They don’t, necessarily. Take Alzheimer’s disease, which is one of the major types of dementia. It is common for damage to appear in the olfactory lobe leading to reduced sense of smell. This symptom is actually a decently sensitive screener for early diagnosis.
https://www.cuimc.columbia.edu/news/can-smell-test-sniff-out-alzheimers-disease
Because dementia literally means disease of the memory center of the brain.
“a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning.”
The underlying disease doesn’t necessarily start in the memory center.
Alzheimer’s dementia usually starts with memory loss and it’s the most common type of dementia, but other types of dementia do not typically start with memory loss. Lewy body dementia tends to start with impairments in attention and executive function, and possibly visual hallucinations. Frontotemporal dementia usually starts with personality/behavioral changes.
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