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Health

Understanding and Coping with Dementia

Written by Allan Bowditch, Chief Communications Officer Engage Estero

Understanding the Difference:
Alzheimer’s Disease vs Dementia

Dementia is a collective term that refers to various symptoms affecting cognitive abilities. At the same time, Alzheimer’s disease is a specific type of dementia characterized by progressive memory loss and cognitive decline.
Other types of dementia exist, each with its distinct causes and characteristics. Dementia is not a normal part of aging. It is caused by damage to brain cells that affects their ability to communicate, which can affect thinking, behavior, and feelings.

Alzheimer’s Disease: A Common Brain Disease in Older Adults

Below is a helpful graphic that indicates the effect on the brain, symptoms, age of onset, diagnosis, and treatment. This graphic covers Alzheimer’s Disease, Frontotemporal Dementia, Lewy Body Dementia, and Vascular Dementia and was produced by The National Institute on Aging1.

While there are some differences between the symptomatology and the conditions, many similarities can make a specific diagnosis difficult. Sadly, given that no current cure is available, many question whether identifying the exact type matters!

View Types of Dementia Chart

Causes

Dementia is caused by a variety of diseases that cause damage to brain cells. These include heart disease, diabetes, stroke, high blood pressure, and high cholesterol. The damage interferes with the ability of brain cells to communicate with each other. Thinking, behavior, and feelings can be affected when brain cells cannot communicate normally. Different types of dementia are associated with particular brain cell damage in specific brain regions. For example, in Alzheimer’s disease, high levels of certain proteins inside and outside brain cells make it hard for brain cells to stay healthy and communicate. The brain region called the hippocampus is the center of learning and memory, and the brain cells in this region are often the first to be damaged. That’s why memory loss is often one of the earliest symptoms of Alzheimer ‘s2.

While most changes in the brain that cause dementia are permanent and worsen over time, thinking and memory problems caused by the following conditions may improve when the condition is treated or addressed:

  • Medication side effects.
  • Excess use of alcohol.
  • Thyroid problems.
  • Vitamin deficiencies.

There is also a hereditary risk involved. Those who have a parent, brother, or sister with Alzheimer’s are more likely to develop the disease. The risk increases if more than one family member has the illness. When diseases tend to run in families, either heredity (genetics), environmental factors, or both may play a role.

However, research reported at the 2019 Alzheimer’s Association International Conference® suggests that adopting multiple healthy lifestyle choices, including a nutritious diet, not smoking, regular exercise, and cognitive stimulation, may decrease the risk of cognitive decline and dementia.

The Signs of Alzheimer’s Disease

Signs of Mild Alzheimer’s disease are:

  • Memory loss that disrupts daily life.
  • Poor judgment, leading to bad decisions.
  • Loss of spontaneity and sense of initiative.
  • Losing track of dates or knowing the current location.
  • Taking longer to complete normal daily tasks.
  • Repeating questions or forgetting recently learned information.
  • Traveling out of the neighborhood.

Problems with:

  • Short-term memory.
  • Keeping track of a purse or wallet.
  • Paying bills.
  • Planning and preparing meals.
  • Remembering appointments.
Dementia symptoms are progressive, which means that the signs of cognitive impairment start slowly and gradually get worse over time, leading to dementia. If you or someone you know is experiencing memory difficulties or other changes in thinking skills, don’t ignore them. See a doctor soon to determine the cause. Professional evaluation may detect a treatable condition. Even if symptoms suggest dementia, early diagnosis allows a person to get the maximum benefit from available treatments and provides an opportunity to volunteer for clinical trials or studies. It also allows time to plan for the future3.

Diagnosis:

To diagnose the cause of dementia, a healthcare professional must recognize the pattern of loss of skills and function. The care professional also determines what the person is still able to do. Recently, biomarkers have become available to make a more accurate diagnosis of Alzheimer’s disease.

No single test can diagnose dementia. You’ll likely need several tests to help pinpoint the problem4.

