- Dementia is a syndrome; Alzheimer’s is a disease
- The symptoms of dementia and Alzheimer’s have significant overlaps
- Dementia has several causes and is potentially reversible; Alzheimer’s cause is unknown and no cure is available
- Dementia and Alzheimer’s progress in three stages: Mild (early-stage), Moderate (middle-stage), and Severe (late-stage)
- Treatments of dementia and Alzheimer’s are similar and have the same goals
- The life expectancy of dementia patients depends on the type of dementia; the life expectancy of Alzheimer’s patients depends on their age and genetic composition
There are stark differences between Alzheimer’s and dementia. Whereas a patient with dementia need not have Alzheimer’s, a patient with Alzheimer’s is by definition with dementia, and Alzheimer’s is notably the most common of more than one hundred dementias.
Dementia is a term that describes several progressive diseases of the mind. The term “dementia”, in times past referred to as senility, derives from the Latin demens, meaning “out of one’s mind”. It is a syndrome, a term that describes several chronic and progressive diseases of the mind, of which Alzheimer’s is the most prevalent.
Dementia is also used as an umbrella term to designate a number of symptoms related to a gradual degeneration in memory and at least one other cognitive faculty severe enough to cause malfunctions in a person’s ability to deal with their activities of daily living (ADLs).
Alzheimer’s is a degenerative disease of the brain that gradually impacts the patient’s memory and causes confusion, disorientation, other thought processes, and problems in communicating. Alzheimer’s is a fatal disease that over time affects all parts of the brain.
Dementia is a syndrome or simply an umbrella term for different diseases, whereas Alzheimer’s is a disease with its own set of symptoms, stages and types. Patients, families and caregivers often find it difficult to discern between Alzheimer’s disease and dementia, for while the two are related, they nevertheless have distinguishing features.
According to the National Institute on Aging (NIA), dementia is a brain disorder that impacts a patient’s ability to perform activities of daily living, while Alzheimer’s is a regressive and irreversible type of dementia that impacts sectors in the brain that affect memory, thought, and language.
A main difference between Alzheimer’s disease and dementia is that Alzheimer’s is degenerative and incurable, whereas certain types of dementia, such as dementias caused by certain thyroid conditions, reactions to medication or deficiencies in vitamins and minerals, can be reversed or are merely temporary.
It is also worth noting that neither dementia nor Alzheimer’s disease are part of the normal aging process. Although memory loss is the one factor that is predominantly associated with both dementia and Alzheimer’s disease, one can experience memory loss without having Alzheimer’s disease or dementia.
In addition, “probable AD” is a term used by physicians who specialize in dementia and Alzheimer’s disease to specify that based on the symptoms and progression of the disease, it is pathologically likely that the patient has Alzheimer’s.
Cognitive symptoms of dementia include memory loss, confusion, loss of visual and spatial skills, and difficulties articulating thoughts.
Behavioral symptoms include crankiness, mood changes, agitation, lack of self-control, poor judgement, and wandering.
Psychological symptoms may include restlessness, withdrawal, mood swings, depression, hallucinations, paranoia and delusions.
Alzheimer’s manifests itself differently in each patient. In the early stages, common symptoms of Alzheimer’s include memory loss, difficulties handling money and making judgments, losing things, stashing things in odd places, and language issues.
In the middle stages, patients with Alzheimer’s begin to have more trouble articulating words and sentences, increased memory issues, verbal and behavioral repetition, wandering, hallucinations, paranoia and wandering, and repetition.
In the advanced stages, people with Alzheimer’s lose the ability to communicate, experience incontinence and sleeplessness, seizures, difficulty swallowing, and suffer groaning and grunting, seizures, and difficulty swallowing.
There is a significant overlap between the symptoms of Alzheimer’s and the symptoms of dementia, particularly in the early stages of Alzheimer’s where there is a loss of memory, a falling-off in the ability to think, and the beginnings of problems communicating.
When the underlying disease is Parkinson’s or Huntington’s, people with dementia are also prone to involuntary muscle movement in the early stages, whereas people with Lewy Body Dementia (LBD) are likely to experience acute sleeplessness, difficulties with balance, and vivid hallucinations.
Dementia occurs when nerve cells in one or more parts of the brain are damaged, and patients with dementia experience different symptoms depending on the location and severity of the damage in the brain.
Although some dementias can be successfully treated, as for example dementias that ensue as a reaction to certain medications or because of vitamin or mineral deficiencies, the majority of dementias are degenerative and progressive in nature.
Progressive diseases like Alzheimer’s, Parkinson’s and Huntington’s are the prime causes of dementia. Other causes however can include chronic abuse of drugs or alcohol, infections, most notably HIV, vascular complications, strokes and chronic depression.
