When I began my journey in geriatric care, first as a nurse and later as a clinic coordinator in a geriatric assessment clinic, I thought I understood dementia. I believed it was simply about memory loss, forgetfulness, confusion, and then decline. But I had no idea then how vast and diverse the landscape truly is.
What I quickly learned, often in moments that brought tears, relief, frustration, and ultimately hope, was that dementia is not a single diagnosis with a single path. It unfolds in many pathways, reflects many stories, and reveals many individual needs. I witnessed the transformative power of early and accurate diagnosis, not just for medical treatment, but for relationships, understanding, and peace.
With the correct diagnosis, the proper care plan, and the right education, caregivers and families suddenly had language for what was happening. They were no longer reacting; they were responding and not lost but prepared. They were able to connect with the person they loved on a deeper emotional level, with empathy, patience, and dignity.
Being present for these moments was eye-opening. And as I gained experience discerning one type of dementia from another, I became more attuned to the subtle first signs when they began, helping families and clinicians be ready rather than caught off guard.
There is hope. There is light. When we properly arm ourselves with knowledge, insight, and preparation, planning can begin.
What Dementia Really Means
When the word dementia enters a conversation, emotions often follow quickly: fear, sadness, uncertainty, and sometimes silence. Many people hear the term and feel as though it both explains everything and nothing at all.
That’s because dementia is often used in everyday language as if it were a single disease. But that couldn’t be further from the truth. Dementia is an umbrella term that describes a range of neurological conditions that affects memory, thinking, judgment, language, and behavior to the point that daily life is impacted. It is not a normal part of aging, although the risk does increase with age.
Understanding the specific type matters greatly because it helps explain why two people with dementia can have very different symptoms, needs, and ways of interacting with the world. The symptoms can look remarkably different from one person to another, shaped by which type of dementia has taken hold and which parts of the brain are most affected.
The Types of Dementia Matter
It is important to note that the different types of dementia affect different areas and systems in the brain first. Some types primarily affect memory; others affect behavior, judgment, movement, or language. Knowing the kind helps:
- Healthcare providers recommend the most appropriate treatments.
- Support caregivers to develop strategies that work.
- Families prepare for future physical, emotional, and practical needs.
Without this clarity, it’s easy to feel frustrated or confused when a strategy that works for one person doesn’t work for another. A correct diagnosis allows care to focus on the person behind the condition, honoring their dignity, history, and humanity.
Most Common Types of Dementia
The most common dementia types seen in older adults include Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia, mixed dementia, and alcohol-related dementia/ alcohol-related cognitive impairment. Each has its own course, symptoms, and needs.
Alzheimer’s Disease
Alzheimer’s disease is the most common form of dementia and most welll known. For many people, it begins gradually. In the early stages, you or your loved ones may notice subtle memory lapses. The difficulties include remembering recent conversations, appointments, or where things were placed. Over time, these changes grow more pronounced and begin to affect daily functioning, reasoning, and decision-making.
Biologically, Alzheimer’s is characterized by abnormal deposits of proteins, amyloid plaques, and tau tangles, which interfere with communication between neurons, leading to progressive brain cell death.
For someone living with Alzheimer’s, supportive routines, gentle reminders, familiar environments, and emotional reassurance can help maintain independence and well-being for as long as possible.
Vascular Dementia
Vascular dementia occurs when blood flow to the brain decreases. This is often due to strokes or chronic small-vessel disease. These conditions cause disruptions to blood flow, which starve our brain cells of oxygen and nutrients, leading to cognitive changes that vary based on the severity and location of these vascular changes.
Unlike Alzheimer’s, the onset of symptoms may appear suddenly after a stroke or progress in a stepped fashion as additional minor injuries occur. People with vascular dementia may notice changes in planning, problem-solving, judgment, and processing speed. Memory may be impacted, but in different patterns than with Alzheimer’s disease.
Managing heart and blood vessel health, controlling blood pressure, cholesterol, and diabetes, is a key priority for people with vascular dementia, as it helps protect the brain and supports overall wellness.
Lewy Body Dementia
Lewy body dementia (LBD) is caused by abnormal deposits of a protein called alpha-synuclein in the brain. These deposits disrupt messaging between neurons and can affect memory, movement, behavior, and mood.
