Dementia describes many conditions that cause physical changes in the brain, leading people to lose some mental abilities. Cortical dementia refers to dementias that damage the cerebral cortex.

The cerebral cortex is the part of the brain responsible for higher mental capabilities. It controls memory, problem-solving, social skills, and language. It also processes information from the five senses: sight, hearing, touch, taste, and smell.

There are several types of cortical dementia, but Alzheimer’s disease and frontotemporal lobe dementias are the most common.

This article looks at cortical dementia and its symptoms, causes, and treatments.

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Different areas of the brain control different functions, and the symptoms of dementia depend on which area is affected.

Cortical dementia describes dementias affecting the cerebral cortex. Doctors also refer to these conditions as neurodegenerative disorders because they cause brain cells to stop working or die.

Functions of the cortex

The cerebral cortex is the outermost layer of the brain and consists of gray matter. It has four regions called lobes. Each lobe is responsible for different tasks:

  • Frontal lobe: This controls a person’s ability to solve problems, make decisions, and control emotions. It also controls speech and language function and motor skills.
  • Parietal lobe: This lobe is primarily responsible for receiving sensory input. It controls spatial awareness, allowing people to move around without bumping into things. It also controls hand-eye coordination, perceives whether things are hard or soft to touch, and processes skills, including math and spelling.
  • Occipital lobe: This controls visual perception, making sense of what a person sees.
  • Temporal lobe: This lobe processes language and sounds, including music, and controls a person’s ability to recognize faces. Part of the temporal lobe, called the hippocampus, is important for memory and learning.

Once the brain cells undergo damage, the effects are usually permanent. This means that symptoms of cortical dementia generally get worse over time.

Types of cortical dementia

Cortical dementias include:

Subcortical dementias affect the layer of the brain directly underneath the cortex, called the subcortex.

The subcortex consists of white matter. White matter carries messages to and from the gray matter, enabling rapid communication between different parts of the brain.

Types of subcortical dementias include:

Dementia symptoms vary depending on the affected area of the brain, but memory loss is often the first sign.

People with Alzheimer’s disease often have trouble processing and remembering new information, as the condition usually starts in the hippocampus — the part of the brain that affects learning. As the condition progresses and more of the brain undergoes damage, the person may become disorientated and confused.

Other symptoms of Alzheimer’s include:

  • changes in personality, mood, and behavior
  • serious memory loss that disrupts daily life
  • changes in judgment
  • an inability to recognize familiar faces or objects
  • difficulty walking or navigating stairs
  • difficulty speaking
  • problems with swallowing

People with frontotemporal lobe dementia tend to either have problems with language, including speech and understanding, or behavioral changes. Changes in behavior can include inappropriate social behavior, lack of empathy and tact, and impulsiveness.

People experience behavioral changes if damage occurs to the frontal lobe, while issues with language and emotion indicate damage to the temporal lobe.

Doctors usually rule out other conditions before diagnosing dementia. They may recommend blood tests and a physical exam. They will also discuss a person’s medical and family history, as some dementias are genetic.

Doctors use cognitive and neurological tests to check a person’s ability to solve problems and may test their language and math skills. They will also conduct memory tests.

A doctor may recommend taking a sample of cerebrospinal fluid (CSF), which surrounds the brain and spinal cord. Analysing CSF can give insights into what is happening within the brain.

Sometimes doctors recommend brain scans to help them identify changes in the brain’s structure.

Different types of dementia have different causes.

Alzheimer’s disease develops when there is a buildup of proteins in the brain. Beta-amyloid protein forms clumps and plaques between brain cells, while tau proteins form tangles inside the nerve cells.

Both types of protein interfere with how the brain sends messages.

People with frontotemporal lobe dementia also have abnormal amounts of tau protein and another kind of protein called TDP-43. Doctors do not fully understand why the brain overproduces these proteins, but they damage nerve cells or neurons.

Researchers have identified several gene mutations that can cause frontotemporal lobe dementia.

Risk factors

Doctors know that certain risk factors increase the likelihood of a person getting dementia. These include:

There are currently no cures for cortical dementias, but doctors can help people manage their symptoms.

They may prescribe medicines to ease a person’s anxiety and reduce aggressive or antisocial behaviors if required. Some medicines may temporarily slow the decline of a person’s mental abilities while improving their memory.

People who experience difficulties swallowing or have trouble speaking may benefit from speech therapy, while occupational therapists can help people find ways to complete their everyday tasks more easily.

Research into new treatments for dementia is ongoing. In June 2021, the Food and Drug Administration (FDA) approved aducanumab (Aduhelm) for people in the early stages of Alzheimer’s. Aducanumab reduces beta-amyloid plaques in the brain, which doctors hope will help slow the effects of the condition.

Dementia is a progressive disease characterized by a steady decline in a person’s mental functions. People with dementia may become increasingly forgetful and have trouble concentrating or focusing. They may lose their language and math skills and their problem-solving ability.

Some people with dementia may find it difficult to control their emotions and become irritable or aggressive. Others may start behaving in inappropriate ways.

As the condition progresses, people with dementia will find everyday tasks difficult and require the help of others to look after them.

There is currently no cure, but doctors can prescribe drugs to help people manage their symptoms.

Cortical dementia is an umbrella term describing damage to parts of the brain in the cerebral cortex. Symptoms include memory loss, a decline in thinking skills, and personality changes.

Alzheimer’s disease is a type of cortical dementia, as are frontotemporal lobe dementias.

As people progress through the stages of dementia, they will need an increasing level of support from others to look after them. There is currently no cure for the condition, but research is ongoing.