Alzheimer's Disease and Dementia

Overview

Many diseases reduce cognitive function, or the ability to think, learn, and remember. It’s possible to have mild cognitive impairment and still function normally, but it increases the risk of developing dementia over time.

When problems with cognitive function affect your ability to do normal activities, it’s called dementia. Dementia includes changes or problems with any of the following:

Memory
Language
Spatial perception
Abstract thinking
Problem-solving skills

Over time, these problems can interfere with work, social interactions, and daily tasks such as:

Shopping
Managing finances
Dressing and bathing
Maintaining a home
Taking medications correctly (missing doses or taking duplicative doses)
Managing social relationships

Types and Causes

There are several different types of dementia. These are summarized here.

Alzheimer’s disease

Alzheimer’s disease causes more than 75 percent of all cases of dementia. People with Alzheimer’s are often unaware that their symptoms are starting or getting worse. The cause of Alzheimer’s is uncertain. However, we know that abnormal forms of 2 proteins called beta-amyloid and tau may contribute to the disease. A buildup of these proteins affects nerve function and leads to brain cell death. Nerve cell damage and death causes ongoing loss of thinking and memory skills.

Some of the most affected nerve cells are those that release acetylcholine. This is a chemical that helps transmit nerve impulses that support memory, attention, and other thought processes.

The risk and frequency of Alzheimer’s increases with age. It’s estimated that about:

10 percent of people older than 65 have Alzheimer’s.
50 percent of people 85 and older have Alzheimer’s.

Genetics are thought to be a rare cause of Alzheimer’s. Having a family history of Alzheimer’s may increase your risk, but the number of cases of hereditary Alzheimer’s are rare. There’s ongoing research about the role genetics plays in dementia risk.

Currently, Alzheimer’s can’t be prevented, slowed, or stopped. Research is underway to find effective treatments.

Vascular dementia

The second most common cause of dementia is vascular dementia, also known as multi-infarct dementia. This type of dementia is caused by a stroke or multiple strokes that have damaged the brain.

Lewy body dementia

Lewy bodies are abnormal collections of protein that develop inside nerve cells. This can cause dementia symptoms that include:

Fluctuating confusion
Visual hallucinations
Rapid cognitive decline
Motor symptoms similar to those seen in Parkinson’s disease

Frontotemporal dementia

Frontotemporal dementias (FTDs) are a group of disorders that affect the frontal or temporal lobes of the brain. These parts of the brain support language, personality, and behavior. As a result, FTD symptoms include personality and behavior changes as well as difficulty speaking. FTD tends to develop earlier than other types of dementia, sometimes affecting people in their 50s and 60s.

Parkinsonian syndrome (Parkinson’s dementia)

People with symptoms seen in Parkinson's disease may have a Parkinsonian syndrome. This can be caused by "atypical Parkinson's" or "Parkinson's plus syndrome," which occur in 20 percent of patients. The symptoms of these syndromes don’t respond as well to medication as Parkinson's disease does. They also tend to progress more quickly. Parkinsonian syndromes can cause dementia symptoms, including problems with thinking and mood changes.

Other rare forms of dementia include:

Progressive supranuclear palsy (PSP)
Normal pressure hydrocephalus (NPH)
Huntington’s disease (HD)
Mixed dementias (a mix of more than one type)

Other causes of dementia can include:

Brain injuries
HIV/AIDS
Heavy alcohol consumption

Symptoms

As we get older, we all have “senior moments” or memory lapses where we forget a name or something we meant to do. This can be annoying but doesn’t prevent us from functioning normally. People with normal memory lapses usually know they’ve forgotten something.

With normal memory lapses, you may:

Forget details, but not events.
Recognize people but have trouble remembering their names.
Forget what you were doing, momentarily.

Dementia affects memory more significantly. People with dementia are usually unaware of how poor their memory has become. They may not even realize that they have forgotten something. These changes can progress rapidly, or over time.

With dementia, people may:

Forget recent events or conversations.
Be unable to manage daily affairs without help.
Lose the ability to recognize themselves or others.
Have trouble following directions.
Become unaware of day or time.
Be less attentive to hygiene.

Stages

Dementia varies from person to person. It can progress quickly in some people or take 10 or more years to develop in others. As thinking becomes impaired, it becomes more and more difficult to perform daily activities.

This chart describes some symptoms of the different stages of dementia.

SYMPTOMS OF DIFFERENT STAGES OF DEMENTIA
Stage of dementia	Symptoms	Affected activities
Mild	Loss of recall/learning ability Difficulty finding words Problem-solving challenges Lack of judgment Problems with basic calculations	Work Money/shopping Cooking Housekeeping Reading Writing Hobbies Medications
Moderate	Recent memory loss Language problems (recalling names and paraphrasing) Insight Visual/spatial ability (confused about where you are)	Finding objects Finding way to places Bathing and grooming
Severe	Inattention Difficulty performing familiar activities Language/speech difficulties	Eating Bowel/bladder control Walking Motor ability

Screening and Diagnosis

If you have symptoms that concern you, such as memory loss or behavior changes, make an appointment with your doctor. It’s helpful to bring someone to the visit who knows you well. They can provide insights on how well you’re functioning.

There is no definitive scan or lab test to confirm a diagnosis of a specific type of dementia, like Alzheimer’s disease, at this time. To help find the best treatment, your doctor will:

Assess your memory and thinking abilities using simple screening tests.
Recommend more in-depth testing depending on your symptoms.