Cognitive and neuropsychological tests

These tests evaluate your thinking ability. Several tests measure thinking skills, such as memory, orientation, reasoning and judgment, language skills, and attention.

Neurological evaluation

Your memory, language skills, visual perception, attention, problem-solving skills, movement, senses, balance, reflexes, and other areas are evaluated.

Brain scans

CT or MRI. These scans can check for evidence of stroke, bleeding, tumor, or fluid buildup, known as hydrocephalus.

PET scans can show patterns of brain activity and determine whether amyloid or tau protein, indicators of Alzheimer’s disease, has been deposited in the brain.

Laboratory tests

Simple blood tests can detect physical problems affecting brain function, such as too little vitamin B-12 or an underactive thyroid gland. The spinal fluid is sometimes examined for infection, inflammation, or markers of degenerative diseases.

Psychiatric evaluation

A mental health professional can determine whether depression or another mental health condition is contributing to your symptoms.

Can Dementia Be Treated?

While there is no cure for dementia, there are options to manage the symptoms that can be considered. The following are used to improve dementia symptoms temporarily.
Cholinesterase inhibitors boost levels of a chemical messenger involved in memory and judgment. They include donepezil (Aricept, Adlarity), rivastigmine (Exelon) and galantamine (Razadyne ER). Although primarily used to treat Alzheimer’s disease, these medicines might also be prescribed for other dementias, such as vascular dementia, Parkinson’s disease dementia, and Lewy Body dementia.

 

Memantine. Memantine (Namenda) works by regulating the activity of glutamate. Glutamate is another chemical messenger involved in brain functions such as learning and memory. Memantine is sometimes prescribed with a cholinesterase inhibitor.

In 2023, the U.S. Food and Drug Administration (FDA) approved lecanemab (Leqembi) for people with mild Alzheimer’s disease and mild cognitive impairment due to Alzheimer’s disease. A phase 3 clinical trial found that the medicine slowed cognitive decline in people with early Alzheimer’s disease. The medicine prevents amyloid plaques in the brain from clumping. The phase 3 trial was the largest to study whether clearing clumps of amyloid plaques from the brain can slow the disease. Lecanemab is given as an IV infusion every two weeks5.

medications

Are you caring for someone with Dementia / Alzheimer’s Disease?

There is no question that aside from the person suffering from this disease, the impact on family members cannot be underestimated. Millions of people living in the United States take care of a friend or family member with Alzheimer’s disease or related dementia. Sometimes, caregivers live with the person or nearby; other times, they live far away. For many families, caring for a person with dementia isn’t just one person’s job but the role of many people who share tasks and responsibilities.

Tips for Caring for a Loved One with Dementia

Here are some tips to consider early on and as the disease progresses. More information can be found relating to this topic at https://www.alzheimers.gov/life-with-dementia/tips-caregivers

Routine

Try to keep a routine, such as bathing, dressing, and eating simultaneously daily.

Records

Help the person write to-do lists, appointments, and events in a notebook or calendar.

Joy

Plan activities that the person enjoys and try to do them simultaneously each day.

Reminders

Consider a system or reminders for helping those who must take medications regularly.

Activity

When dressing or bathing, allow the person to do as much as possible.

Accessibility

Buy loose-fitting, comfortable, easy-to-use clothing, such as clothes with elastic waistbands, fabric fasteners, or large zipper pulls instead of shoelaces, buttons, or buckles.

Safety

Use a sturdy shower chair to support a person who is unsteady and to prevent falls. You can buy shower chairs at drug stores and medical supply stores.

Expectations

Tell the person what you will do, step by step, while you help them bathe or dress.

Consistency

Serve meals in a consistent, familiar place and give the person enough time to eat.

Gentleness

Be gentle and respectful.

Caring for the Cregiver

Being a caregiver can be overwhelming as well as rewarding. Caring for a person with Alzheimer’s or related dementia takes time and effort. It can feel lonely and frustrating. You might even feel angry, a sign you are trying to take on too much. It is important to find time to take care of yourself. Here are some tips that may offer some relief:

Ask for help when you need it. This could mean asking family members and friends for help or contacting local services for additional care.

