People often wonder if Alzheimer’s disease is the same as dementia. The terms are frequently used interchangeably, and people assume that they have the same meaning. Dementia is a broad term that describes a wide range of disorders involving cognitive impairment due to brain damage. Alzheimer’s disease is the most common type of dementia and involves progressive loss of all cognitive functions. In 2013, the American Psychiatric Association proposed a new name for dementia which doctors are starting to use widely – major neurocognitive disorder.
It’s important to note that as we age there are some normal changes in our memory and other cognitive functions. These changes may be noticeable and a nuisance at times, but they should not be so frequent or significant that they interfere with normal daily function. If you suspect that you or someone you love may have cognitive changes that seem more than this normal level, it’s essential to schedule a full clinical assessment as early as possible. The earlier the diagnosis, the greater the opportunity to begin any available treatment or therapy to improve, slow, or stabilize symptoms.
Approximately 70% of people who have dementia have Alzheimer’s. Early symptoms of Alzheimer’s can include:
- Memory loss for recent events
- Repeating questions or comments
- Difficulty completing routine daily tasks
- Disorientation to time, familiar places, or people
- Mood, behavior and/or personality changes (e.g., anxiety, depression, apathy, agitation, inappropriate behaviors)
A comprehensive evaluation to diagnose Alzheimer’s disease and other forms of dementia will involve getting a description and history of the cognitive changes, reviewing the medical and psychiatric history (including review of medications), cognitive testing, relevant lab tests and exams, and a brain scan. Newer brain scans and even cutting-edge blood tests aim to help identify the presence of two key toxic proteins in the brains of individuals with Alzheimer’s called beta-amyloid and tau. The slow but steady build-up of these proteins begins years before symptoms appear, but eventually cause damage to brain cells and their connections that result in cognitive symptoms as well as changes in the appearance and function of the brain on scanning. These observable and measurable changes in a person’s brain are called biomarkers.
There are several general stages to Alzheimer’s.
Presymptomatic with Positive Biomarkers
An individual in this stage does not have any actual cognitive symptoms, but brain scans and/or a spinal tap reveal biomarker evidence of Alzheimer’s disease, such as the presence of beta-amyloid or tau, or patterns of brain shrinkage or loss of function consistent with Alzheimer’s.
Mild Symptoms with Positive Biomarkers
Symptoms of the disease are not highly noticeable except with neuropsychological testing, but individuals are still able to function independently. In addition, there is biomarker evidence of the disease. We call this stage mild cognitive impairment due to Alzheimer’s disease.
In the past, there is where all staging began, but we now know that changes have been occurring in the brain for years before a person reaches this point. Ideally there is biomarker evidence to support a diagnosis of Alzheimer’s disease, although the diagnosis is commonly made based on progressive symptoms that affect all domains of cognitive function. We then can divide it further into mild, moderate and advanced stages (although there are also more detailed staging schemes).
In mild Alzheimer’s disease, individuals are still relatively independent, but increasing need help with daily activities, including cues and reminders. There may also be important changes in mood or behavior that need to be addressed and communication skills are beginning to be more challenging.
In moderate Alzheimer’s disease, most individuals need regular supervision and assistance with daily activities, and should not be driving, managing medications, or engaging alone in any activities that can pose a risk to them. Language and recognition are waning and can cause individuals to be frustrated and angry and want to withdraw from social activities. More care is needed at home or in assisting living facilities.
In advanced Alzheimer’s disease individuals will need 24-hour supervision and assistance with most activities of daily living, including in memory care units, and they will increasingly struggle to participate in activities, communicate, recognize family and friends, and act appropriately. In the very last years of this stage, the ability to walk, talk, feed oneself and control one’s bowel and bladder will fade away. Persons living through advanced Alzheimer’s can still benefit from interactions with caregivers and family. Often a caring touch or soothing music can help calm and reassure an individual when they cannot communicate. Hospice care can help patients and families prepare for end-of-life with dignity and peace.
Resources for Living with Alzheimer’s
At MIND Institute, our entire practice is devoted to empathic diagnosis, brain fitness, mind exercises, innovative research, high-touch, one-on-one care, and support for individuals and their families. We have a dedicated team of clinicians led by nationally known Alzheimer’s expert Dr. Marc Agronin. For more information, call the MIND Institute at Miami Jewish Health hotline at (305) 514-8710.
The Alzheimer’s Association is one of the best resources available. It’s a resource for individuals living with the disease, their families, and caregivers. Caregiver support is critical, and the Alzheimer’s Association provides a searchable database of local support groups. If you are in the midst of a crisis, there is a 24/7 helpline. You can call the Alzheimer’s Association at 1-800-272-3900.
Alzheimers.gov is the federal government resource for people living with Alzheimer’s.
Online communities that provide virtual meetings and virtual interactions are excellent for caregivers with limited time to attend local meetings.