Types of Dementia and Legal Planning in New Jersey

Dementia is a life-altering diagnosis, and it can leave you feeling overwhelmed and confused. You may not only have medical questions about your condition and treatment, but also legal concerns, including planning for the future.

Understanding the type of dementia you have and how it will affect you is a good first step. Next, seeking legal advice will help you solidify your wishes for the future and plan for long-term care.

At the Van Dyck Law Group, our elder law and estate planning attorneys are available to assist you with this process. We can answer questions and provide the needed legal documents if you want to assign a power of attorney, prepare a will, apply for disability benefits, or take other steps to ensure your wishes are carried out. Please contact us today for a consultation to learn more.

Common Types of Dementia

When you hear the word “dementia,” you might think of Alzheimer’s, which is the most common form. But dementia refers to a decline in cognitive functions—such as memory, language, problem-solving, and reasoning—that becomes serious enough to disrupt everyday activities. It isn’t one illness but multiple conditions that produce these symptoms. In this article, we’ll discuss the different types of dementia and their symptoms.

Alzheimer’s Disease

As the most prevalent form of dementia, Alzheimer’s has been heavily studied, but its causes are still poorly understood. Characterized by abnormal beta-amyloid plaques and tangles in the brain, Alzheimer’s often causes memory loss as an early symptom. This is followed by other symptoms, such as disorientation, changes in mood or behavior, confusion, and eventually, difficulty with basic tasks like speaking or walking.

There is currently no cure for Alzheimer’s, and the symptoms tend to grow progressively worse over time. However, several treatments are available that can help slow the progression and alleviate some symptoms.

Creutzfeldt-Jakob Disease and Frontotemporal Dementia

Creutzfeldt-Jakob Disease, or CJD, is a rare disorder known as a prion disease. It develops when prion proteins—present throughout the body but with an unclear role—undergo a structural shift into an abnormal form. This misfolded shape then prompts other prion proteins in the brain to adopt the same distorted structure over time. Later, these abnormal proteins cause dementia symptoms, including memory loss that worsens rapidly.

Some cases of CJD are genetic, while about 1 percent are caused by infections from external prion sources. The majority of cases are “sporadic,” or have no known cause. There is no cure, but medications can help treat some of the symptoms.

Frontotemporal dementia (FTD), also known as frontotemporal degeneration, encompasses a group of conditions resulting from the gradual loss of nerve cells. These cells are either in the brain’s frontal lobes (located behind the forehead) or temporal lobes (situated near the ears).

There are three subtypes of FTD:

• Behavioral  variant FTD, which leads to personality and behavioral challenges
• Primary Progressive Aphasia (PPA), which causes difficulty with language skills, speech, writing, and comprehension
• Motor function, which includes movement disorders like ALS, Corticobasal Syndrome, and Progressive Supranuclear Palsy (PSP)

As with CJD, treatment for FTD is focused on relieving symptoms.

Lewy Body and Parkinson’s Dementia

Dementia with Lewy bodies (DLB) is caused by abnormalities involving the alpha-synuclein protein, which is typically found in the brain but functions differently in people with DLB. This protein causes deposits known as “Lewy bodies” in nerve cells.

Symptoms include challenges with thinking and reasoning, visual hallucinations, REM sleep disorders, and Parkinsonian symptoms. The overlap in symptoms suggests there may be a connection between Lewy bodies and Parkinson’s Disease, although the exact relationship is not yet clear.

Most people are familiar with Parkinson’s Disease as a progressive movement disorder, but many patients also develop dementia after living with Parkinson’s for a year or more. One study found that around 75 percent of those who live with the disease for over a decade will develop dementia.

Some develop another condition called Mild Cognitive Impairment (MCI) before more serious symptoms of dementia begin. These include:

• Difficulty with memory, concentration, or judgment
• Speech challenges
• Having a hard time interpreting visual information
• Hallucinations, delusions, or both
• Mental health symptoms like depression or anxiety
• Sleep issues, such as daytime drowsiness or REM disorders

Treatments for both conditions aim to reduce symptoms. However, treatment plans could be complicated as medications for movement symptoms may worsen dementia symptoms in some patients.

It’s essential to inform your doctor if you experience side effects from a new medication, including an exacerbation of specific symptoms.

Vascular Dementia

Vascular dementia results from issues or interruptions in blood flow to the brain. It can be caused by a stroke, multiple small strokes, or blood vessel disease, damaging small blood vessels in the brain.

While vascular dementia can cause memory difficulties, the most prevalent symptoms involve challenges with thinking and problem-solving. The patient may struggle to follow directions, pay attention, stay organized, or analyze a situation.

Treatment is usually focused on the underlying factors that cause vascular dementia, including high blood pressure, high cholesterol, excessive blood clotting, atrial fibrillation, and high blood sugar.

Down Syndrome and Dementia

People with learning disabilities, especially those with Down Syndrome, are at an increased risk of developing dementia at a younger age. Approximately 20% of people with learning disabilities who are 65 or older will experience some form of dementia.

For those with Down syndrome, the likelihood is significantly greater—around two-thirds of Down Syndrome patients over 60 will be diagnosed with dementia, most often Alzheimer’s disease. The reasons why aren’t fully understood, but the extra copy of Chromosome 21 found in people with Down Syndrome may contribute to protein buildup and plaques in the brain.

Dementia can be harder to diagnose in those with learning disabilities, especially when the person has difficulty communicating. The disease may also progress more rapidly in individuals with learning disabilities compared to those without.

