingly digital world, fostering community and face-to-face interactions has been shown to reduce additional risk factors, such as mental health decline in dementia patients.

Patient FAQs with Dr. Kandel

1. Can dementia be reversed?

Well, it may not be possible to reverse dementia, but we certainly can slow the progression with appropriate diet, nutrition, and lifestyle changes. The most important consideration is to make sure that the correct diagnosis has been established. This requires comprehensive assessment and neurologic evaluation. This is key to determining future impairment.

For more information about neurologic evaluation, visit: When to See A Neurology Specialist


2. I have a history of dementia in my family. Is dementia inevitable for me?

Absolutely not. Diagnostic testing can be very helpful in this regard, including laboratories, imaging, and even spinal fluid evaluation to see if there are any genetic markers that may place you at risk for dementia.

Once again, following appropriate lifestyle changes can have a very positive impact on risk reduction.

For more information about neurologic testing, visit: Neurology and Medical Imaging: What You Need to Know


3. I have a family member struggling with cognitive changes but reluctant to assistance. What can I do to help?

Make sure that the diagnosis has been established correctly. Diagnostic testing in the form of MRI of the brain, EEG, vascular studies, laboratories for reversible causes of dementia, and neuropsychological testing can be very helpful. Being supportive, reassuring, and nonconfrontational is essential in dealing with family members with cognitive changes.

For more tips on how to get the most out of your next doctor’s appointment, visit: How You Can Make Your Neurologist a Better Physician


4. Can one die from dementia?

Individuals don’t die from dementia per se. However, complications of dementia, such as lack of appetite, social withdrawal, and poor self-care, can lead to medical conditions that can cause serious problems. Individuals with dementia must have the medical, psychological, and social support they require.

For more information, please read: Neurology and Mental Health: Connections and Similarities You Need to Know


5. My grandma has Alzheimer’s disease. What can we do to connect as a family with increased challenges?

Establish a family care network of support, obtain as much medical and social information as possible, and ensure that Grandma is in a safe, secure environment that can help her care for all her medical needs. Maintaining family communication is essential to avoid miscommunication and misunderstanding of Grandma’s current medical condition.

For more about Alzheimer’s Disease, please visit: Alzheimers Disease: A Guide For Patients and Families

For more community resources and support on dementia, visit the following:

Alzheimer’s Association:

National Institute on Aging (NIA):

Lewy Body Dementia Association:

National Institute on Aging:

The Association for Frontotemporal Degeneration

Dr. Joseph Kandel portrait

Joseph Kandel, MD

Board Certified Neurologist
Serving Naples and Fort Myers, FL

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“To Cure Sometimes, To Heal Often, To Comfort Always”

Neurology Office, Joseph Kandel M.D. and Associates

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