Beyond Alzheimer’s:
Common Types of Dementia in Aging

Are you dealing with a diagnosis of dementia?

If so, you might be wondering what type of dementia you are dealing with. Or, perhaps you’ve heard someone say it’s important to find out what type of dementia it is.

It’s true that there certainly are different types of dementia, and it’s often said that the most common one is Alzheimer’s disease.

But actually, especially as people get to be age 80 or older, by far the most common type of dementia is mixed dementia. Meaning, the dementia symptoms are caused by a mix of types.

If you are dealing with memory loss or other forms of cognitive decline, it’s a good idea to know the basics about the different types of dementia.

In this article, I’ll cover:

What is dementia and what’s the difference between Alzheimer’s and dementia
The most common types of dementia in older adults
When it might be important to find out what type of dementia it is
My usual approach to using dementia type to help patients

You can also watch my video covering Common Types of Dementia in Aging:

What is dementia?

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Top 10 Checklist for Better Health & Aging in 2026

by Leslie Kernisan, MD MPH

Do you find yourself taking stock and setting goals around the time of New Year’s?

It is indeed an excellent time to reflect on the past year.

And although one can set goals at any time of year, the start of the calendar year is a time that seems to inspire many people to think about their health and how to thrive over the coming year.

If better health while aging is important to you, here are my top ten suggestions for the coming year.

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How to Address Cardiovascular Risk Factors for Better Brain Health:
12 Risks to Know & 5 Things to Do

by Leslie Kernisan, MD MPH

A while back, I wrote an article on cerebral small vessel disease, a very common condition in which the small blood vessels of the brain develop signs of damage.

If you’re an older adult and you’ve had an MRI done of your brain, chances are pretty good that your scan showed signs of at least mild signs of this condition; one study of older adults aged 60-90 found that 95% of them showed signs of these white matter changes.

These are basically like teensy strokes in the brain. Most are un-noticeable to people, but if you have enough of them, you can certainly develop symptoms, such as cognitive impairment, balance problems, or even vascular dementia.

To date, the cerebral small vessel disease article has generated over 100 comments and questions from readers. A common theme was this: “My MRI shows signs of this condition. What can I do?”

As I explain in the article and the comments, the first thing to do is to work closely with your doctors to understand what is the likely cause of the damage to the brain’s small blood vessels.

Now, when you do this, you may well find that your doctor just shrugs, or waves off the question.

That’s because in most people, cerebral small vessel disease is thought to be in large part a result of atherosclerosis (more on this term below) affecting the smaller arteries of the brain. And atherosclerosis affects just about everyone as they age, because it’s related to many basic cardiovascular risk factors that become very common in late-life.

So in many cases, asking the doctor why you have signs of cerebral small vessel disease may be like asking why you might have high blood pressure, or arthritis. These are common conditions and they are usually due to medically mundane causes and risk factors, including sub-optimal “lifestyle” behaviors and the general “wear and tear” on the body that is associated with aging.

(However, in some people, damage to the small vessels in the brain may be related to one or more particular medical conditions. Younger people, in particular, seem more likely to have a particular condition or risk factor that may be causing most of the damage.)

Whether you are younger (i.e under age 60) or older, always start by asking your doctors what they think are the most likely causes for any cerebral small vessel disease, and what they recommend you do to slow the progression.

And for most people, the main advice will be this: evaluate and address your cardiovascular risk factors.

“Vascular,” as you probably already know, means “blood vessels.” And blood vessels are critical to the function of every part of the body, because blood vessels are what brings oxygen and nutrients to every cell in the body. They also carry away waste products and toxins. So, blood vessel health is key to brain health.

This article will help you better understand how to address blood vessel health. Specifically, I’ll cover:

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Cerebral Small Vessel Disease:
What to Know & What to Do

by Leslie Kernisan, MD MPH

Signs of cerebral small vessel disease. From Inzitari et al, BMJ. 2009 Jul 6;339:b2477. doi: 10.1136/bmj.b2477

This article is about the most common aging brain problem that you may have never heard of.

While leading a fall prevention workshop a few years ago, I mentioned that an older person’s walking and balance problems might well be related to the presence of “small vessel ischemic changes” in the brain, which are very common in aging adults. (This is also called “white matter disease.”)

This led to an immediate flurry of follow-up questions. What exactly are these changes, people wanted to know. Do they happen to every older adult? Is this the same as vascular dementia? And how they can best help their parents with cognitive decline?

Well, these types of brain lesions don’t happen to every older person, but they do happen to the vast majority of them. In fact, one study of older adults aged 60-90 found that 95% of them showed signs of these changes on brain MRI.

