Dementia Vs Alzheimer’s Disease: Understanding The Conditions

Dementia Vs Alzheimer’s

Understanding the distinction between dementia and Alzheimer’s disease is akin to navigating the intricate tapestry of cognitive disorders. Dementia serves as the overarching term, a broad category that encompasses a range of neurological conditions characterised by a decline in memory, reasoning, and other thinking skills that significantly impede daily life.

Key difference between Alzheimer’s Disease Vs Dementia

Alzheimer’s disease, on the other hand, stands as the most common cause of dementia, accounting for an estimated 60-80% of cases. It’s a specific illness that not only affects memory but also gradually erodes the ability to carry out the simplest tasks. Delving into the nuances between these two terms illuminates the complexity of brain health and underscores the importance of accurate diagnosis and tailored approaches to care.

What Is Dementia?

Dementia is a collective term used to describe a variety of neurological conditions that affect the brain, leading to a progressive decline in cognitive function beyond what might be expected from normal ageing. This decline is severe enough to interfere with daily life, affecting memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. However, consciousness is not impaired. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation.

From a biological standpoint, dementia is the result of damage to neurons and their connections in the brain. Depending on the area of the brain affected, the symptoms can vary widely among individuals. For instance, damage to the hippocampus, the region of the brain essential for memory formation, is often seen early in dementia, leading to the characteristic memory loss associated with the condition.

In 2022 alone, Dementia was one of the most common health concerns in Australia. An estimated 401,300 Australians were living with dementia, and about 63% of dementia patients were women.

Symptoms of Dementia

Symptoms of Dementia in stages

Dementia symptoms vary depending on the cause and the area of the brain that’s affected, but they generally follow a trajectory from early, subtle signs to more severe impairments as the condition progresses. Here’s an overview from early to progressive symptoms:

Early Signs & Symptoms Of Dementia

Early symptoms of dementia can be subtle and may not immediately disrupt daily life. They include:

  • Memory Loss
    Difficulty recalling recent events, appointments, or conversations, which is more than just occasional forgetfulness.
  • Difficulty with Familiar Tasks
    Struggling to complete routine tasks that the person has performed many times before, such as cooking a meal or using a household appliance.
  • Language Problems
    Difficulty finding the right words during a conversation or reading and writing.
  • Changes in Mood and Personality
    Experiencing mood swings, depression, or becoming easily upset in situations that wouldn’t have previously caused a reaction.
  • Disorientation
    Losing track of the date or time of day, or getting lost in familiar places.
  • Poor Judgement
    Showing a lack of judgement in decisions, like wearing inappropriate clothing for the weather.

Intermediate Symptoms of Dementia

As dementia progresses, symptoms become more pronounced and begin to interfere with the individual’s independence:

  • Increased Memory Loss
    Forgetting details about current events, personal history, and even recognising close family members.
  • Difficulty with Complex Tasks
    Struggling with planning or solving problems, which may manifest in managing finances or following a recipe.
  • Communication Difficulties
    Significant problems with language, such as frequent pausing, inventing new words to describe familiar objects, or repeating phrases.
  • Visuospatial Problems
    Difficulty judging distance or seeing objects in three dimensions; navigating stairs or parking the car becomes challenging.
  • Wandering and Getting Lost
    May wander off and get lost, even in familiar settings.
  • Misplacing Items
    Putting items in unusual places, such as keys in the fridge, and being unable to retrace steps to find them.

Advanced Symptoms of Dementia

In the late stages, the symptoms of dementia significantly affect the person’s ability to function independently:

  • Severe Memory Loss
    Including loss of recognition of friends and family members.
  • Significant Physical Decline
    Difficulty with movement and coordination, needing assistance with daily activities such as dressing, eating, and personal care.
  • Communication Loss
    Eventually, the person may lose the ability to speak or communicate clearly.
  • Behavioural Changes
    May include aggression, agitation, or inappropriate behaviour.
  • Loss of Awareness of Environment
    Becoming less aware of what’s happening around them, including time and place.
  • Increased Susceptibility to Infections
    Especially prone to pneumonia in the later stages.

As dementia progresses, the focus of care shifts towards providing support and comfort, managing symptoms, and maintaining quality of life through personalised care plans, which may include medical management, environmental adjustments, and support for carers.

What Is Alzheimer’s Disease?

Alzheimer’s disease is a progressive neurological disorder that is the most common cause of dementia, characterising a gradual decline in cognitive function and memory. It predominantly affects individuals over the age of 65, though early-onset Alzheimer’s can occur in younger people.

Scientifically, Alzheimer’s disease is characterised by two hallmark abnormalities in the brain: amyloid plaques and tau tangles.