Alzheimer’s disease accounts for roughly 60% of all dementias, and it also accounts for another 20% of dementias when it is mixed with vascular or other dementias.
The main cause of Alzheimer’s disease is traced to a high number of protein deposits from plaques and tangles in the brain, causing connections between nerve cells to weaken and die. Alzheimer’s is also known to run genetically in families.
Physicians can make a diagnosis of Alzheimer’s disease in 90% of cases. For the rest, Alzheimer’s can only be diagnosed after death, in an autopsy.
When the underlying dementia disease is other than Alzheimer’s, the behavioral changes that the person with dementia experiences can at times differ considerably.
For example, A person with Sundowner Syndrome can get particularly agitated, argumentative and even combative at around the time the sun sets in the late afternoon and early evening.
A person with Lewy Body Dementia (LBD) has many traits that are particular to LBD. Here are some of the differences between the behaviors of Alzheimer’s patients and those of other dementias, most notably Lewy Body and Parkinson’s:
- Hallucinations are more frequent and pronounced in Lewy Body patients than in patients with Alzheimer’s, and they occur in earlier stages
- The disruptions in cognitive faculties in Lewy Body patients occur more frequently than in Alzheimer’s
- Life expectancy with Lewy Body patients is a little shorter than with Alzheimer’s patients
- Depression is more prevalent in Lewy Body patients
- Patients with LBD experience impaired motor skills, mimicking symptoms of early stage Parkinson’s, at earlier stages than Alzheimer’s patients
- Parkinson’s patients frequently develop cognitive impairments in later stages
- Some drugs, typically prescribed for agitation or hallucinations, can bring about Parkinson’s in some Lewy Body patients
- With Lewy Body Dementia patients, movement difficulties are spontaneous, and the symptoms more sudden, than with Alzheimer’s
- Shaking and tremors are more pronounced in Parkinson’s
- Drugs that are commonly used for patients with Parkinson’s are less effective in Lewy Body Dementia patients
- Lewy Body is the only disease among Parkinson’s and Alzheimer’s to lose both dopamine and the neurotransmitter “acetylcholine”
- Prevalent in one out of every two DLB patients is a behavior referred to as “Rapid Eye Movement Sleep Behavior Disorder”, involving intense dreaming, tossing back and forth agitatedly, and talking while asleep, with ensuing drowsiness in the daytime.
In the early stages, many people with dementia can still function independently, including holding jobs, driving, and remaining socially active. Difficulties begin to arise when it comes to balancing a household budget, planning and organizing tasks, and managing medications. Early signs may appear such as misplacing the checkbook, forgetting names, or going into the kitchen to get something and not remembering what that was.
The middle stages require an incrementally greater level of care and support. In those stages, repetitive behaviors start setting in, communication becomes all the more difficult, and although patients may still be able to live independently, they require more assistance with their activities of daily living. People with mid-stage dementia often also experience increased memory loss, and sleep pattern disturbances such as sleeping during the day and restlessness at night.
The late stages may last for several years or for just a few months, depending mostly on the individual’s physical conditioning, genes, and various other lifestyle factors. Late-stage dementia is marked by behaviors that are out of character, such as increased agitation, continual questioning, pacing, and unusual sleep patterns. Patients with dementia also lose their ability to communicate, and they become increasingly incontinent and non-ambulatory.
Damage to the nerve cells in various parts of the brain commonly occur years before Alzheimer’s symptoms begin to appear. Alzheimer’s clinicians have broken the disease into two models, the first consisting of seven distinct stages, although many of those stages in fact depict only changes in the severity of the decline. Using the second model, the Alzheimer’s Association simplifies the process by enumerating only three stages to Alzheimer’s, namely mild, moderate and severe.
Mild Alzheimer’s Disease:
Mild Alzheimer’s Disease is not to be mistaken for “early onset Alzheimer’s”, a term used to categorize people who acquire the disease before age 65, i.e. years before Alzheimer’s impacts the majority of people. With mild Alzheimer’s disease, the initial memory loss that occurs is of the type that relates to most recent events and people.
Patients with mild Alzheimer’s disease still function with considerable independence, although they start “misplacing” their keys or eyeglasses, and they start getting stuck with words and names in their communications.
Moderate Alzheimer’s Disease:
In this phase of the disease, the earlier symptoms experienced in the mild stage are amplified and become more of a hindrance in the performing of everyday tasks. A further decline in memory, speech, logic, problem-solving and other cognitive factors means that patients in the moderate stage of Alzheimer’s begin to need an increasing amount of help at every level.