  • Eat nutritious foods, which can help keep you healthy and active for longer.
  • Join a caregiver’s support group* online or in person. Meeting other caregivers will allow you to share stories and ideas and help keep you from feeling isolated.
  • Take breaks each day. Try making a cup of tea or calling a friend.
  • Spend time with friends and keep up with hobbies.
  • Get exercise as often as you can. Try doing yoga or going for a walk.
  • Try practicing meditation. Research suggests that practicing meditation may reduce blood pressure, anxiety, depression, and insomnia.
  • Consider seeking help from mental health professionals to help you cope with stress and anxiety. Talk with your doctor about finding treatment.

*Local Support Group Options
Lee Health hosts an Alzheimer’s Caregiver Support Group
The Dubin Center organizes Caregiver Support Groups
The Alzheimer’s Support Network (Collier County) offers Support Groups

 

Residential Care

At some point, the issue of deciding on residential care is bound to arise. The questions below may be helpful when determining if a move to residential care is a good option:
Is the person with dementia becoming unsafe in their current home?

Is the health of the person with dementia or the caregiver’s health at risk?

Are the person’s care needs beyond the caregiver’s physical abilities?

Suppose the patient’s safety is at risk and their needs are no longer being met. In that case, if a caregiver is struggling to keep up with their needs, and their mental and physical health begins to suffer, then residential memory care is a potential solution. But, long-term memory care in Florida could cost more than $100,000 annually. On average, receiving residential Alzheimer’s care in Florida is around $8,349 per month. Guidance on what options exist regarding various ways to cover the costs of care can be found on the Alzheimer’s site below:

https://www.alz.org/help-support/caregiving/financial-legal-planning/paying-for-care

The Latest News

Diagnosing Alzheimer’s before symptoms emerge could allow yet-to-be-developed treatments to prevent the memory loss, diminished judgment, and eventual dependence the disease causes. Doctors diagnose many diseases, including diabetes and cancer, with tests on asymptomatic people. But how many of those with amyloid in the brain (most of whom will also have tau deposits) will eventually develop dementia? “The answer, unfortunately, is it depends,” Dr. Jack said. Dr Jack is the working group chair and an Alzheimer’s researcher at the Mayo Clinic. The Mayo Clinic Study of Aging followed nearly 5,000 cognitively normal older adults in one Minnesota county for an average of 9.4 years. It found high rates of dementia among those who carried the APOE4 gene, which is associated with an increased risk of Alzheimer’s. However, some do not consider this to be definitive6.

Dr. Jason Karlawish, a geriatrician and co-director of the Penn Memory Center in Philadelphia, said he considers amyloid “a risk factor, in the way smoking is a risk factor for cancer. “But I think the evidence remains not yet clear and convincing that amyloid alone defines Alzheimer’s disease.”

Two major studies of amyloid-reducing drugs in cognitively normal people, expected to conclude in 2027 and 2029, might provide such evidence if they can demonstrate that removing amyloid prevents, arrests, or reverses cognitive decline in that age group.

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Engage Estero is an all-volunteer, nonpolitical, nonprofit Community Engagement Association. We exist to inform citizens of significant community issues and encourage citizen engagement to impact the quality of life in greater Estero favorably.
References

  1. Understanding Different Types of Dementia.

https://www.nia.nih.gov/health/alzheimers-and-dementia/understanding-different-types-dementia

  1. What Is Dementia? https://www.alz.org/alzheimers-dementia/what-is-dementia#causes
  2. Alzheimer’s and Dementia – Alzheimer’s Association.

https://www.alz.org/alzheimers-dementia/what-is-dementia#symptoms

  1. Dementia Diagnosis. The Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-20352019

  1. Dementia Treatment The Mayo Clinic:

https://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-20352019

  1. Healthy, but Diagnosed With Alzheimer’s? New York Times:

https://www.nytimes.com/2024/03/04/health/alzheimers-amyloid-diagnosis.html?te=1&nl=from-the-times&emc=edit_ufn_20240428