Why No Two People With Dementia Are The Same

One of the most important and frequently misunderstood truths about dementia is that its presentation and progression vary significantly from person to person.

While dementia is often spoken about as a single condition, it is not one “disease,” nor does it follow a predictable script. Even when individuals share the same dementia diagnosis (such as Alzheimer’s disease or Lewy Body Dementia), be of similar age, health status, and baseline cognitive function, or even reside in the same care setting, their abilities, behaviours, emotional responses, and care needs may differ substantially.

Observing Alzheimer’s Awareness Month through the lens of this year’s theme, Forget Me Not, underscores the importance of remembering both people living with dementia and the caregivers impacted alongside them. 

The nuanced nature of dementia care is often unfamiliar to new caregivers, making awareness and education essential not only for delivering respectful, person-centred care but also to help prepare caregivers to navigate their caregiving journey and safeguard their own well-being.

Dementia is a Syndrome

Dementia is a broad term used to describe a group of symptoms affecting memory, thinking, communication, and daily functioning. It is caused by different underlying diseases, each affecting the brain in distinct ways.

The Brain Is as Unique as a Fingerprint

No two brains are wired the same, and this remains true even in dementia. Many factors contribute to how dementia presents and progresses in each individual, including:

Which areas of the brain are affected first: Alzheimer’s disease often begins in the memory centres, causing forgetfulness and difficulty learning new information. In contrast, frontotemporal dementia affects the frontal lobes first, which govern executive function, judgment, impulse control, and emotional regulation, leading to behaviours such as impulsivity, socially inappropriate actions, or apathy, even when memory remains relatively intact.

How quickly changes occur: This variability is influenced by factors such as genetic makeup, overall health, coexisting medical conditions, lifestyle, and cognitive reserve. As a result, some individuals may experience slow, gradual memory loss over many years, while others may decline more rapidly, suddenly struggling with daily tasks, decision-making, or communication.

How the brain compensates for losses: Some people have greater neural resilience or cognitive reserve, allowing them to maintain abilities longer despite brain pathology. For example, a person may continue reading, managing finances, or engaging in conversation even as other cognitive functions decline.

Genetic influences and individual biology: Genes such as APOE‑e4 (apolipoprotein E4 variant) and other individual genetic variations can affect susceptibility, symptom patterns, and progression. 

Vascular and cardiovascular health: Conditions like hypertension, diabetes, or a history of stroke affect blood flow to the brain and interact with neurodegeneration. For instance, someone with vascular risk factors may experience more pronounced attention or mobility difficulties, even with similar memory loss to another individual.

Lifestyle and cognitive engagement over the lifespan: Education, mentally stimulating activities, social engagement, and physical activity contribute to cognitive reserve, which can delay or modify symptom onset. A person who regularly engages in complex work or hobbies may retain problem-solving skills longer than someone who does not.

Comorbid health conditions: Additional medical conditions such as depression, chronic inflammation, or sensory impairments can influence how dementia presents. For example, hearing loss or vision problems may increase confusion or agitation, even if cognitive decline is mild.

Environmental and social factors: The level of social support, environmental enrichment, and life experiences also shape dementia symptoms. A person living in a calm, familiar environment with regular social interaction may remain engaged and oriented longer than someone in a stressful or isolating setting.

A Personalized Approach to Dementia Care

Taken together, these factors highlight why a personalized approach is essential in supporting someone with dementia. No single strategy works for everyone, and understanding the individual’s unique presentation, history, and needs allows caregivers – both family and professional- to provide care that is respectful, effective, and compassionate. 

This January, as we honour Alzheimer’s Awareness Month, let us remember that a dementia diagnosis does not mark the end of their journey. 

Educating ourselves about how dementia progresses, the influences on its course, and the ways we can enhance cognitive reserve and overall brain health not only helps us prepare for what to expect, but also empowers us to focus on the factors we can influence, reducing risk, enhancing quality of life, and maintaining well-being for both the person living with dementia and their caregivers.

Let this month be a call to action: to see the person behind the diagnosis, to empower caregivers with knowledge and compassion, and to remind everyone that hope, connection, and meaningful engagement remain possible at every stage of dementia.

At Dementia Solutions, we’ve made it our mission to demystify dementia behaviour and continue to explore person-centred, creative, non-pharmacological solutions to manage dementia-related behaviours. We believe that awareness creation and skill-building through education is the most effective and powerful tool we have to promote and maintain the well-being of both the person with dementia and their caregiver.