Patients and their caregivers at the Alzheimer’s Disease and Memory Disorders Center often ask, “What is the difference between dementia and Alzheimer’s disease?”
The shortest answer is that dementia is an umbrella term for a decline in cognitive function, and Alzheimer’s disease is a specific condition that falls under dementia, though it’s important to understand how we got to these characterizations and when to use the correct term. Over the last five decades, the terms "dementia” and “Alzheimer’s disease” have been used either separately or interchangeably by media and in general conversations, ever since researchers tried to raise awareness about Alzheimer’s disease occurring in the elderly population in the 1970s.
What is dementia?
Dementia is a broad diagnosis based on clinical symptoms associated with a decline in cognitive function, including memory, reasoning, and communication, that is significant enough to impair daily life. Conditions such as Alzheimer's disease, vascular dementia, or Lewy body dementia all fall under this umbrella term.
In the 1970s, clinicians typically used the term dementia to apply to any number of conditions of declining cognitive function. The specific diagnosis of Alzheimer’s disease was only made by the pathologist after a patient died with a clinical diagnosis of dementia and his or her brain was thoroughly examined. Therefore, clinicians used “dementia” as the diagnosis for living patients; pathologists used “Alzheimer’s disease” to describe findings for dead patients.
What is Alzheimer’s disease?
Alzheimer’s disease is a condition that affects specific parts of the brain responsible for cognitive function and is the most common cause of senile dementia.
Since the 1980s, the terminology used for education and advertising has been focused on dementia and its link with Alzheimer’s disease. The public was more familiar with senile dementia than with Alzheimer’s disease at the time, so “dementia” was used to imply Alzheimer’s in media reports. People were more familiar with the term dementia, so clinicians often used that term instead of Alzheimer’s disease to explain to patients and caregivers.
Around this time, Dr. Robert Katzman and other researchers began making great efforts to promote research on Alzheimer’s disease in the growing elderly population. Additionally, the Alzheimer’s Association was established to educate the public about Alzheimer’s disease and care strategies. At the time, however, many patients disliked using the phrase “Alzheimer’s disease” as their diagnosis because it might imply a terminal illness.
Alzheimer’s disease awareness increases
In 1994, former President Ronald Reagan publicly announced his diagnosis of Alzheimer’s disease through a Alzheimer's letter | PBS published in newspapers across the United States. His wife, former First Lady Nancy Reagan, made great efforts to donate money for research and advocate for care afterward. Using the phrase “Alzheimer’s disease” became much more common, and the public has recognized ever since that Alzheimer’s disease is a public health issue in our society.
After this increase in awareness, some patients did not want to use “dementia” as the word to describe their symptoms and preferred the diagnostic term—Alzheimer’s disease. As one of my patients said, the word “dementia” felt demeaning and hurt their feelings.
Treating dementia versus treating Alzheimer’s
Dementia is the diagnostic terminology used to summarize symptoms of cognitive decline and behavioral changes. Dementia has a long list of causes, which are broken down by treatable or reversible causes and primary degenerative causes. In short, there’s not really a treatment for dementia itself, but there are treatment options for symptoms associated with specific types (Alzheimer's, vascular, Lewy body, or other) of dementia.
Alzheimer’s disease is the best known and studied of primary degenerative causes of dementia and is the only one that has FDA-approved treatments. The first medication for Alzheimer’s treatment was approved in 1993, and since then, we’ve made great strides in improving medication to delay symptom onset and help patients live longer with less immediate cognitive decline.
Evolution of diagnostic criteria and changing how we think about dementia
The latest edition of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (commonly referred to as “the DSM”) created new terminology to replace the phrase “dementia.” The terms “mild neurocognitive disorder” and “major neurocognitive disorder” are now preferred by clinicians, as they indicate the wide spectrum of cognitive changes patients may experience.
Major neurocognitive disorder is equivalent to “dementia” when patients exhibit severe cognitive symptoms that make them unable to maintain independent living. When the individual exhibits a mild degree of cognitive impairment and can still carry out independent living tasks, these patients are diagnosed with mild neurocognitive disorder.
With advanced diagnostic tools, Alzheimer’s disease can manifest either as major neurocognitive disorder or as mild neurocognitive disorder. In order words, clinicians can recognize mild cognitive and behavioral symptoms of underlying Alzheimer’s disease in patients before they progress into the dementia stage. Nowadays, we not only have a diagnostic entity – mild neurocognitive disorder due to Alzheimer’s disease – but we also have FDA-approved treatment for this early stage to prevent the future progression into dementia.
Getting help for cognitive decline
If you notice that you or a loved one are experiencing signs of cognitive decline, the Alzheimer’s Disease and Memory Disorders Center can help. We provide a comprehensive evaluation, including the history, physical examination, and neuropsychological testing or imaging of each patient to help identify their specific type and causes of cognitive symptoms. Learn more about the center on our website or speak with your primary care provider about a referral to the clinic.
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