Dementia and Alzheimer's Disease: What are the Differences?

Dementia vs. Alzheimer's Disease

With the improvement in health services and public welfare and the success of family planning programs in Indonesia, the population pyramid shows changes that affect health service policies and strategies. The number of the elderly population is increasing. This trend has been anticipated by various institutions, both the government and the private sector, by paying better attention to groups of people aged over 65 years. Health problems in the elderly population are closely related to the process of unavoidable degeneration. The whole body system, sooner or later, will degenerate. Clinical, laboratory and radiological manifestations depend on the organ and affected system. One of the typical clinical manifestations is the onset of dementia. Dementia can occur at any age, depending on the causative factor. However, dementia is most common in the elderly. 

From the medical aspect, dementia is a problem that is no less complicated than the problems found in other chronic diseases (stroke, diabetes mellitus, hypertension, malignancy). Medical and health sciences have a mission to improve the quality of human life. Someone who has dementia will inevitably experience a decrease in quality of life. Its presence in family or community become a burden for the environment, and they are no longer independent.

Dementia is as known as a gradual loss of cognitive function, multidimensional and persistent, caused by organic damage of the central nervous system. It is not accompanied by acute loss of consciousness, such as delirium. Meanwhile, Alzheimer's disease is a brain disorder that is irreversible and progressive associated with changes in nerve cells, thereby causing brain cell death. Alzheimer's disease occurs gradually; it is not part of the normal aging process and is the most common type of dementia. 

The terms "dementia" and "Alzheimer's" are often used as though they mean the same thing. They are related, but there are important differences between the two. Dementia and Alzheimer's disease are not the same. Dementia has been known as the term used to describe symptoms that impact memory, the performance of daily activities, and communication abilities. Alzheimer's disease gets worse with time and affects memory, language, and thought. Although symptoms of the two conditions may overlap, distinguishing them is essential for management and treatment.

Dementia

Dementia is a syndrome, not a disease. A syndrome is a group of symptoms that does not have a definitive diagnosis. Dementia is a broad ("umbrella") term for an individual's changes in memory, thinking or reasoning. There are many possible causes of dementia, including Alzheimer's. The World Health Organization Trusted Source says that 47.5 million people around the world are living with dementia.

Symptoms of Dementia

The symptoms of dementia will vary depending on the cause, but common signs and symptoms include cognitive and psychological changes. 

It is easy to overlook the early symptoms of dementia, which can be mild. It often begins with simple episodes of forgetfulness (memory loss) which is usually be noticed by someone else. People with dementia have trouble keeping track of time and tend to lose their way in familiar settings.

As dementia progresses, it can have a significant impact on the ability to function independently. It is a significant cause of disability for older adults and places an emotional and financial burden on families and caregivers. They become harder to recall names and faces, communicate or find words, get lost with visual and spatial abilities, confusion and disorientation, and have difficulty with coordination and motor functions. 

Obvious signs of dementia include repetitious questioning, inadequate hygiene, and poor decision-making. In the most advanced stage, people with dementia become unable to care for themselves and cannot handle complex tasks. They will struggle even more with keeping track of time and remembering people and places they are familiar with. Behavior continues to change and can turn into depression and aggression.

Diagnosis of Dementia

There is no one test to determine if someone has dementia. Doctors diagnose Alzheimer's and other types of dementia based on a careful medical history, a physical examination, laboratory tests, and the characteristic changes in thinking, day-to-day function and behavior associated with each type. Doctors can determine that a person has dementia with a high level of certainty. But it's harder to determine the exact type of dementia because the symptoms and brain changes of different dementias can overlap. In some cases, a doctor may diagnose "dementia" and not specify a type. If this occurs, it may be necessary to see a specialist such as a neurologist, psychiatrist, psychologist or geriatrician.

Causes of Dementia

Many conditions can cause dementia, including degenerative diseases such as Alzheimer's, Parkinson's, and Huntington's. Each cause of dementia causes damage to a different set of brain cells. Alzheimer's disease is responsible for about 50 to 70 percent of all cases of dementia. Other causes of dementia include: infections, such as HIV; vascular diseases; stroke; depression; chronic drug use.