Severe Alzheimer’s Disease:
Challenges to the caregivers of patients with Severe Alzheimer’s Disease reach a highpoint in which total care is required. Severe symptoms include acute muscle weakness, weight loss, appetite suppression, and an inability to swallow.
In this severe stage, Alzheimer’s patients may no longer be able to walk, sit up, or hold their head up. Eventually, the ability to swallow, to control bladder and bowel functions, and an increased susceptibility to infections such as urinary tract infections and pneumonia take over.
Treating most dementias, including Alzheimer’s disease, aim principally at mitigating the harsher aspects of some symptoms and, whenever applicable, at attempting to slow down the progression of the underlying diseases and thereby prolong the lives of patients.
In that respect, there are no major differences between the treatments of Alzheimer’s and dementia.
We noted earlier however that some dementias are temporary in nature, or are reversible and cured. Those are dementias that arise from certain thyroid conditions, as well as from reaction to medications and/or vitamin and mineral deficiencies. The treatment of dementias like that naturally start with prescribing vitamin-rich diets, as well as treating the specific underlying thyroid condition.
For all stages of Alzheimer’s, donepezil (brand name Aricept), and rivastigmine (Exelon) are used. Those are Cholinesterase Inhibitors that boost levels of the chemical messengers that affect recall and reasoning. They are mostly used in the treatment of Alzheimer’s disease, but they have also been recommended for vascular dementia, Parkinson’s disease dementia, and Lewy body dementia.
Galantamine (Razadyne), another cholinesterase inhibitor, is also approved by the Federal Drug Administration (FDA) for use for patients with mild to moderate Alzheimer’s.
For the more severe stages of Alzheimer’s, memantine (Namenda) and donepezil (Namzaric) are usually prescribed. Memantine is a chemical messenger that regulates brain tasks, including processing new information and recall.
Although stringent FDA testing and guidelines rarely apply to many supplements, some natural remedies and herbals have proved to be beneficial for dementia patients.
For example, Omega-3 fatty acids, found in seafood, seem to lower the risks of developing dementia. Eating fish regularly seems to provide a degree of protection, although once Alzheimer’s has set in, Omega-3 fatty acids have little effect.
Ginkgo has also been thought to improve memory and is safe to use, although again clinical studies report conflicting results for people with dementia. Coconut oil is under study as well for possibly slowing the pace of progression.
A Health-Oriented Daily Routine
The best therapy of course is unconditional love and care, which can be a challenge to both family members and caregivers. Patient-centered dementia care, enhances the dementia patient’s individuality by aiming to boost uplifting sentiments, nurture what each dementia patient can still do, and further their independence.
A nutritious diet, good hydration, plenty of sleep, and exercise, those would be the constituents of a daily routine that can perhaps mitigate the most severe of symptoms and delay the dementia’s progression. Exercise, whether going for a walk or gentle leg lifts in bed, is particularly helpful to both patient and caregivers.
A key component of the health-based approach to dementia care builds on the ability to continue with past social activities and lifelong joys. For example, if in the past, a person used to walk barefoot around the house and in the yard, then they should be permitted to tread barefoot on a sunny day in the back yard.
As a result, little things like that endorse patients’ will to rise to the occasion, and that in turn boosts their self-esteem and alleviates the stress and anxiety that is often an integral part of their dementia.
Additional therapies that may help include music or pet therapy. Visits from therapy dogs that are empathic and affectionate toward the patient, or even adopting a cat or a dog have been shown to be helpful.
Aromatherapy, notably the use botanical oils such as rosemary and lavender oil, can be calming and soothing. Massage therapy often incorporates aromatherapy in its soothing effects, and can also ease anxiety.
Art therapy such as painting, collage, photography, and clay with emphasis on the method and not the end product can be relaxing. Art can provide fun and joy, pieces of life that are often missing for people with dementia.
The life expectancy of persons with dementia depends to a large extent on the precise dementia they suffer from.
For example, while Parkinson’s disease (PD) is not fatal, complications that arise from that disease put the life expectancy of someone with PD at between 10 and 20 years from onset.
Lewy Body Dementia (LBD) is much more relentless than other dementias, with a lifespan after onset of only 5 to 7 years.
In the case of vascular dementia, although treatment with medications can prolong life, the average survival period from the time of diagnosis is around four years, the worst lifespan among all the dementias.
By contrast, although the life expectancy of a person with Alzheimer’s disease depends on several factors such as their age and genetic composition, it is generally thought that the average Alzheimer’s patient lives for around ten years from onset before succumbing to the disease.
These statistics are considered unreliable as two thirds of deaths of Alzheimer’s patients are attributed to pneumonia and other infections, rather than to their Alzheimer’s.