Amyloid Plaques

Amyloid plaques are a hallmark abnormality associated with Alzheimer’s disease, crucial to its pathogenesis and progression. These plaques consist of dense deposits of a protein fragment called beta-amyloid (Aβ) that accumulate extracellularly in the brain tissue. Beta-amyloid is derived from the larger amyloid precursor protein (APP), which is normally present on neuron surfaces. In Alzheimer’s disease, APP is abnormally processed by enzymes, leading to the accumulation of Aβ fragments.

The formation of amyloid plaques is thought to disrupt cell-to-cell communication at synapses, contribute to inflammatory responses in the brain, and initiate a cascade of neural damage and death. This disruption affects the brain’s ability to process and store information, leading to the cognitive decline and memory loss characteristic of Alzheimer’s disease.

Simply put, imagine your brain as a bustling city, where neurons (brain cells) are like houses, and the connections between them are roads. In Alzheimer’s disease, something goes wrong with the waste disposal system, leading to piles of rubbish (amyloid plaques) accumulating around the houses and blocking the roads. 

These piles of rubbish are made from a sticky protein called beta-amyloid, which normally floats around without causing any trouble. However, in Alzheimer’s, this protein sticks together in clumps outside the neurons, forming what we call amyloid plaques.

These plaques are a bit like having heaps of rubbish blocking the city streets: they get in the way of the brain cells communicating with each other, making it hard for messages to get through. This blockage can lead to the brain cells getting damaged and eventually dying, which is why people with Alzheimer’s start to forget things and have trouble thinking clearly. The build-up of these plaques is one of the first signs that the brain is under attack from Alzheimer’s, and it happens long before any symptoms like memory loss start to show.

Tau Tangles

In Alzheimer’s disease, alongside the notorious amyloid plaques, there’s another troublemaker at play called tau tangles. Imagine the inside of our brain cells as a well-organised railway network, where tracks (microtubules) guide nutrients and essential materials to their destinations. Tau is a protein that acts like the sleepers on railway tracks, maintaining their straight and functional structure.

However, in Alzheimer’s disease, tau starts behaving oddly. Instead of supporting the tracks, it begins to detach and clump together with other tau proteins, forming what we call tau tangles. These tangles disrupt the railway system within the cell, leading to a breakdown in the transport of essential nutrients and messages. Without these vital supplies and communications, brain cells eventually deteriorate and die.

The spread of tau tangles throughout the brain follows a predictable pattern, and as they reach different regions, they affect various cognitive functions such as memory, language, and reasoning. This progression of tau tangles is closely linked with the worsening of Alzheimer’s symptoms. In essence, if amyloid plaques are considered a cause of traffic jams in the city (brain), tau tangles are like sabotaging the city’s railway system, causing widespread disruption to its essential functions.

What Are the Signs and Symptoms of Alzheimer’s Disease?

The known signs and symptoms of Alzheimer’s Disease

Alzheimer’s disease unfolds in a gradual manner, with its signs and symptoms evolving from mild forgetfulness to severe cognitive and physical impairments. The journey from early onset to the progressive stages can significantly vary from person to person, but typically follows a general pattern:

Early Onset Alzheimer’s

  • Memory Loss
    One of the earliest signs is forgetting recently learned information, important dates or events, and increasingly needing to rely on memory aids (like reminder notes or electronic devices) or family members for things they used to handle on their own.
  • Difficulty in Planning or Solving Problems
    Some may experience changes in their ability to develop and follow a plan or work with numbers. They may struggle with following a familiar recipe or keeping track of monthly bills.
  • Difficulty Completing Familiar Tasks
    Daily tasks at home, at work, or during leisure activities become challenging. This could include navigating to a familiar location, managing a budget at work, or remembering the rules of a favourite game.
  • Confusion with Time or Place
    Losing track of dates, seasons, and the passage of time. They may have trouble understanding something if it’s not happening immediately. Sometimes, they may forget where they are or how they got there.
  • Trouble Understanding Visual Images and Spatial Relationships
    For some, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance, and determining colour or contrast, which may cause problems with driving.

Mid-Stage (Progressive) Symptoms of Alzheimer’s

  • Increased Memory Loss and Confusion
    Forgetting significant events or the names of close friends and family, potentially withdrawing from social situations due to these lapses.
  • Difficulty with Language
    Struggling to follow or join a conversation, stopping in the middle of a conversation and not knowing how to continue, or repeating themselves.
  • Poor Judgement
    Experiencing changes in judgement or decision-making, such as paying less attention to personal grooming or being easily fooled or taken advantage of.
  • Changes in Mood and Personality
    Becoming confused, suspicious, depressed, fearful, or anxious. They may be easily upset at home, with friends, or when out of their comfort zone.

Late Stage Signs of Alzheimer’s

  • Severe Memory Loss
    In the late stages, individuals may lose the ability to hold a conversation, respond to their environment, or control movement. Communication becomes minimal and eventually non-existent.
  • Physical Difficulties
    Experiencing trouble walking, sitting, and eventually swallowing. The muscle mass can waste away, leading to being bedridden.
  • Complete Dependence on Others
    In the final stage, individuals need round-the-clock assistance with daily personal care.

