The Difference Between Alzheimer’s and Dementia

The stress of caring for someone with Alzheimer’s or dementia is often complicated further by the confusing terms used to describe cognitive impairment. Some people might use “Alzheimer’s” and “dementia” interchangeably, but their distinction is important. Alzheimer’s is one type of dementia, but there are many others. There is much that we know about these diseases, and although we don’t have a cure for dementia or Alzheimer’s, we can utilize education, communication, and activity strategies to improve our loved one’s well-being and comfort.

All dementias are characterized by varying degrees of decline in memory, judgment, reasoning, planning, and thinking skills. Dementia is not a normal part of aging, although advanced age is a risk factor for many dementias. The term “dementia” refers to any condition which impacts cognitive functioning—including memory, problem-solving, decision-making, or social abilities—so severely that daily functioning is compromised as well.

You may wonder why it matters what kind of dementia someone has. Each type of dementia has a different trajectory, so getting a diagnosis can help families plan for the future and tailor their approach to care. Let’s look at Alzheimer’s disease, the most common type of dementia, which accounts for 60-80% of dementia cases, as well as other dementia types.

Alzheimer’s Disease

Alzheimer’s disease usually begins with impairment in memory and thinking skills, and eventually causes difficulty functioning and carrying out simple tasks.

Symptoms of Alzheimer’s Disease

Everyone’s journey with Alzheimer’s will be a little different, but in general, these are the most common symptoms.

• Memory: Forgetting appointments, events, or conversations. Eventually, someone with Alzheimer’s may forget who family members are.
• Misplacing and losing items.
• Difficulty with word finding, making engaging in conversations challenging.
• Thinking, Reasoning, and Planning: Multitasking is difficult, making managing finances and paying bills challenging. Daily tasks such as dressing, cooking, and driving become increasingly problematic, compromising safety.
• Judgment and Decision Making: Judgment and decision-making can lead to unsafe behaviors such as wandering, wearing inappropriate clothes for the weather, and leaving the stove on.
• Responding appropriately to emergencies may not be possible.
• Driving is not safe due to getting lost and impaired reaction time.
• Behavior and Personality Changes: Social withdrawal and depression.
• Anger or aggressive behavior.
• Wandering.
• Delusions and hallucinations.
• Changes in sleep and appetite habits.
• Agitation.

Causes of Alzheimer’s Disease

Although we haven’t found one cause of Alzheimer’s, we know that a combination of factors contributes to the development of the disease.

Genetics

There are two main types of Alzheimer’s disease: early-onset and late-onset. Late-onset first appears in the mid-60s or later and is the most common type. Early-onset typically occurs between the 40s and 60s and is rare.

Early-Onset Alzheimer’s

Some early-onset cases are caused by an inherited change in one of three genes. In other cases, research shows that other genetic components are involved.

Late-Onset Alzheimer’s

One genetic risk factor—having one form, or allele, of the apolipoprotein E (APOE) gene on chromosome 19—does increase a person’s risk. APOE ɛ4 is called a risk-factor gene because it increases a person’s risk of developing the disease, but that doesn’t mean that having APOE ɛ4 allele will necessarily lead to Alzheimer’s.

Environment and Lifestyle

There is continued research and interest in the interplay between environmental and lifestyle factors and the development of Alzheimer’s disease. We aren’t ready to say that lifestyle factors can prevent or cure Alzheimer’s disease, but a healthy approach can improve outcomes.

Here are some risk factors:

• High blood pressure
• Lack of exercise
• Obesity
• Diabetes
• Hearing impairment
• Smoking
• Depression
• Binge drinking
• Lack of sleep
  

Other Types of Dementia

There are many types of dementia, and these are the most common ones. Other dementias not included in this list are Huntington’s disease, alcohol-related dementia, Normal Pressure Hydrocephalus, and Progressive Supranuclear Palsy, among others.

Creutzfeldt-Jakob Disease

Creutzfeldt-Jakob Disease is a rare form of dementia that progresses rapidly. There are subsets of Creutzfeldt-Jakob Disease, and each has a different cause, ranging from genetics to exposure to an external source of abnormal prion protein. Some cases have no identifiable cause.

Dementia with Lewy Bodies (DLB)

Lewy body dementia is a broad term that includes dementia with Lewy bodies and Parkinson’s disease dementia. People with DLB can experience movement disorders like those found in Parkinson’s, including rigid muscles, shuffling, trouble initiating movement, and hunched posture.

The key difference between DLB and Alzheimer’s is that memory loss is not usually an early symptom of DLB, but problems with judgment, visual perception, and planning often are. Delusions and hallucinations are more prominent early on in DLB, and so is REM sleep disorder.

Frontotemporal Dementia (FTD)

FTD is a group of disorders caused by progressive loss of brain cells in the frontal lobes. FTD is characterized by significant changes in behavior and personality, which can make this type of dementia challenging for family caregivers.

What differentiates FTD from Alzheimer’s disease are the following:

• FTD typically begins earlier than Alzheimer’s. People are typically diagnosed in their 40’s to early 60’s.
• Memory loss is typically not an early symptom in FTD like it is in Alzheimer’s.
• Getting lost is more common in Alzheimer’s than in FTD.
• Changes in impulse control and behavioral changes are an early symptom of FTD, whereas in Alzheimer’s, behavioral changes occur later in the disease process.

Vascular Dementia

Vascular dementia is caused by inadequate blood flow to the brain, often due to a stroke or series of strokes. Vascular dementia can coexist with other types of dementia, including Alzheimer’s and Lewy Body Dementia.

Symptoms of vascular dementia may be noticed post-stroke and include confusion, disorientation, headaches, difficulty walking, trouble speaking or understanding speech, paralysis on one side of the body, and poor balance. Risk factors include lifestyle habits that affect brain health, such as smoking, lack of exercise, alcohol consumption,
obesity, and high cholesterol.

Mixed Dementia

Mixed dementia is a combination of brain changes associated with Alzheimer’s along with symptoms of vascular dementia or Lewy Body Dementia. Most people are diagnosed with one type of dementia, and other brain changes are detected during autopsy.

Parkinson’s Disease Dementia

Not everyone who has Parkinson’s will develop dementia. Common symptoms include memory, concentration, and judgment problems, delusions and hallucinations, depression and anxiety, speech problems, and sleep disturbance.

Putting it all Together

A diagnosis of dementia can be challenging and overwhelming for families and their loved ones. However, we learn more every day about how to help people navigate and care for someone with these diseases. Regardless of diagnosis, providing compassionate care that improves the well-being and quality of life of those with Alzheimer’s and other dementias is the top priority.