Which is Worse: Dementia or Alzheimer’s?

Imagine your elderly mother, once sharp as a tack, now struggling to remember your name or what she had for breakfast. Is it dementia, or is it Alzheimer’s disease? Many people use these terms as if they’re the same, but they’re not. While Alzheimer’s is the most common cause of dementia, accounting for 60-80% of cases, dementia is an umbrella term for a range of conditions that impair cognitive function. 

With 6.7 million Americans living with dementia today and that number projected to nearly triple by 2060, understanding the difference between dementia and Alzheimer’s is critical for anyone with an aging loved one. Getting the correct diagnosis is the first step to accessing appropriate treatment, care, and support services.

Whether you’re concerned about your own brain health or that of a loved one, we’ll arm you with the knowledge you need to face the challenges ahead with greater clarity and confidence. Let’s get started by defining what we mean by “dementia.”

What is Dementia?

Dementia is not a specific disease but rather a syndrome – a group of symptoms that affect cognitive function. It’s characterized by a decline in memory, language, problem-solving, and other thinking skills that interfere with a person’s ability to perform everyday activities independently. 

While dementia is more common in older adults, it is not a normal part of the aging process. It’s caused by damage to brain cells that affects their ability to communicate with each other. This damage can accumulate over time, leading to progressively worsening symptoms.

Key characteristics of dementia include:

• Gradual onset and progressive worsening of symptoms.
• Impairment in two or more cognitive domains (e.g., memory, language, judgment).
• Decline severe enough to interfere with daily functioning and independence.
• Changes in mood, behavior, and personality.

What is the worst type of dementia? There is no single dementia that is “the worst.” There are several different types of dementia, each with its own unique features and underlying causes. The most common types include:

• Alzheimer’s disease
• Vascular dementia
• Lewy body dementia  
• Frontotemporal dementia
• Mixed dementia (a combination of two or more types)

Understanding what sets Alzheimer’s apart from other types of dementia is an important first step in getting an accurate diagnosis and appropriate care.

Understanding Alzheimer’s Disease

Alzheimer’s disease is a progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out simple tasks.

What Happens in the Alzheimer’s Brain?

In Alzheimer’s disease, abnormal deposits of proteins form amyloid plaques and tau tangles throughout the brain. These plaques and tangles disrupt the normal function of brain cells, causing them to lose their connections with other cells and eventually die.

The damage typically starts in the brain region responsible for forming new memories, which is why memory loss is often one of the first symptoms of Alzheimer’s. What triggers Alzheimer’s to get worse is the progression of damage that spreads to other parts of the brain that control language, reasoning, and social behavior.

What Makes Alzheimer’s Worse?

While the exact cause of Alzheimer’s is not fully understood, several risk factors are thought to increase the risk of developing the disease:

• Age: The greatest risk factor for Alzheimer’s is advancing age. Most people with the disease are 65 or older, with less than 10% occurring before then.
• Family history: People with a parent or sibling with Alzheimer’s are 30% more likely to develop the disease.
• Genetics: Certain genes, particularly the APOE-e4 gene, which is carried by about 25% of the population, have been linked to an increased risk of Alzheimer’s.
• Head injuries: Traumatic brain injury (TBI), particularly repeated concussions, have been linked to a higher risk of dementia.
• Heart health: Conditions that damage the heart and blood vessels, such as high blood pressure, high cholesterol, and diabetes, may increase the risk of dementia.
• Lifestyle factors: Research suggests that a healthy lifestyle, including regular exercise, a balanced diet, and staying socially and mentally active, may help reduce the risk of cognitive decline and dementia.

Symptoms and Stages of Alzheimer’s

Alzheimer’s disease typically progresses slowly in three general stages:

1. Early (mild) stage: 

• Memory problems, such as difficulty remembering the right words
• Taking longer to complete normal daily tasks
• Losing or misplacing valuable objects
• Increasing trouble with planning or organizing

2. Middle (moderate) stage:

• Increased memory loss and confusion
• Difficulty recognizing family and friends 
• Start to develop paranoia
• Impulsive behavior or poor judgment
• Experiencing hallucinations
• Changes in sleep patterns and wandering

3. Late (severe) stage:

• Severe memory loss; may not recognize close family members
• Loss of ability to communicate coherently
• Difficulty swallowing and controlling bladder and bowel function  
• No awareness of recent experiences or surroundings
• Inability to communicate

It’s important to note that the progression of Alzheimer’s varies from person to person, and not everyone will experience all of these symptoms. Make sure to be on the watch for signs of dementia worsening.

