Alzheimer's and Other Dementias:

What is dementia?

Dementia refers to the loss of memory and other cognitive skills due to changes in the brain caused by disease or trauma. The changes can affect thinking, memory and reasoning, and may occur gradually or quickly. Memory loss alone is not always a sign of dementia, but memory loss along with other forms of cognitive impairment is an indicator that dementia may be occurring. 

Cognitive functions that might be affected by dementia include:

• decision making/judgment
• memory
• spatial orientation
• thinking/reasoning
• verbal communication
• neglect of personal safety, hygiene, and nutrition
• coordination or balance

A person with dementia might...
…repeatedly ask the same questions …become lost or disoriented in familiar places …be unable to follow directions …be disoriented as to the date or time of day …not recognize and be confused about familiar people …have difficulty with routine tasks such as paying the bills …neglect personal safety, hygiene, and nutrition

Alzheimer's disease

Alzheimer's disease is the most common cause of dementia, affecting as many as 4 million Americans. Alzheimer’s is a brain disease characterized by lesions that gradually destroy cells in the brain. As nerve cells die, affected areas of the brain wither and become smaller. The areas of the brain that control memory, logical thinking, and personality are generally the most affected. As areas in the brain become smaller, cavities within the brain containing fluid become enlarged.

Symptoms of Alzheimer's disease include the following:

• Loss of recent memory
• Problems with language, calculation, abstract thinking, and judgment
• Depression, anxiety, and personality changes
• Unpredictable quirks or behaviors
• Late in the disease, delusions and hallucinations
• Trouble knowing time, date, or place

Alzheimer's disease is not curable and is not a normal process of aging.

Other forms of dementia

Vascular dementia

Vascular Dementia (Multi-Infarct Dementia) results from a series of small strokes or changes in the brain's blood supply. Blood clots block small blood vessels and destroy brain tissue. The strokes interfere with the function of daily activities and cause memory problems and slurred speech. The location in the brain where a stroke occurs may account for the seriousness of the problem and symptoms. Sudden symptoms may be a sign of this dementia. It is not reversible and there is no cure.

Symptoms of Vascular Dementia include the following:

• Wandering or getting lost in familiar surroundings
• Moving with rapid, shuffling steps
• Loss of bladder or bowel control
• Laughing or crying inappropriately
• Difficulty following instructions
• Problems handling money

Less common forms of dementia

Pick’s Disease
Pick’s Disease affects personality, orientation and behavior. It may be more common in women and occurs at an early age.

Creutzfeldt-Jakob Disease
An infectious organism is responsible for this disease, whose symptoms include memory and behavioral problems and a loss of coordination. The disease progresses rapidly along with mental deterioration and involuntary movements.

Huntington’s Disease
Huntington’s is an inherited, degenerative disease. The disease causes involuntary movement and usually begins during mid-life. Other symptoms include disorientation, personality changes, impaired judgment, memory and speech problems.

Parkinson’s Disease
Parkinson’s is a progressive disorder of the central nervous system. The symptoms include tremors, speech problems, stiffness of limbs and joints and physical movement. In later stages of Parkinson's Disease, some patients develop dementia.

Lewy Body Disease
This disease causes symptoms similar to Alzheimer's disease, including memory problems, confusion, language problems and difficulty with current events. Individuals with Lewy Body Disease experience hallucinations and can become fearful.

Conditions causing symptoms similar to Alzheimer's disease and dementia

Other conditions can cause symptoms like Alzheimer’s disease and other dementias.

Conditions Similar to Alzheimer's Disease
Central nervous system conditions	Parkinson’s disease, Huntington’s disease, head injuries, brain tumor, or stroke.
Systemic conditions	Poor nutrition, dehydration, lack of sleep, high fever, infection, poisoning, hormone imbalances, and vitamin deficiencies
Substance-induced conditions	Side-effects of medications, drug interactions, alcoholism or drug abuse
Psychological stress and psychosis	Emotional trauma or stress, clinical depression, schizophrenia or delirium

Many of these conditions that mimic dementia are reversible if treated early. That’s why it’s important to get a medical evaluation if you are concerned about dementia-like symptoms.   