Further tests may include:

Neurological evaluation.
Blood counts, liver, thyroid, and kidney lab tests. We may also test your vitamin B12, calcium, and electrolyte levels.
CT or MRI scan of the brain. Imaging studies can show atrophy (shrinkage) of the brain.

Related Conditions

There are several conditions and medications that can cause symptoms similar to dementia. Treating these conditions or adjusting medications may improve or even resolve dementia-like symptoms.

Depression

People with depression frequently complain of problems with mental function and memory. This has been termed pseudo-dementia. It's a common cause of cognitive difficulties and is treatable. It’s hard to tell depression and pseudo-dementia apart. Someone may feel depressed because they’re having cognitive problems. Treating depression may improve cognitive symptoms.

Anticholinergic drugs

These drugs are used to treat a variety of symptoms including stomach cramps, ulcers, motion sickness, and bladder incontinence (leakage). They work by blocking the effects of acetylcholine (a chemical that helps transmits nerve impulses that support memory and attention). These medications may change brain chemistry and cause impairment in memory and other thought processes. Your doctor may recommend alternative treatments if these drugs are affecting your ability to think and remember.

Sleeping pills and antianxiety medications

Medications such as diazepam, lorazepam, and even diphenhydramine (an antihistamine) can affect your cognitive abilities as you get older. Your body is also less able to break down these drugs. Your doctor may discuss different medications if your thinking skills are affected.

Medications

Unfortunately, at this time no medications are available to stop Alzheimer’s disease and other types of dementia. We can prescribe medications to treat the symptoms. However, the benefit is minimal and occurs only in some individuals.

Acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine)

These drugs inhibit an enzyme that breaks down acetylcholine (a chemical neurotransmitter involved in memory, judgment, and other thought processes). Brain cells that release acetylcholine are among the first to be affected by the disease. In some people, these drugs can temporarily delay symptoms from getting worse. However, they don't keep the nerve cells from dying so they don't prevent the disease from worsening over time.

Side effects include:

Upset stomach
Diarrhea
Agitation (which is rare)

NDMA receptor antagonists (memantine)

This medication treats the symptoms of dementia and Alzheimer’s. It’s an option for people in later stages of disease who are unable to tolerate acetylcholinesterase inhibitors. The drug can slightly improve mental function and memory but may not prevent the disease from getting worse.

Side effects include:

Tiredness
Dizziness
Confusion
Headache
Sleepiness
Constipation
Vomiting
Pain

Anti-amyloid monoclonal antibodies (aducanumab, lecanemab)

This is a new type of medication for mild dementia that’s only appropriate for specific cases. Additional studies are underway to determine if the benefits outweigh the significant risks of potential complications.

Antidepressants

Depression occurs in about 40 percent of people with Alzheimer’s and may make mental abilities worse. Antidepressants can relieve symptoms of depression and may improve quality of life.

Other Treatments

Some patients turn to complementary and alternative methods of care or explore clinical trials for treating Alzheimer’s.

Complementary and alternative therapies

Hundreds of herbal remedies, vitamins, and dietary supplements are marketed as treatments for Alzheimer’s disease and other types of dementia, or as products that can prevent it. Some of these products may help with symptoms of dementia and be part of a healthy lifestyle. However, there’s no scientific research or data that proves any supplement or remedy prevents, treats, or reverses dementia despite manufacturer claims.

Many vitamins and supplements can have negative interactions with other medications. If you’re considering any alternative therapies, please talk with your doctor first. They can ensure these therapies don’t interfere with your medications.

Clinical trials

Clinical trials of potential treatments for dementia and Alzheimer’s disease are underway around the world. Learn more about clinical trials at the National Institutes of Health.

Lifestyle Recommendations

There are a number of ways to keep your brain active and adjust activities that may not be safe for someone with dementia.

Brain activities

Exercising your brain may help reduce the risk of dementia. Try these activities:

Start a new hobby, take a class, or learn something new.
Simplify your life. Avoid unnecessary complications and prepare for the future.
Join a group exercise class.
Keep blood pressure under control.
Know what medications you’re taking and why. Learn about the side effects and alternatives.
Complete an advanced directive and identify someone to make decisions on your behalf if you are unable to do so.
Find a primary care doctor who understands you and your condition.

Driving

It may not be safe to drive if you have dementia, even for people who are in the very early stages. Ask the Department of Motor Vehicles to evaluate your driving ability before you, or a loved one, gets behind the wheel.

California law requires physicians to submit a report to the Department of Public Health if someone has a condition that causes confusion, memory problems, or dementia.

Watch for these signs that you or a family member are having difficulty driving:

Driving at inappropriate speeds, either too fast or too slow.
New scrapes or dents on car, garage, or mailbox.
Minor "fender benders" or other accidents or incidents.
Getting lost in familiar places.
Having trouble navigating turns.
Moving into a wrong lane.
Having delayed response to unexpected situations.

Caregiver Support

Providing care for someone with dementia can be challenging. There are lots of resources for caregivers to learn to care for someone with dementia. This includes education and resources for:

Designating someone to make decisions on your behalf when you are no longer able.
Helping with communication and other behaviors.
Planning for long-term care.
Keeping someone with dementia safe.

The Alzheimer’s Association and California Caregiver Resource Centers have resources, classes, and a support line to help caregivers.

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