Understanding the Difference Between Dementia and Alzheimer’s Disease

Dementia affects millions of people and is one of the leading causes of disability among older adults. Although many people use the terms dementia and Alzheimer’s interchangeably, they are not the same thing.

What Is Dementia?

Dementia is not a single disease. It is an umbrella term that describes a group of symptoms that interfere with memory, thinking, reasoning, language and the ability to perform everyday activities that affect a person’s independence and quality of life.

Occasional forgetfulness is a normal part of aging, but dementia goes far beyond misplaced keys or forgetting someone’s name. It involves a progressive decline in cognitive function that makes routine tasks increasingly difficult.

Alzheimer’s Disease vs. Dementia

Alzheimer’s disease is the most common type of dementia, accounting for approximately 60 to 80 percent of all dementia cases. While every person with Alzheimer’s disease has dementia, not everyone with dementia has Alzheimer’s disease.

Several other forms of dementia exist, each with its own characteristics:

• Alzheimer’s disease primarily affects memory before progressing to other thinking skills.
• Vascular dementia results from reduced blood flow to the brain, often after strokes or other blood vessel damage.
• Lewy body dementia may cause fluctuations in attention, vivid visual hallucinations, sleep disturbances and Parkinson-like movement problems.
• Frontotemporal dementia typically affects personality, behavior, decision-making or language before memory becomes significantly impaired. 

Because treatments and progression differ, obtaining an accurate diagnosis is important.

Symptoms and Stages of Dementia

Dementia generally develops gradually and progresses through several stages.

Early-stage dementia:

• Forgetting recent conversations or appointments
• Difficulty finding the right words
• Losing items frequently
• Trouble concentrating or making decisions

“Early signs I often see involve the details of life, such as hygiene, use of medication, detail and direction confusion, and engaging less in conversations than was their previous pattern,” according to James Schindler, MD, family physician and director of the Methodist Family Medicine Residency program at Covenant Health’s Methodist Medical Center. “With couples, I see the affected partner pausing more and the other partner ‘filling in’ the story without even being aware of the loss.” 

Middle-stage dementia:

• Increased confusion
• Difficulty managing finances or medications
• Becoming lost in familiar places
• Personality or mood changes
• Needing assistance with daily activities

Dr. Schindler says that patients may become confused when driving and end up lost in a place that should be familiar. With frontal lobe impairment, they may be more impulsive or inappropriate in social situations. For instance, “when startled at night, they may awaken and assume it’s morning, then proceed to get dressed and start the day.”  

Late-stage dementia:

• Severe memory loss
• Difficulty recognizing loved ones
• Problems communicating
• Loss of mobility
• Dependence on caregivers for personal care

Not everyone progresses at the same rate, and symptoms vary depending on the type of dementia.

What Causes Dementia?

Dementia results from damage to brain cells, but the cause depends on the specific type.

Alzheimer’s disease involves abnormal protein deposits in the brain that gradually destroy nerve cells. Vascular dementia develops when blood flow to the brain is interrupted or reduced. Other forms result from diseases affecting brain tissue, movement disorders or other neurological conditions.

Age remains the greatest risk factor, but cardiovascular disease, diabetes, smoking, high blood pressure, obesity and head injuries may also increase the risk.

How Is Dementia Diagnosed?

There isn’t a single test to diagnose dementia. Because memory loss and trouble focusing can result from many conditions, some reversible, healthcare providers rely on several sources of information to make a diagnosis.

Changes in personality or health should be discussed with a trusted healthcare professional. “Beyond that, some testing to see how severe the memory loss is can be helpful for the patient and family,” Dr. Schindler says. Diagnosing dementia usually includes a medical history review, physical exam, cognitive and neurological testing and, in some cases, brain imaging or genetic testing.

Is Dementia Hereditary?

Most cases of dementia are not directly inherited. While having a parent or sibling with Alzheimer’s disease can increase a person’s risk, genetics is only one factor among many.

A small percentage of Alzheimer’s cases are caused by inherited genetic mutations that typically lead to symptoms at a younger age. However, these inherited forms are rare. Lifestyle, cardiovascular health and environmental factors play a much larger role.

Conditions and Medications That May Worsen Dementia

Some health conditions and medications can worsen memory problems or mimic dementia symptoms. Examples include:

• Heavy alcohol use, which can damage brain cells over time
• Diphenhydramine, an antihistamine that may increase confusion in older adults
• Untreated hearing loss, which places additional strain on the brain and has been linked to faster cognitive decline
• Gabapentin, which may cause drowsiness or cognitive side effects in some individuals.

Can Dementia Be Prevented?

Although there’s no way to completely prevent dementia, research suggests that a healthy lifestyle may lower the risk.

Experts recommend:

• Following a diet rich in fruits, vegetables, whole grains, fish, nuts and healthy fats
• Limiting alcohol consumption
• Exercising regularly
• Maintaining healthy blood pressure, cholesterol and blood sugar levels
• Staying socially and mentally active
• Getting adequate sleep
• Correcting hearing loss when possible

Confronting Someone You Suspect Has Dementia

Starting a conversation about memory concerns can be difficult. Rather than accusing someone of having dementia, experts recommend approaching the discussion with empathy and specific observations.

The Alzheimer’s Association suggests speaking to the person one-on-one so they don’t feel threatened by a group and have the conversation in a location where they will feel most comfortable.  Download the Alzheimer’s Association’s 10 Steps to Approach Memory Concerns worksheet to help you prepare.

Treatment Options

While there is currently no cure for most types of dementia, treatment can improve quality of life and help manage symptoms.

Treatment may include:

• Medications that improve memory or slow cognitive decline in some patients
• Physical and occupational therapy
• Cognitive stimulation activities
• Management of underlying medical conditions
• Structured daily routines
• Caregiver education and support 

Support Resources

• In Knoxville, the Community Action Committee Office on Aging provides information about places that offer daytime caregiving services, some of which care for Alzheimer’s patients
• The Alzheimer’s Association – Tennessee Chapter and Alzheimer’s Tennessee offer support groups and Caring and Caregiver Workshops where family members can share experiences, gain support and learn from others facing similar challenges.

Living with Dementia

A diagnosis of dementia can be life-changing, but it does not define the person. Many individuals continue to enjoy meaningful relationships, hobbies and fulfilling experiences for years. With the right care, support and planning, people with dementia can remain engaged in the activities and relationships that matter most.

“There’s no need for family to bear all the stress of what this condition brings,” Dr. Schindler says.  If you or a loved one is experiencing memory loss, confusion or changes in thinking, talk with a healthcare provider. A Covenant Health provider can help determine the cause of symptoms and create a personalized plan for care, support and peace of mind.