Alzheimer's and dementia - What relatives need to know

Alzheimer's and dementia are terms that scare many people. But knowledge creates security. In this magazin , you will find out what Alzheimer's disease is all about, how Alzheimer's and dementia differ, what symptoms occur and how people with dementia can be supported in everyday life in the best possible way. Whether you are a caregiver, family member or interested party - this article offers you comprehensive information, practical everyday tips and empathetic guidance through a difficult topic.

What is dementia? - An introductory overview of a complex topic

Dementia affects many people and presents those affected as well as their relatives with major challenges. But what exactly is behind the term? What distinguishes dementia from other brain diseases, especially Alzheimer's disease? In order to better understand the disease, it is important to classify the basic characteristics, causes and manifestations of dementia.

Definition and basic features

Dementia is a generic term for a variety of illnesses that are associated with a progressive loss of mental abilities. Those affected gradually lose functions such as memory, orientation, thinking and language.

What is Alzheimer's?

Alzheimer's is the best known and most common form of dementia worldwide. The disease mainly affects older people, but can also occur in younger people. Its progression is gradual but irreversible and brings with it profound changes in thinking, remembering and acting. For relatives, the question often arises: "Which is worse, Alzheimer's or dementia?"

To understand this, it helps to take a closer look at the origin, the typical symptoms, the course and the special features of Alzheimer's disease.

Definition of Alzheimer's disease

Alzheimer's disease is a specific form of dementia. It particularly often affects older people, but can also affect younger people. It is characterized by gradual losses in short-term memory and later also in long-term memory.

How does Alzheimer's develop?

The exact causes of Alzheimer's disease have not yet been conclusively researched. However, scientists assume that various factors interact. The focus is particularly on so-called amyloid plaques, which are deposits of incorrectly folded protein (beta-amyloid) that accumulate between the nerve cells in the brain and disrupt their communication.

In addition, so-called tau fibrils form inside the nerve cells, which block cell transport and ultimately lead to the death of the affected nerve cells.

Another suspected mechanism is a chronic inflammatory reaction in the brain, triggered by a dysregulation of the immune system. Impaired blood circulation as well as genetic and environmental factors could also contribute to the development of the disease. The complex interactions of these processes gradually lead to the breakdown of nerve cells, which manifests itself in the form of memory loss, disorientation and other cognitive impairments.

Difference between Alzheimer's and dementia

Alzheimer's and dementia are often equated in everyday life, but there is a crucial difference: "dementia" is the generic term for various diseases that are associated with a progressive loss of mental functions. "Alzheimer's", on the other hand, is the most common form of these diseases and describes a very specific type of dementia with a characteristic course.

While the term dementia refers to a complex of symptoms that can also occur with other causes such as vascular dementia, frontotemporal dementia or Lewy body dementia, Alzheimer's describes a neurodegenerative disease with specific changes in the brain. These include protein deposits (amyloid plaques), the clumping of tau proteins and the gradual destruction of nerve cells.

Alzheimer's usually progresses slowly over several years and initially mainly affects short-term memory. In other forms of dementia, such as vascular dementia, the progression can be more sudden or gradual, depending on whether there are circulatory problems in the brain.

Symptoms such as hallucinations (in Lewy body dementia) or severe personality changes (in frontotemporal dementia) also differ significantly from Alzheimer's disease.

Which is worse: Alzheimer's or dementia?

Many people ask themselves this question. It is important to know: Alzheimer's is a form of dementia. The difference is that "dementia" is the generic term and "Alzheimer's" describes a specific form. Therefore, no form is "worse" per se, the course and symptoms are decisive.

Symptoms and signs: What should you look out for?

Typical signs of the onset of Alzheimer's disease or other forms of dementia are increasing memory gaps, which are particularly noticeable due to forgetfulness and short-term memory. For example, people with Alzheimer's forget conversations, appointments or activities they have just completed. As the disease progresses, orientation problems occur, even familiar surroundings can seem strange, routes are confused or completely forgotten.

Language can also be affected: patients search for words, sentences seem halting and their ability to express themselves decreases. Everyday tasks such as cooking, shopping or personal hygiene become increasingly difficult.

Changes in personality and behavior are another important warning signal. For example, previously balanced people can suddenly become irritable, suspicious or depressed. The tendency to withdraw socially increases and emotional control can diminish.

The earlier these symptoms are recognized and classified, the faster a diagnosis can be made by experts and appropriate support can be organized.

Causes of Alzheimer's and other forms of dementia

In order to better understand dementia and Alzheimer's disease in particular, it is worth taking a look at the various triggers and risk factors. The causes are complex and range from genetic to biological and lifestyle-related influences.

Although the exact mechanisms have not yet been fully deciphered, scientists have gained numerous insights into potential triggers in recent decades.

Genetic factors and familial clustering

Alzheimer's occurs more frequently in some families, which indicates a genetic predisposition. Certain genetic mutations can significantly increase the risk, particularly in the case of so-called familial Alzheimer's disease, which begins at a comparatively young age. However, this form is rare.