A defining feature of LBD is fluctuation in alertness and attention. Someone might be very aware and engaged at one moment and confused or drowsy the next. Visual hallucinations, movement changes similar to Parkinson’s disease, and sleep disturbances are also common and can be frightening or confusing without the proper context.
Care for someone with LBD often focuses on creating a calm, consistent environment and educating caregivers about symptom fluctuations so they can respond with reassurance instead of alarm.
Frontotemporal Dementia
Frontotemporal dementia (FTD) often affects people earlier than other forms of dementia, sometimes in middle age, and tends to impact behavior, personality, and language first rather than memory.
Changes may include impulsivity, apathy, poor judgment, or difficulty communicating. These behaviors can be challenging for loved ones, but understanding that they result from changes in the frontal and temporal lobes, not from intentional choices, helps caregivers respond with compassion rather than frustration.
Mixed Dementia
Many people have more than one type of dementia at the same time, most commonly Alzheimer’s disease combined with vascular dementia. This overlap is called mixed dementia and is actually quite common.
With mixed dementia, symptoms may not fit neatly into one category, which can sometimes make diagnosis and care planning more complex. Thorough evaluation by medical professionals guides coordinated care that considers multiple contributing factors and allows for tailored support.
Alcohol-Related Dementia / Alcohol-Induced Cognitive Impairment
Alcohol-related dementia or alcohol-induced cognitive impairment refers to cognitive decline caused by the effects of chronic heavy alcohol use on the brain. Chronic heavy alcohol use over many years can lead to alcohol-related brain damage that affects cognition and daily functioning.
Recent research has started to reveal how strongly heavy alcohol use can impact brain health. It shows that heavy alcohol consumption is associated with a significantly higher risk of all types of dementia, especially when use spans decades. It also indicates that alcohol disrupts brain structure, damages white matter pathways, and contributes to nutritional deficiencies, especially thiamine deficiency, which can further worsen cognitive decline.
Because some alcohol-related cognitive changes may be partially reversible when alcohol use stops, early recognition and intervention can be especially meaningful. Treatment often includes stopping alcohol use, medical evaluation, nutritional support, thiamine replacement if needed, and lifestyle support. When alcohol use is part of the cognitive picture, reducing or eliminating alcohol becomes a central component of the care plan.
Evaluating alcohol history is, therefore, an essential part of cognitive assessment. Understanding whether alcohol plays a role can guide more personalized treatment, improve safety, and help stabilize or even partially improve cognitive function when addressed early.
Living Well With Dementia
Receiving a dementia diagnosis affects the entire family, emotionally, socially, and practically. While the journey can be challenging, it can also be full of meaningful moments, connections, and opportunities to honor the life and identity of the person living with dementia.
Some of the most helpful practices for everyday life include simplifying the environment, maintaining familiar routines, using calm and clear communication, and focusing on remaining abilities rather than losses. These adjustments reduce stress and help preserve dignity.
Caregiving is a demanding role, and support is essential. Support groups, respite care, education, and community resources can help caregivers prevent burnout and remain physically and emotionally healthy.
One of the greatest gifts caregivers can offer is presence, showing up with respect, love, and understanding, even when symptoms are complex or unpredictable.
Medicare’s GUIDE Program
The Medicare Guiding an Improved Dementia Experience (GUIDE) program is one option available to support people living with dementia and their caregivers. Launched in 2024, GUIDE connects individuals living with dementia and their caregiver with a dementia care navigator and a coordinated care team. This care team will help manage symptoms, plan ahead, and connect with services. It also offers caregiver education and Medicare-funded respite care so that caregivers can take needed breaks.
GUIDE is covered under Medicare Parts A and B, adds no extra monthly fees, and works alongside your regular doctors. For many families, it provides clarity, support, and relief, but it is one of several resources available. Talk with your healthcare provider to see if GUIDE is available in your area and whether it may be helpful for your situation.
A Person and Not a Diagnosis
It is critically important to remember that A diagnosis changes the brain; it does not erase the human being within it. If you, a loved one, or someone you care about is living with dementia, there is still a lifetime of experiences, relationships, strengths, and worth. Understanding the type of dementia and what it means allows support that honors dignity, preserves meaningful connection, and helps people live well each day.