Do you have a loved one or know someone who has been diagnosed with dementia? Do you know what that means? Is all dementia the same? What is the difference between dementia and Alzheimer’s Disease – or are they the same? This entry aims to clarify this topic and help you answer these questions with confidence.
Domains of Cognition Cognition – or thinking – is a very complex topic. It cannot be simplified to memory alone. In fact, it is split up into categories of memory related difficulties (amnestic symptoms) and non-memory related difficulties (non-amnestic symptoms)
Amnestic symptoms Getting lost, losing items, or forgetting recent or remote events, names, and places are some common amnestic symptoms. Non-amnestic symptoms Having difficulty with attention, problems with maintaining a train of thought, difficulty with complex or multi-step processes, personality changes, or inappropriate behaviors are some common non-amnestic symptoms. Normal Aging versus Cognitive Impairment versus Dementia Many people are aware that having some difficulties with memory or being forgetful can commonly be seen as we age. But what is “normal,” and what meets criteria for cognitive impairment or dementia?
Typical aging and memory A typical aging process can result in a person occasionally having difficulty finding the right word, rarely forgetting an appointment, or infrequently forgetting a date. This also can involve the development of slight challenges in maintaining attention on a task or multitasking. These symptoms alone do not necessarily suggest an underlying problem.
Mild Cognitive Impairment In addition to the above symptoms associated with typical aging and memory, mild cognitive impairment may involve forgetting important information that the person previously would have remembered such as the name of a family memory or friend, have more significant word finding difficulty than peers, or struggling with complex tasks. Often times during this process, it may be difficult to manage finances independently. Studies have shown that up to 10-15% of people who have Mild Cognitive Impairment may develop dementia each year. Up to a third of people with Mild Cognitive Impairment may progress to Alzheimer’s Dementia within 5 years.
Dementia Dementia has symptoms that are more severe than Mild Cognitive Impairment, with one key being that the degree of the symptoms begins to interfere with activities of daily living like bathing/showering, going to the bathroom, getting dressed, eating, etc. Dementia may also involve more change in behaviors or personality.
Is All Dementia Alzheimer’s Disease?
Not all Mild Cognitive Impairment or Dementia is due to Alzheimer’s disease. There are many other causes. These can be due to single events like a stroke or traumatic brain injury, or otherwise due to an ongoing disease process like Lewy Body Dementia, FrontoTemporal Dementia, or others. There are some rare causes of rapid dementia such as Cretzfeldt-Jakob disease, autoimmune encephalitis, or Wernicke Korskakoff Syndrome. To learn more about these, review our article on Dementia (https://neurox.us/dementia/). Alzheimer’s disease is a distinct cause of a pattern of dementia due to a neurodegenerative process, that it is due to a gradual destruction of the brain tissue that progresses over time.
What is Alzheimer’s Disease?
This disease is named after Dr. Alois Alzheimer, who had a patient with progressive loss of memory, difficulty with her language, and had changes in her behavior. After her death, Dr. Alzheimer examined her brain and found unique abnormalities that he detailed in a scientific publication. Alzheimer’s Disease is the most common cause of dementia in the world, accounting for about 60 to 70% of all dementia throughout the world. Over time, the disease causes progressive damage to the brain due to abnormal protein being deposited around and in the brain cells. This involves amyloid plaques and neurofibrillary tau tangles. This can shrink the brain and cause the brain cells to lose function. This impairs the ability of the brain to function normally, generally in a pattern of continuous slow decline.
What Aspects of Cognition are Most Affected in Alzheimer’s Disease?
Memory is typically involved in Alzheimer’s Disease, such as repeating the same questions or statements multiple times, forgetting appointments or events, losing objects, getting lost in otherwise familiar places, having difficulty finding the correct words for objects, and eventually forgetting the names of family members. Other aspects of thinking such as multitasking, dealing with abstract concepts, working with numbers, or managing finances are often involved. Judgment – or the ability to make reasonably considered decisions – is commonly affected. Multi-step tasks that require planning – such as a common occurrence in cooking – may be affected. This later can affect dressing and hygiene. In many cases, a wide variety of behavior or personality changes can emerge. This can include mood swings, social withdrawal, paranoia, irritability, change in sleep patterns, wandering, or delusions. Occasionally, a person with Alzheimer’s Disease may develop disinhibition, which means that they may be more likely to do things that are inappropriate or socially unacceptable.
What Aspects of Cognition are Relatively Preserved in Alzheimer’s Disease?
