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Is it Forgetfulness, Dementia, or Alzheimer's Disease?

You are intent on going somewhere for a meaningful purpose. But when you reach your destination, you can't recall why you needed to be there. Could this common occurrence be caused by age-related forgetfulness, a distraction that detoured your brain while you were multi-tasking, or dementia?

The Centers for Disease Control and Prevention explains, "As we age, our brains change, but Alzheimer's disease and related dementias are not an inevitable part of aging. Up to 40 percent of dementia cases may be prevented or delayed. It helps to understand what's normal and what's not when it comes to brain health."

More than 100 different causes of memory and thinking changes exist, and many may have overlapping characteristics, according to Michelle Sorweid, DO, MPH, a geriatric physician and cognitive disorder specialist with the Aging Brain Care Program at University of Utah Health and clinical assistant professor in the Division of Geriatrics at University of Utah.

"Short-term memory loss isn't the only presenting symptom of cognitive impairment," Sorweid says. "Sometimes we might see things like personality changes or even severe depression." Sorweid observes that patients may lack interest in day-to-day activities and things they used to enjoy—and such symptoms could be signs that something is changing in the brain.

Stages of Dementia and Alzheimer's Disease

Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person's daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person's functioning, to the most severe stage, when a person must depend completely on others for basic activities of daily living. Alzheimer's disease is the most common cause of dementia among older adults.

If you or a loved one are experiencing memory loss, confusion, or changes in language, mood, or personality, you may:

  • Ask the same questions repeatedly
  • Forget or mix up words
  • Take longer to complete familiar tasks
  • Get lost while walking or driving in a familiar area, or
  • Lose or misplace items

Short-term memory problems are typically one of the first signs of Alzheimer's disease. A decline in other aspects of thinking, such as finding the right words, vision/spatial issues, and impaired reasoning or judgment, may also signal the very early stages of Alzheimer's disease.

In later stages, severe Alzheimer's disease symptoms include:

  • Loss of language and ability to communicate,
  • Loss of bladder or bowel control,
  • Weight loss,
  • Seizures,
  • Difficulty swallowing, and
  • Inability to complete common tasks that were once familiar

Cognitive Testing

A cognitive disorders specialist can evaluate the degree to which cognitive decline may be affecting your life or the life of a loved one. During an initial evaluation, it will be helpful for you to be accompanied by a family member, friend, or caregiver who knows you well.

The following tests are used to make cognitive diagnoses:

  • Magnetic resonance imaging (MRI) uses a computer, radio frequency, and magnetic field to create pictures of the inside of your body. MRIs may reveal abnormalities in different areas of the brain, indicating cognitive impairment associated with Alzheimer's disease.
  • Positron emission tomography uses small amounts of radioactive dye to see inside your body and help identify plaques in the brain that are indicators of Alzheimer's disease.
  • Neuropsychological testing uses a variety of tests to assess memory, reasoning, problem-solving, and other functions. You may be asked to answer questions, write, draw, or respond to items on a computer.

Differential Diagnoses

Sorweid emphasizes the importance of an accurate workup and diagnosis. She recalls a patient in the hospital for severe memory changes who also had harmful thoughts about herself. When the patient was discharged, she was informed she had dementia. "When she came to see us, we discovered that she was just severely depressed," Sorweid says. "And she was doing well functionally after receiving treatment for her depression. She did not have dementia; she had severe depression."

Sorweid notes that other symptoms such as high blood pressure, diabetes, high cholesterol, abnormal heart rhythms, smoking, and sleep apnea related to memory and thinking changes can be treated to prevent further decline. These risk factors should be addressed early on to prevent dementia later in life.

"Not all memory and thinking changes equate to Alzheimer's disease or a dementia process," Sorweid says. "Those are certainly possibilities, and the earlier we know what's happening, the more we can do to make an impact on someone's quality of life." For this reason, Sorweid encourages families and patients to seek cognitive screening assessments as early as possible.