Alzheimer's Disease

Alzheimer's disease is the most common cause of dementia. It makes up 60% to 80% of all dementia cases. Alzheimer's is not a normal part of aging --- it's a progressive brain disease, meaning it gets worse over time. The exact cause is unknown, and no cure is available. The time from diagnosis to death can be as little as three years in people over 80 years old. However, it can be much longer for younger people.

Symptoms of Alzheimer's Disease

Common Alzheimer's symptoms include:
(1) Trouble remembering names, events, or conversations, (2) Problems concentrating, (3) Personality changes, like not caring about things you used to, mistrust of others, or aggression, (4) Mood changes, (5) Depression, (6) Impaired judgment or decision making, and (7) Confusion.

It gets more challenging to carry on a conversation or do everyday tasks. A doctor can not say you have Alzheimer's with absolute certainty, but they can do things pretty sure. They include testing your attention, memory, language, and vision and looking at images of your brain. These images are taken with an MRI (magnetic resonance imaging) machine, which uses powerful magnets and radio waves to make detailed pictures.

Diagnosis of Alzheimer's Disease:

The diagnosis of Alzheimer's is based on clinical symptoms and mental status examination, which is often difficult to distinguish from other diseases in the early stages. It causes delays in the diagnosis and treatment of the disease. Until now, no treatment can cure Alzheimer's. Several types of drugs that exist today are symptomatic therapies developed based on the pathophysiology of this disease. Drugs that can be used are cholinesterase inhibitors such as Donepezil and rivastigmine, or the N-methyl-D-Aspartate (NMDA) antagonist Memantine.

Causes and Effects of Alzheimer's on the Brain

Damage to the brain begins years before symptoms appear. It happens when proteins (called plaques) and fibers (called tangles) build up in your brain, block nerve signals, and destroy nerve cells. As neurons are injured and die throughout the brain, connections between networks of neurons may break down, and many brain regions begin to shrink. These changes can cause the symptoms of Alzheimer's disease. These include memory loss; problems with thinking and planning; behavioral issues; and, in the last stage, a further decline in functioning, which can even include trouble swallowing. By the final stages of Alzheimer's, this process---called brain atrophy---is widespread, causing significant loss of brain volume. Memory loss may be mild at first, but symptoms get worse over time.  

Treating Alzheimer's Disease vs. Other Types of Dementia

Neither Alzheimer's nor most other types of dementia have a cure. Doctors focus treatments on managing symptoms and keeping the disease from getting worse. 

Some of the treatments for dementia and Alzheimer's overlap. The common treatments are: (1) Cholinesterase inhibitors that can help with memory loss in certain types of dementia and Alzheimer's, (2) Glutamate inhibitors help with learning and memory in both dementia and Alzheimer's, (3) Sleep medications may help with sleep changes, (4) Antidepressants can help with depression symptoms, and (5) Antipsychotic medications may help with behavior changes.
Some types of dementia respond to treatment, depending on what is causing it. Your doctor may recommend: (1) Stopping the use of drugs and alcohol, (2) Tumor removal, if any, (3) Treating a B12 deficiency, (4) Treating hydrocephalus (extra fluid on the brain),(5) Getting blood sugar under control, and (6) Thyroid medication.

References:
1. Lakhan SE, Chawla J. Alzheimer disease. https://emedicine.medscape.com/article/1134817-overview
2. AAIC 2018. First practice guidelines for clinical evaluation of Alzheimer's disease and other dementias for primary and specialty care. https://www.alz.org/aaic/downloads2018/Sun-clinical-practice-guidelines.pdf
3.  Dementia fact sheet. (2016, April).Retrieved from who.int/mediacentre/factsheets/fs362/en
4. Symptoms of dementia. (2015, June 17). Retrieved from nhs.uk/Conditions/dementia-guide/Pages/symptoms-of-dementia.aspx