What’s the difference between dementia and Alzheimer’s disease? To answer that question, think first of holding an apple in your hand. You know it’s an apple, but what type is it? McIntosh? Gala? Red Delicious? An apple, you realize, is a category of fruit, but the type is what gives it a distinctive flavor.
Think of dementia as the apple and Alzheimer’s as a type of apple, and there’s the answer. Dementia is not a disease but a broad-reaching classification of cognitive decline. Alzheimer’s is a type of dementia; in fact, its' the most common form.
“Dementia is not a specific disease, but it refers to a group of symptoms, particularly a progressive decline in functioning that interferes with daily activities,” says Dr. Paul Eslinger, professor of neurology and a physician at Penn State Milton S. Hershey Medical Center (www.pennstatehershey.org). “Alzheimer’s disease is a specific disease process that has certain characteristics of changes in the brain and does manifest as a type of dementia.”
The person diagnosed with dementia of any kind, including Alzheimer’s, has “substantial, life-altering changes in one or more major aspects of mental functioning,” says Dr. Richard Paczynski of Neurology Services, part of Holy Spirit and Geisinger Health Systems in York (www.hsh.org).
If a loved one shows signs of dementia, proper diagnosis of the cause and type is essential to planning treatment and care, say medical experts.
The causes of dementia
Dementia has more than fifty causes. Alzheimer’s manifests in memory and cognitive impairment, plus social and emotional changes. Other common causes show up differently, from the Parkinson’s-like symptoms of Lewy Body dementia to the loss of social filters and restraints—think of the sweet old lady who suddenly swears like a sailor— of frontotemporal dementia.
While some memory loss goes along with growing older, “dementia is not a normal part of aging,” says Gay Plastina, RN Staff Educator with Messiah Lifeways in Mechanicsburg (www.messiahlifeways.org).
“If I lost my car keys and can’t find them, it’s because of some memory loss,” she says. “If I lost my car keys and only look in the fridge because I’m determined that’s where they belong, that’s dementia.”
Diagnosing dementia
It’s hard to know when loved ones cross the line from normal aging to early signs of Alzheimer’s or other forms of dementia, says Eslinger. Still, many families are seeking early diagnosis that leads to proactive treatment. Diagnosis starts by reviewing behavior, symptoms, and medications. Next comes the medical evaluation, perhaps with blood work and a brain scan. Finally, cognitive testing reveals objective measures of memory, attention, problem-solving, and language abilities.
Diagnosis is “a complicated matter,” says Paczynski. “It’s not a matter of going in for a simple test. There’s often ambiguity. As a general rule of thumb, as time goes on and patients progress and other conditions are excluded, it becomes clearer what the course should be.” Examination by a neurologist or geriatric psychiatrist with expertise in treating and managing dementias can help families “cut to the chase” and perhaps access sophisticated clinical trials.
When it comes to Alzheimer’s, researchers have found that about half of those in a stage of short-term memory loss called “mild cognitive impairment” can, in a few years, develop Alzheimer’s, says Eslinger. It’s “a very important stage to not ignore. If it appears that the patient is living independently but their memory is progressively changing, it’s time for an evaluation.” With two FDA-approved medications that can slow the progression of symptoms and delay the need for nursing home care, “it can be very helpful to identify these individuals as early as possible.”
Reversible causes
Other diseases can be at play in dementia. There may be damage caused by stroke. There can also be hypertension, diabetes, or high cholesterol. Multiple head traumas or alcohol and drug abuse can also damage the brain.
The correct diagnosis is especially important because an underlying cause might be CPT, or “common potentially treatable,” says Paczynski. For instance, “pseudo dementia,” with such symptoms as forgetfulness and slow responses, can emerge from untreated depression. Hypothyroidism, or low thyroid, can be a CPT, as can vitamin B12 deficiency. Something called normal pressure hydrocephalus, or NPH, causes retention of fluids in the brain, with symptoms that include dementia, incontinence, and an irregular gait.
Finally, there may be drug addiction or misuse of prescriptions. Some elderly people might be mixing amphetamines or marijuana with alcohol, taking too much Ativan, or “surreptitiously using Valium,” says Paczynski. “For all the world, they look like they’re becoming demented.”
A promising future
Lifestyle choices can “slow down or combat symptoms” of dementia, says Eslinger. Exercise and good nutrition, such as a Mediterranean-style diet, are important, and so are social engagement and cognitive exercise. Some drug trials are targeting the abnormal buildup of amyloid proteins in the brain that cause Alzheimer’s, while others are boosting the metabolism of neurons in brain. “In the next five years, we’re going to see at least two or three new treatments emerge that will have a more significant slowing effect on the symptoms.”
Genetic engineering has created a fertile ground for breakthroughs, as brain tissue grown in artificial environments can be used to “test hundreds of modifications of drugs very rapidly,” says Paczynski. “I’m pretty optimistic that at some point in my career, you’re going to see a drug that will slow things down dramatically.”
Until that time, families are turning to the Alzheimer’s Association (www.alz.org) and other resources for help. Alzheimer’s “is one of those types of diseases you can’t manage yourself,” says Plastina. “It is going to involve everybody in the family. It’s important that caregivers get their own help and support. Take a break, get out and support yourself, because otherwise you’ll burn yourself out.”
In the growing level of resources available to help patients, Eslinger sees “a very positive message. I can provide to patients a lot more than we could five or ten years ago.”
