What is the difference between 'dementia' and 'Alzheimer's'?

[Notta]

As far as I can find out, Alzheimer's is a sub-set of dementia. My mother-in-law has been showing early signs of 'dementia', but when I ask my father-in-law if the doctor mentioned Alzheimer's he said the doc said it wasn't that.

My elderly uncle died in November, and he had 'dementia', too. Even though as a layperson I could see no difference between Alzheimer's and dementia, and he had no specific chemical test or brain scan to make this diagnosis.

I'm wondering if doctor's are hesitant to say 'Alzheimer's' since people know it is a death sentence, when 'dementia' sounds like a much simpler disease that may have a possible treatment.

[Jobar]

You should ask Sohy about this; she's an expert.

My own understanding is that dementia is a symptom, and Alzheimer's is one of the diseases that can cause it.

[VoxRat]

You should ask Sohy about this; she's an expert.

My own understanding is that dementia is a symptom, and Alzheimer's is one of the diseases that can cause it.This is my understanding too.

There are all sorts of things that can cause "dementia". Like heavy metal poisoning, for instance.

Alzheimer's is characterized by particular anatomic findings; I'm not sure the diagnosis is ever definitive until autopsy.

[David B]

My mother became increasingly demented over the last few years of her life, and the docs did scans and things to see what was going on.

They were quite clear that she had had a succession of mini-strokes, rather than Alzheimers. In practical terms - not a lot of difference.

David

[DMB]

MY mother suffers from dementia, which is getting steadily worse. In her case there is little doubt that her primary problem was vascular dementia, since she had had decades of untreated very high blood pressure (she was very stubborn and always believed that doctors and pills were dangerous) and a series of TIAs or mini-strokes. Each time you have one of these, it destroys a bit of the brain.

Recently I talked to one of her nurses and she said that she might actually have Alzheimer's as well. One sort of dementia doesn't preclude another. AFAIK it is difficult to diagnose Alzheimer's for sure while the patient is alive, but it does tend to produce a much faster decline, both physical and mental, than some other forms of dementia.

[JamesBannon]

From what I understand, Alzheimers is similar to Pick's Disease & CJD in that the protein structures in the brain disintegrate over time. They can only really be told apart by detailed microscopic examination of the tissues, obviously not a thing that can be done while the patient is alive. The MRI findings are similar in all three disease I think.

"Dementia" is just a generic term for loss of cognitive function. When I was nursing, the commonest cause was hypoxia as a result of Chronic Obstructive Airways Disease and the next commonest was stroke. There are dozens, if not hundreds, of other causes ranging from infection to tumours.

[Howardbemyname]

I'm wondering if doctor's are hesitant to say 'Alzheimer's' since people know it is a death sentence, when 'dementia' sounds like a much simpler disease that may have a possible treatment.

Until recently I think it was more common for doctors ( for non-neurologists anyway) to say "Alzheimer's" instead of "dementia" - to the non-specialist it really wasn't worth making the distinction because:

1) There really wasn't a treatment for most forms of dementia

2) Eventually (unless the patient died of something else first) most forms of dementia progress to the same grim place (Alzheimer's often progresses more rapidly & devasatingly).

[DISCLAIMER: I'm not a medical profesional; what follows is anecdotal, based on my experience with my late mother, other elderly relatives & my current nonagenarian neighbor.]

It seems that some of the Alzheimer's medications (e.g. Aricept or Exelon) actually work better in treating (even reversing) non-Alzheimer's dementia than they do for Alzheimer's; to the point where if the meds provide significant improvement for a reasonable time it's a strong sign that the patient doesn't actually have Alzheimer's.

As more doctors become aware of this, they're more likely now to say "dementia" & hold out the genuine possibility of treatment (though that may not pan out).

[Monad]

Dementia is a group of syndromes characterized by acquired, persistent impairment of multiple cognitive domains - memory, language, attention, executive function, and visuospatial ability - severe enough to impair competence in daily living, occupation, and social interaction (paraphrase of Grabowski & Damasio, 2004). As has been said, the term itself merely describes the symptoms, not the specific causes or diseases involved.

There are many types of dementia - perhaps several dozen or more - the most common being Alzheimer's disease or Alzheimer's type dementia (which is probably in itself not one disease but several), Vascular dementia (of which there are also several subtypes), dementia with Lewy bodies and the fronto-temporal dementias (again several diseases with different causes, Pick's being the most well known). Then there are Parkinson's disease dementia, AIDS dementia, Korsakoff's disease (alcohol related), hereditary diseases like Huntingdon's and Creutzfeldt–Jakob (there are also acquired versions of this), Progressive Supra Nuclear palsy, Primary Progressive aphasia and many many more.

Sometimes, as DMB states, a person may have more than one type - in particular it is not uncommon for a person who has vascular dementia to then go on to develop Alzheimer's; impairment of the brains blood supply may well be one of the causes of Alzheimer's (one of several - it seem there is not always a single cause but rather a cascade). Similarly Lewy body dementia and Parkinson's with cognitive impairment can overlap.

Colloquially many people (even doctors) will use the two terms "dementia" and "Alzheimers" interchangeably. And yes, "dementia" is also a symptom - a person may have dementia but as a consequence of having a treatable illness (many of my patients have had what we call "acute confusional states" as a result of something like a urinary tract infection or chest infection)

Good list of clear information can be found here:

http://alzheimers.org.uk/site/scripts/home_info.php?homepageID=23

[DMB]

Yes. That reminds me that my mother's dementia temporarily worsened when she had a urinary infection about four years ago. Mind you, there has been a noticeable decline during those four years.

