Expert: Mary Gordon - 6/10/2007

Question
Are alzheimer's disease and dementia the same thing? My mother is 83 and for the last seven years years her memory has been failing.  Her physician has given her some kind of pill to take to help this. She lives with my brother who is a vietnam vet and is legally blind but who still sees enough to take care of mom. Mostly, she just lays on the couch and watches television or sits at the table and smokes.  She has smoked since she has been  a teen. She weighs only 88 lbs, but was diagnosed with hyper-thyroid some years back and had to eventually get a radio-active pill created especially for her height, weight, which killed the thyroid and now she just take meds to keep it normal. My brother does most everything around the apartment and pays of their bills, plus cooks, does the laundry, etc. He is very good to her.  I try to get mother out a day each week and always take her when she has doctors' appointments, etc.  She has two sisters, one 84 and one who  77 visit her and sometimes take her with them when they go somewhere. If mother would get outside of her apartment complex, my brother says she would get lost.  He let her take the trash out once because she kept wanting to, but he watched her out of the window and she didn't seem to know how to get back to the house after she put the trash in the can.  She doesn't remember her grandchildren and great-grandchildren's names most of the time  and will ask who I am talking about when I bring them up, but when I explain who they are, then she remembers them. This started around eight years ago.  I wonder if she really does have Alzheimer's or if it is just dementia. When we go somewhere she usually always wears the same outfit and my brother has been having trouble getting her to take a bath lately.  She takes sponge baths at the sink though.  Her memory is great from back when she was growing up and of times like that.  She can sing so many of the old songs and sings them when we go somewhere together in the car.  Her personality stays the same, she is always pleasant to be around and appreciative.  Sometimes, she notices my brother trying to
which she thinks is overprotect her and complains a little bit, but that is all. Do you think my mother has Alzheimer's?  

Answer
Hi Connie,

Dementia is a word like fever. It describes a symptom - not what is CAUSING the symptom. If you went to a doctor because you have a fever, you want a diagnosis - which is not that you have a fever (thanks Doc, but I already KNOW I'm running a fever). What you want to know is why, what is causing it, is there anything that can be done to help?

Dementia just means a person is cognitively impaired - they may have memory problems, be confused, have impaired judgement, etc. etc. Any number of specific diseases can cause dementia. For example, having a series of small strokes can leave you with brain damage that affects your mind - that is called vascular or multi-infarct dementia.  You can develop dementia from Vitamin B12 deficiency, from thyroid problems, from forms of hydrocephalus (water on the brain), from Parkinson's disease, from lung diseases that reduce the oxygen getting to your brain.

Alzheimer's Disease is just one cause of dementia among dozens and dozens. Here is a good overview of some of the many types of illnesses that can impact a person's mind.
http://www.emedicinehealth.com/dementia_overview/page2_em.htm

Another thing to keep in mind is that there is no such thing as a disease called "senility". "Senility" just means, old and confused. It is not normal to become demented just because of age - it is always, always caused by something - so dementia or senility is NOT a diagnosis. It just means the older person happens to have some sort of brain impairment from something.

Its impossible to say if your mother has dementia from Alzheimer's or from something else - this is something to discuss with her doctor. I presume she is on Aricept or something similar. All this kind of drug does is slow down the progress in some people. Her symptoms do sound fairly typical for Alzheimer's - most of them do lose their memory from in reverse order. My mother in law actually got to the point where she forgot she was ever married. She'd give her maiden name if you asked her who she was, and she asked about her long dead parents all the time, and wanted to go home to them.  Her memories of her young life were very vivid and intact, although with time, those went as well.

Your mother does have some type of progressive, incurable dementia causing illness - and so its time to make some plans for the future, because your legally bind brother is not going to be able to look after her alone much longer.

Below my signature, I have pasted the stages of Alzheimer's. Most of the other common diseases that cause progressive dementia follow a similar pathway. If you read these, you will see that she is in Stage 6. What comes next may be beyond a son's ability to cope with - she will need supervision and support with personal hygiene and dressing, and she will become incontinent.

Ultimately, she will not be able to walk or talk either, feed herself or do anything for herself. Its not possible to say just when these things will happen, but you do need to have a plan (i.e. have looked at your options, the costs, the pros and cons, and some idea which you prefer). Its important to have plan ready to go, so if tomorrow your brother gets sick, or she stops being able to use the bathroom alone and he can't cope with incontinence, you aren't in a crisis.

Because of the wandering, if there is any chance she might get out on her own, you might want to get her registered with the local Alzheimer's Association or the police as a potential "wanderer". Most places have some sort of program (i.e. they keep information on the person on file, including a description, a photo, contact and address info, so its ready to go in case the person gets out and gets lost). A medical alert bracelet saying the person is memory impaired also helps, since if she got lost, they can trace her family through the bracelet - she is unlikely to be able to tell anyone where she lives or who to call. Another idea is to iron name tags in her clothing with her name and a family members phone number.

Hope this helps

Mary G.

Stages of Alzheimers

In 1982 Dr. Barry Reisberg published what was to become the best and most widely accepted description of the stages of Alzheimer's disease. Even today, years later, when experts refer to a person being in stage 5 or stage 6, they are referring to Dr. Reisberg's scale of seven stages.

Adapted from Reisberg, B., Ferris, S.H., Leon, J.J.