Memory is typically involved in Alzheimer’s Disease, such as repeating the same questions or statements multiple times, forgetting appointments or events, losing objects, getting lost in otherwise familiar places, having difficulty finding the correct words for objects, and eventually forgetting the names of family members. Other aspects of thinking such as multitasking, dealing with abstract concepts, working with numbers, or managing finances are often involved. Judgment – or the ability to make reasonably considered decisions – is commonly affected. Multi-step tasks that require planning – such as a common occurrence in cooking – may be affected. This later can affect dressing and hygiene. In many cases, a wide variety of behavior or personality changes can emerge. This can include mood swings, social withdrawal, paranoia, irritability, change in sleep patterns, wandering, or delusions. Occasionally, a person with Alzheimer’s Disease may develop disinhibition, which means that they may be more likely to do things that are inappropriate or socially unacceptable. What Aspects of Cognition are Relatively Preserved in Alzheimer’s Disease? A person with Alzheimer’s Disease often will still be able to read, listen, tell stories, remember old memories, sing, enjoy music, dance, or do crafts. These can offer quality of life for the person.
What is the Difference Between Early-Onset Alzheimer’s Disease and Alzheimer’s Disease?
Early-Onset Alzheimer’s Disease is when symptoms start before the age of 65. There are rare genetic abnormalities that can result in a person even developing symptoms at as early of an age as one’s thirties. In these cases, there usually is a strong family history of multiple generations of people in the family with Alzheimer’s Disease. Down Syndrome is also associated with being more likely to develop early onset Alzheimer’s Disease, as Down Syndrome involves three copies of chromosome 21 where genes associated with harmful amyloid are found
How is Alzheimer’s Dementia Diagnosed?
Most often, detailed Neuropsychological testing can reveal a pattern that is consistent with Alzheimer’s disease. It is most helpful if family and friends can be questioned by the examiner to get additional input to the patient’s history. Occasionally, advanced imaging of the brain can be considered to evaluate for other causes of the symptoms, or can confirm expected findings with Alzheimer’s Disease. In the research setting, there are possibilities of cerebrospinal fluid testing or other experimental testing. The diagnosis of Alzheimer’s Disease can also be made by autopsy.
What is the Expected Course for Alzheimer’s Disease?
As mentioned, Alzheimer’s Disease is a progressive condition that steadily worsens over time. The person with Alzheimer’s Disease may need more and more support over time, such as help with daily living, finances, nursing care, and later may need assistance with nutrition and hydration. The average life expectancy after diagnosis is 8 to 10 years. The most common causes of death in Alzheimer’s Disease are dehydration, malnutrition, or pneumonia due to difficulty swallowing (aspiration pneumonia).
What Are the Medical Treatments for Alzheimer’s Disease?
The current medications available for Alzheimer’s Disease include cholinesterase inhibitors (Aricept, Exelon, Razadyne) or an NMDA-receptor medication (Namenda). Studies have shown that these medications can offer small improvements in memory and cognitive testing when used early in the process. However, this does not reverse the underlying progression and further worsening is still to be expected. Medications can also be considered to treat other symptoms of Alzheimer’s Disease, such as medications for sleep difficulties, agitation, or anxiety. Treating behavioral symptoms can improve a person’s comfort and help caregivers.
What Non-Medication Recommendations Exist for Alzheimer’s Disease?
There are many non-medication-based recommendations for Alzheimer’s Disease. These can include things like improving the quality of sleep, eating a healthy and balanced diet, routinely exercising, and also staying mentally and socially engaged while early in the disease process. It can also be helpful to label items, write reminders, and record instructions for activities of daily living. It can be important to pursue legal manners such as designating a durable power of attorney for medical and financial matters, as it is expected that a person with Alzheimer’s Disease will lose the ability to complete these tasks. Later, skilled nursing services or placement in a setting that is optimized for people with dementia may be beneficial. Family members can also be counseled on the importance of maintaining physical and social interaction with the person and giving them a sense of worth and usefulness. Family and friends can try to stay patient and positive when a person is having memory problems.
What is Being Researched for Alzheimer’s Disease?
Scientists are making significant progress in learning more about the Alzheimer’s Disease process. There is hope that learning more about this can lead to new targets to treat with medications to stop or reverse the process. Currently, medications to reduce the amount of amyloid protein produced are being studied, but there are a multitude of clinical trials in progress for various approaches. There is hope on the horizon for Alzheimer’s Disease. Caregiver Support Alzheimer’s Disease can be troubling not only for the person but also their family. This can take a massive toll on the whole support structure. Caregivers can benefit from support groups, respite care, and other resources that may be available in the community