Often, by the time dementia is identified, symptoms may have already become more severe. Additionally, many people in this group have other health issues that may not be effectively treated or managed, highlighting the critical need for timely, specialized care and consistent support.

Huntington’s Disease

Huntington’s Disease is a genetic disorder that usually appears in middle age, with early symptoms including difficulty with movement and emotional or behavioral issues. In the initial phase, some people may begin to show signs of dementia, including challenges with thinking and interpreting information.

They might struggle to understand others’ emotions and have trouble with memory, focus, and organizing tasks. These cognitive and emotional changes can make it harder for them to maintain personal relationships or perform effectively at work.

Memory problems are common, but can present differently than in other forms of dementia, such as Alzheimer’s. Often, those with Huntington’s can recall recent events easily, but sometimes forget procedures, like how to complete a task. Unlike patients with Alzheimer’s, they usually recognize people and places until much later in their illness.

There is currently no cure for Huntington’s disease, but researchers are exploring potential gene therapies. In the meantime, some treatments may help with symptoms.

Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) occurs when excess cerebrospinal fluid accumulates in the brain, but without a corresponding rise in pressure on the brain tissue. This condition typically affects people over the age of 60. Symptoms include confusion, issues with walking and gait, difficulty staying focused, trouble answering questions, and impaired memory, particularly of recent events.

NPH is often confused with other health conditions that affect older adults, including other types of dementia. Once it is diagnosed, it can be treated by placing a shunt to drain the excess fluid away from the brain. This process improves movement symptoms, but is only sometimes effective for dementia symptoms.

Posterior Cortical Atrophy

Posterior cortical atrophy (PCA) is a condition marked by the slow and progressive breakdown of the brain’s outer layer, specifically in the rear (posterior) region of the brain. In many cases, this area displays amyloid plaques and neurofibrillary tangles—abnormal protein deposits commonly associated with Alzheimer’s disease, although they are located in a different region. However, in some people, the brain changes seen in PCA resemble those found in other conditions, such as dementia with Lewy bodies or certain forms of Creutzfeldt-Jakob disease.

For this reason, it’s not clear whether PCA is a variant of Alzheimer’s Disease or a separate condition. Additionally, PCA is difficult to diagnose, and some patients diagnosed with Alzheimer’s may have PCA.

Symptoms usually begin with visual difficulties. The patient may struggle with reading, distinguishing between moving and stationary objects, or identifying familiar objects. Some have hallucinations, challenges with math or spelling, or anxiety. Memory isn’t usually affected until later in the illness.

There are no current treatments for PCA, and more research is needed to determine if Alzheimer’s medications would be helpful. Sometimes symptoms can be managed with medication.

Mixed Dementia

As discussed earlier, there is occasionally an overlap between different forms of dementia, and some patients may have features of more than one type. This is called mixed or multifactorial dementia, notable for brain changes from two or more forms of dementia occurring at the same time.

Early in the course of the illness, the patient may not exhibit any symptoms. As the illness progresses, they will often develop mild cognitive decline, which typically presents as difficulty remembering things or struggling to find words. Later, memory loss becomes more pronounced and begins to interfere with regular tasks, such as household chores or work. Eventually, the patient may need assistance with daily life.

As with other forms of dementia, mixed dementia has no cure, but cognitive therapies and medications may help slow the progression and reduce symptoms.

New Jersey Legal Planning for Dementia Types

Most forms of dementia are progressive, which means they become more severe over time. When you or a family member receives a dementia diagnosis, you may have serious concerns about the future, such as:

• What if we can’t afford long-term care?
• What type of long-term care is best suited to my situation?
• Will I qualify for Medicaid, SSDI, or other assistance?
• What happens when I can no longer make medical decisions or manage my money?

At Van Dyck Law Group, we understand how stressful these concerns can be, and we want to help you obtain the knowledge you need to make an informed decision. When you schedule a consultation with us, we’ll take the time to listen to your questions, learn about your circumstances, and explain all your options.

For most people facing dementia, it’s a good idea to sign a power-of-attorney document (POA) naming another person to manage your affairs when you can’t. There are multiple types of POAs, and we’ll review the differences so you can decide what’s right for you.

We’ll also advise you about other documents you may need, such as a healthcare advance directive, so you can clearly express your wishes regarding future treatment. Additionally, we’ll discuss your financial situation and options for covering treatment and long-term care.

New Jersey Dementia Planning FAQ

Can You Sign Legal Documents If You Have Dementia?

You can sign documents as long as you still have capacity, or the ability to understand what you’re signing. In some cases, you may need a medical evaluation to determine if you have the capacity to make decisions. If so, we encourage you to put the proper documents in place before your condition worsens.

What if Your Loved One No Longer Has Capacity and Did Not Previously Choose a POA?

If your loved one can no longer manage their affairs and didn’t previously select a POA, you may be able to have a guardian or conservator appointed by the court. Typically, this occurs when a client realizes their family member needs someone to step in and make decisions about matters such as medical care, long-term care, or finances. Once a medical expert has determined that a family member lacks capacity, we can request that the court appoint a guardian or conservator to make decisions on their behalf.

Where Can You Learn More About Legal Planning for Dementia in New Jersey?

If you or a loved one needs assistance with a professional New Jersey Alzheimer’s planning attorney, Van Dyck Law Group is here to help. Our skilled elder law attorneys are dedicated to guiding you through your options, addressing your questions, and preparing legal documents that align with your personal goals.

We understand the emotional and logistical difficulties that can arise with a dementia diagnosis, and we’re here to provide steady, compassionate support every step of the way. Please contact us anytime at (609) 293-2621.