Cognitive decline and memory loss versus dementia

Some people believe that gradual decline in short-term memory and reaction time is a normal part of growing older.  People start losing brain cells beginning in their 20’s, but recent brain research shows that throughout life, the brain can grow new connections between cells.  Scientists have raised doubts about the “common wisdom” that gradual losses of memory and thinking capacity are a natural part of aging.  Some studies suggest that most memory loss in older people is the result of lack of social stimulation or due to not “exercising” mental abilities.  While many people do experience mild and gradual memory loss after age 40, severe and rapid memory loss is definitely not a part of normal aging.

The most common forms of decline that have been associated with aging are:

• Slower thinking and problem-solving (the speed of learning and recall slows down; short-term memory takes longer to function; reaction time increases)
• Decreased attention and concentration
• More distractedness (all of the interruptions make learning more difficult)
• A greater need for hints to jog the memory

We do see these mental changes in some people, but we can also find many examples of people who continue to improve themselves and learn new skills as they get older.  For some, their greatest accomplishments have come late in life.  It seems likely that exercising mind and memory can help keep us mentally sharp just as physical exercise keeps us physically fit, no matter how old we are.  Recent research suggests that good health habits and mental stimulation may prevent dementia altogether or at least delay its onset. 

Are dementia-like symptoms possible without having dementia?

It is possible to have dementia-like symptoms without having dementia. Certain emotions might result in dementia-like symptoms. Boredom, extreme sadness, loneliness, anxiety, and stress all might manifest themselves in forgetfulness, memory loss and confusion.  Boredom is common for people facing retirement or just beginning it, and might leave a person feeling and acting confused, indecisive, and forgetful because of lack of outside direction for the activities of the day.

Coping with the loss of a loved one might trigger, along with sadness and loneliness, a sense of bewilderment about life and an inability to move on with day-to-day routines. Oftentimes, people feeling confused about how to pull themselves out of sadness, grief or anxiety might behave unpredictably – forgetting when they normally remember, not paying attention, losing ability to focus, and seeming generally out-of-it. 

The losses that occur as we age can lead to social isolation resulting in a kind of lethargy or disorientation due to lack of the mental stimulation that occurs when interacting with others. 

Why should memory decline be monitored?

Monitoring memory decline over time is important because:

• There is a lot that you can do to prevent memory loss and even to reverse mild changes
• Memory problems may be due to a disease that can be successfully treated if diagnosed early
• If the problem is Alzheimer's, early detection offers the possibility of slowing the disease with drugs or non-medicinal means

If you are concerned about symptoms, a geriatrician can help determine the source of your difficulties and suggest a treatment plan.

References and resources for Alzheimer's and Other Dementias

General information on Dementia

Dementia - different types – Brief descriptions of the various dementias with an overview on signs of dementia and numerous links to articles on Alzheimer’s symptoms and Alzheimer’s care.  (Better Health Channel, Australia)

About Dementia – An overview of major forms of dementia, with selected links to detailed information on some dementia types, from the (Alzheimer's Association of Los Angeles)

Types of Dementia (commercial site) – Links to articles on many kinds of dementia, an overview and a medication overview.  (eMedicineHealth.com)

Alzheimer’s disease and dementia

The Forgetting: A Portrait of Alzheimer's – Website for the show "The Forgetting." Includes several excellent resources about Alzheimer's, including Symptoms, The Experience, Risk Factors, Coping, Together Time, and Resources. (Public Broadcasting System (PBS))

Dementia: Not always Alzheimer's – Several types of dementia are described with links to more detailed descriptions and to numerous writings on Alzheimer’s disease. (Mayo Clinic)

Mild cognitive impairment, memory loss, and aging

Mild Cognitive Impairment (MCI) – Mild cognitive impairment and memory loss that is not classified as dementia is now called MCI. This article explains the relationships between MCI & normal aging, and MCI & dementia, along with links to articles on several dementia types. (University of California San Francisco Memory and Aging Center)

Memory Loss and Aging – What’s Normal, What’s Not – Information for seniors and their families about what is considered normal memory loss and when to worry. (American Academy of Family Physicians – commercial site)

Doug Russell, L.C.S.W., Jeanne Segal, Ph.D.,  Monika White, Ph.D., and Suzanne Barston contributed to this article. Last modified on: 12/10/07.