In other words, if your older parent ever gets an MRI of the head, he or she will probably show some signs of these changes.

So this is a condition that older adults and families should know about. Furthermore, these changes have been associated with problems of consequence to older adults, including:

Cognitive decline,
Problems with walking or balance,
Strokes,
Vascular dementia.

Now, perhaps the best technical term for what I’m referring to is “cerebral small vessel disease.” But many other synonyms are used by the medical community — especially in radiology reports. They include:

White matter disease
Small vessel ischemic disease
Brain lesions
Periventricular white matter changes
Perivascular chronic ischemic white matter disease of aging
Chronic microvascular changes, chronic microvascular ischemic changes
Chronic microvascular ischemia
White matter hyperintensities
Age-related white matter changes
Leukoaraiosis

In this post, I will explain what all older adults and their families should know about this extremely common condition related to the brain health of older adults.

In particular, I’ll address the following frequently asked questions:

What is cerebral small vessel disease (SVD)?
What are the symptoms of cerebral SVD?
How is cerebral small vessel disease related to vascular dementia and cerebrovascular accidents?
What causes cerebral SVD?
How can cerebral SVD be treated or prevented?
Should you request an MRI if you’re concerned about cerebral SVD?

I will also address what you can do, if you are concerned about cerebral SVD for yourself or an older loved one.

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How to Evaluate, Prevent & Manage Constipation in Aging

by Leslie Kernisan, MD MPH

Constipation is not a glamorous topic, but it’s certainly important, especially in older adults.

As anyone who has experienced occasional — or even chronic — constipation can tell you, it can really put a damper on quality of life and well-being.

Constipation can also cause more substantial problems, such as:

Severe abdominal pain, which can lead to emergency room visits
Hemorrhoids, which can bleed or be painful
Increased irritability, agitation, or even aggression, in people with Alzheimer’s disease or other forms of dementia
Stress and/or pain that can contribute to delirium (a state of new or worse confusion that often happens when older adults are hospitalized)
Fecal incontinence, which can be caused or worsened by having a hard lump of stool lodged in the lower bowel
Avoidance of needed pain medication, due to fear of constipation
Worsening of urinary leaks

Fortunately, it’s usually possible to help older adults effectively manage and prevent constipation. This helps maintain well-being and quality of life, and can also improve difficult behaviors related to dementia.

The trouble is that constipation is often either overlooked or sub-optimally managed by busy healthcare providers who aren’t trained in geriatrics. They are often focused on more “serious” health issues. Also, since many laxatives are available over-the-counter (OTC), some providers may assume that people will treat themselves if necessary.

Personally, I don’t like this hands-off approach to constipation. Although several useful laxatives, such as polyethylene glycol (brand name Miralax) are indeed available OTC, I’ve found that the average person doesn’t know enough to correctly choose among them.

Also, although in geriatrics we often do end up recommending or prescribing laxatives, it’s vital to start by figuring out what is likely to be causing — or worsening — an older person’s constipation.

For instance, many medications can make constipation worse, so we usually make an attempt to identify and perhaps deprescribe those.

In short, if you’re an older adult, or if you’re helping an older loved one with health issues, it’s worthwhile to learn the basics of how constipation should be evaluated and managed. This way, you’ll be better equipped to get help from your health providers, and if it seems advisable, choose among OTC laxative options.

Here’s what I’ll cover in this article:

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Providing Elder Care: Covering the Cost of Home Care, Assisted Living & Other Options

by Leslie Kernisan, MD MPH

One of the most common questions I get asked is “How can I get care for my aging parent and how much will it cost?”

The answer generally depends on these factors:

What kind of elder care does the older person need or want?
What are the available options for providing the needed elder care?
How much do the different options cost?
What are the options for paying for the desired type of elder care?

These are important questions to consider. If your aging parent seems to need help, it’s imperative to find out what are your options for providing the needed support. And finances do often determine how a family proceeds with arranging elder care.

And even if your aging parent doesn’t need help now, they very well might in the future. So it’s also reasonable to plan ahead, and consider how elder care might be provided, if/when it becomes needed in the future.

Now, the truth is that most older adults don’t need much assistance from others. But research shows about 70% of older adults do end up needing some form of “senior care,” for a time ranging from a few months to several years.

So in this article, I’ll share the key things to know, about options for elder care and how to pay for it. Specifically, I’ll cover: [Read more…]

Is Your Aging Parent OK?
What to check & how to talk about it

by Leslie Kernisan, MD MPH

Have you been getting worried about your aging parent, or wondering if they are ok continuing to live as they are?

