I am so confused as to what type of AD my husband might have. He was diagnosed three and a half years ago. Since then we were told he is starting parkinsons and that is just recent. I would like to know exactly what type of AD he has. The more I read about AD and the different types leaves me confused. My husband sometimes has a hard time communating, his words are not full sentences. This fustrates me because I can't determine what he wants me to do or fix or is he looking to eat etc. He still knows who I am and knows the family.
By reasearching and going to classes on AD has educated me somewhat but I would like to know more.
I am so sorry for your loss. It is certainly a journey when caring for someone, regardless of the reason.
The dementias are ordered in number of occurrence, so the largest disease group is Alzheimer's (official name is Dementia of the Alzheimer's Type or DAT) -- 4 subsets, Lewy Bodies Dementia -- 3 subsets, Vascular Dementia -- 3 subsets, Frontal Temporal Dementia -- 9 subsets, Parkinson's Dementia -- 2 subsets, Wernicke-Korsakoff Dementia (alcohol dementia), Huntington's/Huntington's Chorea -- 2 subsets, Creutzfeldt-Jacob Disease, etc. This grouping of dementias account for approximately 92 percent of all the dementias.
It is recognized that different presentations of disease behaviors alert physicians to specific dementias. A full battery of testing for any dementia would include blood work specific to dementia, PET scans, EEG, EKG, CAT scans, MRI, cognitive exams, etc. Dementia is not diagnosed by a simple set of questions. (A definitive diagnosis for Alzheimer's can be made with 100 percent accuracy through a spinal tap.) For a doctor to make a diagnosis, he or she takes the symptoms presented, the results of testing, rule out everything it cannot be and the end result should be the correct disease. Without a spinal tap for DAT, the diagnosis is still considered to have a 96-98 percent accuracy if the full battery of tests were completed.
But many of the behaviors you describe would point more towards a Lewy Bodies dementia. And LBD is most commonly misdiagnosed as DAT several times before a correct diagnosis is made. LBD frequently has a Parkinson's attachment, which is not understood, but is recognized. In some people, PD presents first, followed by LBD. In other people, LBD is diagnosed first and the PD symptoms begin later. Some people do not develop the Parkinson features.
Mixed Dementia is a subset of Vascular dementia. It means damage from stroke activity (large, medium or smalls strokes or a combination of strokes) has caused Vascular dementia and now Alzheimer's has crept in as well. Therefore this dementia is a "mix" of two dementias.
It is not unusual for people to have more than one dementia. And it is not
uncommon for a person to have features of Alzheimer's as well as other dementias. Research is indicating that if a person has one form of dementia and lives long enough, Alzheimer's creeps in as well. This is believed to be due to the failure of the Tau protein found within the cell structure and this collapse of the Tau protein is common in many forms of dementia.
As for the mini mental status exam -- the MMSE, this exam was developed to check for orientation, not cognition. By the time a person scores poorly on this exam, the dementia process is typically quite advanced. Doctors continue to use this test because it is the test insurance companies recognize and pay for during the doctor's examination. A more useful testing tool is the SLUMS test or St. louis University Mental Status exam. This test was developed specifically to measure for cognition and is available to download.
By late stage five on the DBAT (dementia behavioral assessment tool) all dementias begin to be very similar. This is because the damage to the brain, regardless of the type of dementia is significant. Stage five people for example have lost 1/2 pound of brain tissue in the beginning of stage five, but a pound or so of brain tissue is gone by the end of stage five. People with two pounds or less of brain tissue tend to have similar behaviors and declines towards end of life, which is why late stage five, stage six and stage seven are about the same for any person regardless of the type of dementia.
You can ask the court to order a second opinion. I just wonder how this got so out of control and niece obtaining guardianship. It may be too late without getting another attorney involved.