Comparing Dementia and Alzheimer’s

While Alzheimer’s disease is the most common cause of dementia, it’s important to understand that not all dementia is due to Alzheimer’s. There are several key differences between dementia and Alzheimer’s:

• Dementia is an umbrella term for a group of symptoms affecting cognitive function, while Alzheimer’s is a specific brain disease that causes dementia.
• Each type of dementia has some distinct features and symptoms. For example:
  • Vascular dementia: Is vascular dementia fatal? While not immediately so, it can be life-threatening over time as complications like strokes and infections worsen its progression, which is caused by reduced blood flow to the brain and often progresses in noticeable steps rather than a gradual decline.
  • Lewy body dementia is characterized by visual hallucinations, Parkinson’s-like symptoms, and REM sleep behavior disorder.
  • Frontotemporal dementia primarily affects behavior, personality, and language rather than memory.  
• Some types of dementia, such as those caused by vitamin deficiencies, medication side effects, or infections, may be reversible with treatment. Alzheimer’s is not reversible.

Getting a Diagnosis

If you or a loved one is experiencing cognitive impairment, memory problems, or noticing signs of dementia worsening, it’s important to see a doctor for a thorough evaluation. Early diagnosis allows for better planning and access to treatments that may help manage symptoms effectively.

The diagnostic process typically involves:

• A detailed medical history and neurological exam.
• Cognitive assessments to test memory, language, problem-solving, and other mental skills.
• Brain imaging (CT or MRI) and lab tests to rule out other potential causes.
• In some cases, biomarker tests for Alzheimer’s (though these are not widely available).

While there is no single test that can definitively diagnose Alzheimer’s or other dementias, a combination of assessments can help doctors determine the most likely cause with a high degree of accuracy. An accurate diagnosis is essential for getting the right treatment and support.

Treating Dementia and Alzheimer’s

Although there is currently no cure for Alzheimer’s or most other types of dementia. Treatments are available to help manage symptoms and improve quality of life. These include:

• Medications: Cholinesterase inhibitors (such as Aricept, Exelon, and Galantamine) and memantine (Namenda) can temporarily improve memory and thinking in some people with Alzheimer’s.
• Non-drug therapies: Cognitive stimulation, exercise programs, and activities that promote social engagement and mental stimulation may help delay cognitive decline.
• Treating underlying causes: In some cases, treating conditions such as depression, medication side effects, or vitamin deficiencies can improve dementia symptoms.
• Caregiver education and support: Learning what makes dementia worse, how to communicate effectively, and strategies for managing challenging behaviors can greatly improve the quality of life for both the person with dementia and their caregivers.

Supporting Loved Ones with Dementia or Alzheimer’s 

Caring for someone with dementia or Alzheimer’s can be emotionally and physically challenging. If you’re a caregiver, remember that you’re not alone and that taking care of yourself is essential, too. Some tips:

• Educate yourself about the disease and what to expect as it progresses. 
• Build a support network of family, friends, and local resources such as support groups and respite care services.
• Communicate with patience, compassion, and respect. Focus on their feelings rather than correcting facts.  
• Create a safe, structured environment with familiar routines and activities promoting purpose and accomplishment.
• Plan for the future, including legal, financial, and long-term care decisions. Consider consulting with an elder law attorney or financial planner.

Remember, no one should face these challenges alone. Don’t hesitate to seek help and support when you need it.

The Path Forward: Advancing Dementia Research and Care

While the impact of Alzheimer’s and other dementias can feel overwhelming, there are reasons for hope. Scientists worldwide are working tirelessly to unravel the complex causes of these diseases and develop new treatments.

While we may not yet have all the answers, by working together and supporting ongoing research and care initiatives, we can make a meaningful difference in the lives of those affected by dementia and Alzheimer’s. 

As a society, we must continue to prioritize brain health, advocate for policies that support individuals and families facing these diseases, and fight the stigma that still surrounds dementia. With knowledge, compassion, and a commitment to progress, we can face this challenge head-on and build a brighter future for all those touched by Alzheimer’s and dementia.