As a physician, I often sit with families who have just received a diagnosis of dementia.

There is usually a pause at some point in the conversation — after the questions about memory loss, safety, and next steps — when someone asks, “What kind of dementia is it?”

It’s an important question, and one that is often misunderstood.

Dementia is not a single disease. It is a broad term used to describe a decline in cognitive function that affects daily life. But beneath that label are several different conditions, each with its own pattern, progression, and challenges.

Understanding the differences can help families make sense of what they are seeing.

The most common type is Alzheimer’s disease.

This is the form many people are familiar with. It often begins with subtle short-term memory loss — misplaced items, repeated questions, difficulty recalling recent conversations. Over time, the changes become more noticeable. Language becomes harder, decision-making is affected, and daily tasks require more support.

The progression is typically gradual, unfolding over years. Families often describe it as a slow shift, where small changes add up over time.

But not all dementia follows that pattern.

Vascular dementia is often different. It is related to reduced blood flow to the brain, sometimes following a stroke or a series of smaller vascular events. Instead of a steady decline, families may notice a stepwise pattern — periods of stability followed by sudden changes. There may also be more difficulty with focus, organization, and processing information, even early on.

Then there is Lewy body dementia, which can feel unpredictable.

Families often describe fluctuations — good days and bad days, sometimes within the same week. Visual hallucinations are common, as are changes in alertness and attention. There may also be physical symptoms, such as slowed movement or stiffness, similar to Parkinson’s disease. It can be confusing, especially when someone seems clear one day and significantly different the next.

Another form that presents in a very different way is frontotemporal dementia. In these cases, memory may not be the first concern. Instead, families notice changes in personality or behavior. Someone who was once reserved may become impulsive. Social boundaries may change. Judgment may be affected. Because it doesn’t initially look like “typical” memory loss, this type of dementia is often misunderstood.

In many cases, there is not just one process happening. Some individuals have what we call mixed dementia — a combination of conditions, most commonly Alzheimer’s and vascular changes. This can create a more complex picture, where symptoms overlap and evolve over time.

Despite these differences, there are common threads. A gradual change in how a person thinks, behaves, and interacts with the world. A need for increasing support. And a growing reliance on others to help navigate daily life.

What I often remind families is that while the diagnosis helps guide us, it does not define the person.

Each individual experiences dementia in their own way. Their history, personality, and environment all shape how the condition unfolds. That is why care must be individualized — flexible enough to adapt as needs change, and thoughtful enough to meet the person where they are.

Understanding the type of dementia provides a framework. It helps explain what is happening and what to expect. But just as importantly, it allows families to respond with more clarity and confidence.

Because in the end, this is not just about identifying a condition. It is about understanding a person — and providing the kind of care that honors who they are, every step of the way.