*****

Lovely to see you here, Monad. Would you like to start an Intro thread? :)

[Notta]

Thank you for all the information. After watching a couple of relatives by marriage of mine die from dementia-related problems, I'm very relieved that both of my parents managed to die very quickly with all their mental facilities intact. Dying after you've lost the ability to recognize your spouse and your children and being reduced to a shell of a human being is a tough way to go.

[Cath B]

Yes. That reminds me that my mother's dementia temporarily worsened when she had a urinary infection about four years ago. Mind you, there has been a noticeable decline during those four years.


Yes, UTIs seemed to be associated with more pronounced dementia in my mother (who was also David B's mother) too.

And a couple of years ago she became temporarily aggressive while being treated with high dose steroids. That was a very difficult time for us all.

[sohy]

Yes, UTIs seemed to be associated with more pronounced dementia in my mother (who was also David B's mother) too.

Very elderly people, even those without dementia, often become confused when they have a UTI. Whenever one of the residents where I work is more combative and confused than usual, the first thing we suspect is UTI.

The dementia question has already been answered. I use the term dementia as a general term for all of the diseases causing these symptoms. It's easier and I think many people are given the Alzheimer's label incorrectly. For that matter, many people are given the dementia label incorrectly. In the states, the term is frequently used as a diagnoses.

There is also a term, minimal cognitive impairment, which has it's own diagnoses code. Most of those that suffer from this will eventually develop full blown dementia, if they live long enough. Many of my clients have MCI, although the doctors around here never use that term. They just slap that dementia label on them. With very few exceptions, primary care physicians in my area have very little understanding or expertise with those that suffer from dementia.

My experience has been that people with dementia can continue to have quite a bit of quality of life until the later stages if they have caregivers that understand how to manage their symptoms effectively. Of course, there are always a few that even challenge me, despite my experience with this awful disease. I feel for the non professional staff. They are the true caregivers, despite low pay and lack of respect. I admire them.

[Monad]

Yes, UTIs seemed to be associated with more pronounced dementia in my mother (who was also David B's mother) too.

Very elderly people, even those without dementia, often become confused when they have a UTI. Whenever one of the residents where I work is more combative and confused than usual, the first thing we suspect is UTI.


Yeah it's good practice to do the detective work and eliminate physical causes first - UTI, chest infection, B12 levels, changes of medication, thyroid function, blood sugars etc - there are many things that can tip the balance and produce confusion with or without an underlying cognitive impairment. UTI's really mess up your system actually - I had one once that developed into a kidney infection and it felt really awful, didn't cause confusion but did make me feel very vulnerable and low and was also surprisingly painful when it got to my kidneys. I can only try and imagine what it must be like to be experiencing that level of awfulness when you do have a cognitive impairment and can't communicate what you are going through, except through your actions. People need to be very careful indeed about not attributing so-called "challenging behaviour" to a diagnosis of "dementia" so easily without really attempting to identify the needs being expressed or not being met first.

[sohy]

So true. I currently have at least five or six clients that came to us with the Dx. of dementia, when at worst they have MCI. Also, I just read yesterday in Medscape, I think, that the newest evidence suggests that MCI doesn't lead to full blown dementia nearly as often as we previously thought.

[Full Tilt Boogie]

As far as I can find out, Alzheimer's is a sub-set of dementia. My mother-in-law has been showing early signs of 'dementia', but when I ask my father-in-law if the doctor mentioned Alzheimer's he said the doc said it wasn't that.

My elderly uncle died in November, and he had 'dementia', too. Even though as a layperson I could see no difference between Alzheimer's and dementia, and he had no specific chemical test or brain scan to make this diagnosis.

I'm wondering if doctor's are hesitant to say 'Alzheimer's' since people know it is a death sentence, when 'dementia' sounds like a much simpler disease that may have a possible treatment.

My father died last year. He'd suffered with dementia for at least the last five years of his life. Ultimately, he died (so his death certificate states) of a "bladder infection". Being wheelchair-bound, and after repeatedly being catheterised for years, and repeated bladder infections as a result (you're prone to them when catheterised - they're unavoidable), the antibiotics simply wouldn't work any more - after they'd tried pretty much every one available. Once the final infection set in, his bladder acted as a flushing bag of poison which set about rather adeptly attacking his internal organs until they failed.

Any way, as I understand it, and in my experience, one of the main differences between dementia and Alzheimer's is that the latter condition can see the sufferer prone to unpredictable bouts of spontaneous and barely controllable (by others) violence - but severe depression is common in both conditions. Luckily my father never so much as raised his voice in anger, let alone his fists; although, prior to being put on much needed - though only mild - antidepressants, he did wail and moan during bouts of huge confusion.

Luckily, by chance, I have one of Australia's leading authorities on dementia and Alzheimer's as a mate, Professor Brian Draper (http://www.amazon.co.uk/Understanding-Alzheimers-Other-Dementias-ebook/dp/B004PYDS2Y/ref=sr_1_1?s=books&ie=UTF8&qid=1308903435&sr=1-1)

Having gone through this with my father, I wouldn't wish it on my worst enemy.