Dementia and Alzheimer’s: They Are Not the Same Thing

I have noticed something over and over again when talking with people about dementia and Alzheimer’s disease. We tend to put the two words together. Someone forgets a name, gets confused, repeats a question, or begins having trouble managing things they used to do easily, and we say, “I think they have dementia.” Or, just as quickly, we say, “I think they have Alzheimer’s.”

But these two words do not mean the same thing. And understanding the difference may help us replace some fear with something much more useful: Understanding.

Let’s start with the simplest explanation I know. Think of dementia as an umbrella.

Dementia is not one particular disease. It is a general term used to describe a decline in memory, thinking, reasoning, language, judgment, or other abilities that becomes significant enough to interfere with everyday life. Under that umbrella are different diseases and conditions that can cause those changes.

Alzheimer’s disease is one of them. In fact, Alzheimer’s is the most common cause of dementia, accounting for an estimated 60–80% of dementia cases. But it is not the only cause. Vascular dementia, Lewy body dementia, frontotemporal dementia, and other conditions can also cause dementia. Sometimes more than one disease is present at the same time.

So, when someone says, “My mom has dementia,” that doesn't necessarily tell us why she is having these changes. And that “why” matters.

So how do we tell the difference? The honest answer is: We can't diagnose it by watching someone forget things.

There can be a tremendous amount of overlap between the different types of dementia.

But sometimes the pattern gives doctors important clues.

With Alzheimer’s disease, problems with remembering newly learned information are often among the earliest signs. Someone may ask the same question repeatedly, forget a conversation that happened recently, or have difficulty retaining something they were just told. But Alzheimer’s doesn't always begin exactly the same way in every person. Problems with finding words, judgment, reasoning, or visual-spatial abilities can also appear early.

Other dementias may begin differently.

A person with vascular dementia may have more difficulty with planning, organizing, or making decisions.

Lewy body dementia can involve changes in movement, fluctuations in alertness, visual hallucinations, or acting out dreams.

Frontotemporal dementia may begin with striking changes in personality, behavior, language, or judgment, sometimes before significant memory problems appear.

And sometimes the changes don't fit neatly into one box at all, and that is one reason diagnosis can take time.

But here is the part I really want people to hear. Not every memory problem is dementia, and not every episode of confusion means someone has Alzheimer’s disease.

There are many things that can affect how the brain works; Medication side effects, sleep problems, depression, thyroid problems, vitamin B12 deficiency, certain infections, alcohol or substance use, nutritional problems, and other medical conditions can all contribute to problems with memory or thinking.

Some of these problems can improve when the underlying cause is identified and treated. This is why I don't want anyone to look at a loved one who has suddenly become confused and immediately think: “This is Alzheimer’s.” Sometimes it isn't, but sudden confusion deserves medical attention.

Especially in an older adult, a sudden change over hours or days can be delirium rather than dementia. Delirium can have many causes, including infection, medications, dehydration, metabolic problems, or illness. It is different from the gradual cognitive decline we generally associate with dementia. That distinction can be incredibly important.

What about normal aging? This is another place where we can get confused. Most of us have walked into a room and forgotten why we went there. We have misplaced our glasses, forgotten someone's name, and we have stood in the grocery store trying to remember what we came for. That's being human.

Normal aging can bring some changes in memory and the speed at which we retrieve information. What becomes more concerning is when cognitive changes begin interfering with everyday life, managing money, preparing familiar meals, finding the way home, using familiar appliances, having conversations, taking medications correctly, or making decisions that once came naturally.

The question isn't simply: “Are they forgetting?” The better question is: “What are they forgetting, how often is it happening, and is it changing their ability to live their life safely and independently?”

And what if it really is Alzheimer’s? This is where I want to be careful with the word untreatable. Alzheimer’s disease currently has no cure, and the underlying disease is progressive. But that does not mean there is nothing that can be done.

There are medications that may temporarily help or stabilize thinking and memory for some people. And there are now FDA-approved disease-modifying treatments for certain people with early Alzheimer’s disease. These treatments do not cure Alzheimer’s, but clinical studies have shown that they can slow cognitive decline in appropriate patients.

There is also so much more to treatment than medication. Good care means looking at the whole person. It means paying attention to sleep, nutrition, movement, pain, hearing and vision, medications, environment, relationships, emotional well-being, safety, and the things that still bring someone pleasure and meaning. Because a diagnosis does not erase the person.

And perhaps most importantly... Please don't try to diagnose your loved one from a Facebook post. Please don't assume that because Grandma is repeating herself, she has Alzheimer’s. Please don't assume that because Grandpa suddenly became confused, he has dementia. And please don't assume that because someone has been diagnosed with dementia, you already know what is causing it.

Ask questions.

When did this begin? Was it sudden or gradual?

What changed first?

What can they still do? What has become difficult?

Are there new medications?

Have they been sleeping? Eating? Drinking enough?

Have they had an illness or infection?

Are they experiencing depression, grief, pain, or another major change?

And most importantly: Has someone evaluated what is actually happening?

A medical evaluation can help distinguish normal aging, mild cognitive impairment, dementia, delirium, Alzheimer’s disease, another type of dementia, or another medical condition affecting cognition.

Sometimes the answer will be difficult. Sometimes it will be frightening. And sometimes the answer may be something that can be treated. But we cannot know which one it is until we look.

So, let's stop using these words interchangeably. Dementia is an umbrella, and Alzheimer’s is a disease that can live underneath that umbrella. And neither word tells the whole story of the person sitting in front of us.

The person is still there. The memories may change, the words may change, their abilities may change, and the way they experience the world may change. But they are still a person who deserves patience, dignity, connection, and love.

Maybe instead of asking, “Does Mom have dementia or Alzheimer’s?” we can begin by asking, “What is happening to Mom, and how can we understand it well enough to help her?” That is a very different question. And sometimes, a better question is the beginning of better care.

A little about why I wrote this: 

I am not a doctor, a scientist, or a dementia specialist. I am simply someone who has spent many years sitting beside people and their loved ones as they navigate the end of life.

Over the past several months, I have had the privilege of supporting several people living with dementia and Alzheimer’s disease, and I have watched firsthand how differently these conditions can present themselves, how the body and mind can change, and how much uncertainty those changes can create for the people who love them.

This piece has been months in the making. I have read, researched, asked questions, talked with physicians who work in this field, and, most importantly, paid attention to what I have been witnessing in the people I care for.

I wanted to understand it better myself, and I thought perhaps what I was learning might help you understand it better, too. I am sharing this not as medical advice, but because I believe people deserve information that is understandable, compassionate, and useful.

If you notice changes in yourself or someone you love, please talk with your doctor. Don't assume. Don't be afraid to ask questions. And don't be afraid to seek answers.

I am not your doctor, I am simply someone who cares deeply about you and the people you love, and I want you to have the tools and understanding you need to care for yourselves and for one another with the dignity, patience, and compassion you deserve.

With gratitude,

Gabby