Maybe they’ve been mostly okay but now you’re spotting some problems with memory, such as forgetfulness or asking the same questions repeatedly. Or maybe you’ve noticed trouble with driving, keeping up the house, managing stairs, or paying bills.

Some aging parents simply begin to seem more withdrawn. Others start leveling accusations at others, claiming someone took or moved something, or acting paranoid.

When families notice these types of changes, it’s often really hard to know what to do next. How do you know if they really need help or not, and what kind of help to get? And what do you do if they refuse to discuss it, or get mad when you bring it up?

Since this is such a common dilemma for families, I’ve recorded a video, explaining exactly what you can do, if you’ve noticed some worrisome changes in your parent and are trying to figure out what to do next. Here’s how to know if your aging parent needs help, and how to talk to them about your concerns.

This video covers:

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9 Great Gift Ideas for Older Adults & Family Caregivers

by Leslie Kernisan, MD MPH

It’s getting to be that time of the year: the season when many of us start looking for a thoughtful gift to give to an older loved one.

I’ll be honest: I’m not much of a shopper and it’s not my style to give physical gifts just for the sake of doing so.

But I do think it can be wonderful to give something that brightens a person’s day.

And it’s even better when a gift is practical, useful, or otherwise helps an older person make the best out of life.

In this article, I’ll share my list of eight gifts that can help older adults cope with common late-life challenges.

Four are for older adults in general, and then four are especially useful for those living with Alzheimer’s or a related dementia.

Four great gift ideas for older adults:

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6 Ways that Memory & Thinking Change with Normal Aging (& What to Do About This)

by Leslie Kernisan, MD MPH

It’s annoying but unfortunately true: most parts of the body work less well as one gets older and older.

This is even true of the brain, which is part of why it becomes more common to experience a “tip of the tongue” moment as one gets older.

Such age-related changes in how the brain manages memory, thinking, and other mental processes are called “cognitive aging.”

Understanding how aging changes cognitive function is important. It can help you understand what to anticipate when it comes to your own aging. It can also help families better understand the changes they’re noticing in an older person, and whether those are out of the ordinary or not.

Since I’ve often written about changes in thinking that are abnormal and concerning in older adults, I thought it might be helpful for me to write an article outlining what is normal and to be expected.

Specifically, I’ll cover:

How cognitive aging differs from other diseases and conditions that affect memory and thinking
6 ways that memory and thinking change with aging
The difference between crystallized and fluid intelligence
How to tell cognitive aging apart from more worrisome changes, such as mild cognitive impairment and signs of Alzheimer’s and related dementia
Practical takeaways and what you can do

[Read more…]

Vitamin D: What to Know
(& Why to Be Careful About High Doses)

by Leslie Kernisan, MD MPH

Confused by all the back and forth in the media about vitamin D?

That’s understandable. Once touted as the thing to take for health and well-being, vitamin D has actually not been meeting expectations in randomized trials. It’s even been demoted in some expert recommendations.

That said, there is still a pretty easy and straightforward approach that most older adults can take.

In this post, I’ll explain what I recommend to most of my older patients, and why it’s important to be careful about taking higher doses of vitamin D3.

I’ll also address the following vitamin D frequently asked questions:

How much vitamin D to take every day?
What does vitamin D do?
What to know about the symptoms of vitamin D deficiency
The benefits and side effects of vitamin D
Which type of Vitamin D should I take?
Do I need to have my vitamin D blood level checked?
What should one’s vitamin D level be?
Will vitamin D really prevent falls or fractures?
Will vitamin D prevent dementia, cancer, and/or premature death?
I am outside a lot. Do I need a vitamin D supplement?
I heard that a higher level of vitamin D is better for you. How much is too much?

You can also learn more about the surprising risks of too much vitamin D in aging in this video:

Now, when I first wrote this article in 2015, vitamin D supplementation for older adults was recommended by experts — to help reduce the risk of falls and fractures, among other things — although most geriatrics experts did not think the high doses (e.g. 2000 IU daily or more) that many people take are indicated.

(For years now, many people have had unrealistic expectations of what vitamin D can do for them. Sometimes this is because they think it will improve their health. In other cases, it seems to be because their doctors never got around to reducing a higher dose which should’ve only been used for a limited time period. Either way, it’s concerning because taking high doses of vitamin D has been linked to problems, as I explain below.)

Today, experts in geriatrics are reassessing what to recommend for vitamin D supplementation.

This reassessment is in large part driven by the publication of a large randomized trial of vitamin D supplementation in older adults, the VITAL study, plus a few other research studies that have suggested that higher doses of vitamin D supplementation are associated with more falls and hospitalizations.

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What is dementia?

Four great gift ideas for older adults:

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