Types of Dementia and How Each Changes What to Look for in a Home

The National Institute on Aging defines dementia as the loss of cognitive functioning, meaning thinking, remembering and reasoning, to such an extent that it interferes with a person's daily life and activities. It is not one disease. The Institute lists Alzheimer's disease, frontotemporal dementia, Lewy body dementia and vascular dementia as types, along with mixed dementia, a combination of two or more.

Symptoms overlap, and the Institute notes that diagnosis can be difficult. Which type a person has is a question for the doctor, often a neurologist. What a family can do is learn how the diagnosed type tends to show up, because that shapes the kind of home and staff that will suit. For how needs grow over time, see dementia stages and care needs.

Alzheimer's disease is the most common dementia diagnosis among older adults, according to the National Institute on Aging. Memory problems are typically one of the first signs. As it progresses the Institute lists wandering and getting lost, confusion, sleep changes, and restlessness in the late afternoon or evening. In a home, the things to look at are supervision, a steady daily routine, and how staff respond to late-day restlessness. See sundowning and behavior changes.

Vascular dementia, the Institute says, comes from conditions that interrupt the flow of blood and oxygen to the brain and damage its blood vessels. Brain scans can show evidence of prior strokes, which are often small. Symptoms can begin gradually or suddenly and then progress over time, with possible short periods of improvement, and can include poor judgment and loss of the ability to perceive danger.

For a home, that pattern points to two questions: how staff notice and report a sudden change, and whether the home can also manage what a stroke may have left behind, such as trouble walking or speaking. Ask the doctor which other conditions need watching, and give the home that list.

The National Institute on Aging describes Lewy body dementia as a disease linked to abnormal protein deposits in the brain that can lead to problems with thinking, movement, behavior and mood. Visual hallucinations occur in most people with it, often early. Alertness and attention can change unpredictably from day to day, so a person may seem better one day and worse the next. Movement symptoms can include stiffness, a shuffling walk, balance problems and falls. Sleep disorders are common, including one in which a person seems to act out dreams.

The Lewy Body Dementia Association adds a point that matters when choosing a home: people with Lewy body dementia may react to certain medications differently than people with Alzheimer's or Parkinson's disease, and some medications can make symptoms worse. This is a matter for the doctor, not the care home. Ask the doctor whether any medications should be avoided, and make sure the home has the diagnosis and that instruction in its records. Our guide to dementia medications in care homes explains consent and the right to refuse.

On a tour, ask how the home handles falls, what happens at night, and how staff respond to a resident who is seeing things that are not there.

Frontotemporal disorders, the National Institute on Aging says, result from damage to nerve cells in the frontal and temporal lobes of the brain. They are rare and tend to occur at a younger age than other forms of dementia. The most common form, behavioral variant frontotemporal dementia, involves changes in personality, behavior and judgment: acting impulsively, losing interest in family, compulsive eating. Another form, primary progressive aphasia, affects the ability to speak, read, write and understand. Memory may be unaffected at first.

The Institute stresses that people with these disorders cannot control their behaviors. A home that suits a frail older resident with Alzheimer's may be a poor match for a younger, physically active person whose main symptom is impulsive behavior. Ask whether staff have cared for someone with this diagnosis, how they respond to behavior without relying on medication, and how old the other residents are.

Age can matter for admission, too. California defines an elderly person, for admission to a residential care facility for the elderly (RCFE), as someone 60 or older. Most residents of an RCFE must be that age, and any younger residents must have needs compatible with the others. Our guide to assisted living under 60 covers the options.

Use the diagnosis to sharpen your questions. Every home should be able to answer these:

No. The state's regulations for RCFEs, the license that covers assisted living, board and care homes and memory care, use dementia as a general term for major neurocognitive disorder. The definition includes Alzheimer's disease and related disorders, and it names vascular dementia, Lewy body dementia, Parkinson's disease and frontotemporal dementia. The same dementia care rules apply to all of them.

What differs is the home. Each one decides for itself which needs it can manage, so two licensed homes can give different answers about the same person. Bring the diagnosis in writing and the questions to ask on a memory care tour.

Hamssa Benrekia is a senior living placement specialist in Torrance with a background in hospice, palliative care and home health. She works with families in the South Bay and Harbor area of Los Angeles County. Tell her the diagnosis and what daily life looks like now, and she can shortlist licensed homes that say they care for those needs and go on the tours with you. She does not diagnose or advise on treatment. See memory care placement, contact Hamssa, or return to the California Assisted Living Placement Guide.