Treatments in Dementia Vs Alzheimer’s Disease

With similarities and differences between dementia and Alzheimer’s disease, are there any differences in the treatments? 

The treatment of dementia and Alzheimer’s disease involves nuanced approaches, reflecting the underlying causes and specific symptoms of each condition. While Alzheimer’s disease is the most common cause of dementia, dementia itself is a broader term that encompasses a range of neurological conditions, each with its own causes and treatment strategies. Let’s explore the differences in treatments for dementia and Alzheimer’s, using a scientific lens.

Treatments for Alzheimer's Disease

Alzheimer’s treatments focus on managing symptoms and, in some cases, attempting to slow the progression of the disease. There is currently no cure for Alzheimer’s, but there are medications and non-pharmacological approaches designed to help manage its symptoms. 

That being said, the treatments for Alzheimer’s disease and dementia, while aiming to manage symptoms and improve quality of life, come with their own set of risks and side effects. These may vary depending on the specific medications and approaches used. 

Cholinesterase Inhibitors
Drugs such as donepezil, rivastigmine, and galantamine increase levels of acetylcholine in the brain, a neurotransmitter involved in memory and judgement. By enhancing communication between nerve cells, these medications can modestly improve symptoms or slow down their progression.

Side effects can include nausea, vomiting, diarrhoea, muscle cramps, and an increased risk of heart block in people with heart problems.  There are also associated risks of overstimulation of  parasympathetic nervous system, such as increased hypermotility, hypersecretion, bradycardia, miosis, diarrhoea, and hypotension, may be present

NMDA Receptor Antagonists
Memantine works by regulating the activity of glutamate, another neurotransmitter involved in learning and memory. It can help slow the progression of symptoms in moderate to severe cases of Alzheimer’s.

Common side effects include:

  • Dizziness and headaches, which can affect one’s balance and concentration.
  • Constipation, which might necessitate dietary adjustments or the use of laxatives.
  • Confusion, particularly in the initial stages of treatment, which may temporarily worsen symptoms.
  • Elevated blood pressure, necessitating regular monitoring.
  • Drowsiness, affecting one’s ability to operate machinery or drive.

Comprehensive Management Strategies
Non-drug approaches include cognitive therapy, physical activity, social engagement, and nutritional advice. These strategies aim to improve quality of life and may help preserve cognitive function for longer.

Treatments for Other Types of Dementia

Treatment strategies for other types of dementia depend on the specific cause:

Vascular Dementia
Managing underlying conditions such as hypertension, diabetes, and high cholesterol is critical to slow the progression of vascular dementia. Lifestyle modifications and medications to control blood pressure, cholesterol, and blood sugar levels are common treatments.

Medication treatments for Vascular Dementia may have side effects such as kidney damage, liver damage, gastrointestinal issues, dizziness, and an increased risk of falls, especially in the elderly. With the known risks, it is very important to consult with healthcare professionals to get the most suited medications for the condition.

Lewy Body Dementia
This type of dementia may respond to cholinesterase inhibitors similarly to Alzheimer’s. However, patients with Lewy Body Dementia can have severe reactions to certain antipsychotic medications, so treatment requires careful management. Medications may also be used to manage symptoms like movement difficulties or hallucinations.

Frontotemporal Dementia
There are no specific drugs approved for frontotemporal dementia. Treatment focuses on managing symptoms, with speech and language therapy for communication problems, and sometimes antidepressants or antipsychotics to address behavioural changes.

Parkinson’s Disease Dementia
Cholinesterase inhibitors can also be beneficial in managing cognitive symptoms associated with Parkinson’s disease dementia. Treatment also includes medications and therapies to manage Parkinson’s motor symptoms. But it is also important to note that common medications used to treat Parkinson’s Disease Dementia may have these side effects: 

  • Nausea
  • Dizziness
  • Orthostatic hypotension (a sudden fall in blood pressure when standing up), hallucinations, and increased risk of confusion.

Tailoring Dementia Treatment: Specific Approaches for Different Types

While there are commonalities in the treatment of different types of dementia, such as the use of cholinesterase inhibitors in Alzheimer’s, Lewy Body Dementia, and Parkinson’s Disease Dementia, the key difference lies in the tailored approach based on the underlying cause. Alzheimer’s treatments specifically target its hallmark symptoms and attempt to modify its progression, whereas treatments for other dementias focus more on managing the broader spectrum of symptoms and underlying conditions.

For all types of dementia, including Alzheimer’s, non-pharmacological interventions play a crucial role in managing the disease. These include cognitive stimulation, physical activity, dietary modifications, and social engagement, which can help improve quality of life and functionality.

Written by

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.

Written by

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.

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