In most cases, it is a so-called sporadic Alzheimer's disease, in which no direct familial clustering is detected. Genetic factors also play a role here, for example the ApoE4 gene, which is considered a risk marker.

However, the presence of this gene does not necessarily mean that the disease will break out. Rather, it is a complex interaction of genetic predisposition, ageing processes, environmental factors and lifestyle, which together influence the risk of developing the disease.

Risk factors in everyday life

The relevant risk factors in everyday life include

• Smoking: It promotes inflammatory processes and impairs blood circulation, including in the brain.
• High blood pressure (hypertension): Persistently high blood pressure damages the blood vessels and increases the risk of vascular damage.
• Diabetes mellitusPermanently elevated blood sugar levels damage nerves and blood vessels, which can lead to cognitive impairment.
• Lack of exerciseRegular physical activity promotes blood circulation and cell metabolism in the brain.
• Unhealthy dietHigh-fat, high-sugar and low-vitamin diets are associated with an increased risk of dementia.
• Chronic stress: Prolonged mental stress can have a negative effect on brain performance and memory.
• Little mental stimulation: A lack of cognitive challenge through reading, social contacts or learning processes, for example, has an unfavorable effect on mental fitness.

These factors can be positively influenced in many cases, which is why they also play an important role in the prevention of dementia.

Progression and stages of the disease

The progression of a dementia disease such as Alzheimer's is gradual and takes place in different stages, which differ significantly in terms of symptoms, challenges and support requirements. It is helpful for those affected, relatives and carers to know the typical phases so that they can adapt to changes at an early stage and organize appropriate help.

It is important to understand that every illness is individual, even if certain patterns and developments are frequently repeated.

Classification into levels

Dementia is usually divided into three stages: mild, moderate and severe. Each stage brings different challenges:

• Mild stage: those affected show first memory problemsespecially in short-term memory. They forget names or appointments, lose objects more frequently and have difficulties with more complex tasks. independent living is usually still possible in this phase, but with an increasing need for support with organization and planning.
• Intermediate stage: The cognitive impairments increase. Disorientation, speech difficulties, personality changes and problems in everyday life become much more pronounced and the affected person now needs regular help with everyday tasks such as cooking, shopping or personal hygiene. For relatives the amount of care required increases significantly.
• Severe stage: In the advanced stage, those affected increasingly lose basic abilities such as eating, walking or control over bodily functions. Communication is severely restricted or no longer possible.

There is a complete need for care. Relatives are under great emotional and physical strain and are dependent on professional support.

Overview of forms of dementia

Dementia is not a single disease, but a collective term for various illnesses that are all associated with the progressive deterioration of mental abilities.

Each form of dementia has its own course, its own causes and different focal points in terms of symptoms. A sound understanding of these differences helps relatives and those affected to cope better with everyday life and find targeted support.

Alzheimer's dementia

Alzheimer's dementia is by far the most common form of dementia and accounts for around 60 to 70 percent of all cases. The onset is usually gradual: initially, difficulties occur in the short-term memory, such as forgetting recent conversations, misplaced objects or current events.

As the disease progresses, long-term memory also deteriorates and there are increasing problems with orientation, speech disorders and personality changes. Everyday activities such as cooking, shopping or operating technical devices become increasingly difficult. The progression is chronic and progressive, which requires continuous adaptation of care and support.

Vascular dementia

Vascular dementia is caused by circulatory disorders in the brain, which result in the death of nerve cells. This can be caused by minor or major strokes, microbleeds or a chronic lack of blood flow.

The progression of this form of dementia is often intermittent, meaning that the mental abilities do not deteriorate continuously as with Alzheimer's, but in sudden, sometimes dramatic steps. This can manifest itself, for example, in a sudden speech disorder, a change in behavior or acute disorientation. Depending on which areas of the brain are affected, different symptoms come to the fore. Vascular dementia often occurs together with other physical illnesses, such as cardiovascular problems or diabetes. Close medical care is therefore particularly important.

Lewy body dementia

Lewy body dementia is a special form of dementia that is characterized by strong fluctuations in mental performance depending on the time of day. Pronounced attention deficit disorders and visual hallucinations are typical, which appear very real to those affected and can sometimes be frightening.

Other characteristics include motor symptoms reminiscent of Parkinson's disease, such as muscle stiffness, tremors and slowness of movement. The so-called REM sleep behavior disorder syndrome, in which those affected act out their dreams, is also common. Due to the variety and complexity of the symptoms, diagnosis is often difficult and is often only made at an advanced stage. Care requires special attention and good coordination between medical, nursing and family support.

Frontotemporal dementia

Frontotemporal dementia (FTD) mainly affects people in middle age and is much rarer than Alzheimer's dementia. In contrast to other forms of dementia, the focus here is not on memory impairment, but on massive changes in social behavior, personality and emotional expression. Those affected often appear apathetic, show inappropriate reactions, lose their social inhibitions or behave in an increasingly tactless and distant manner. There is also a noticeable loss of empathy.

There are different variants of FTD. In the so-called behavioral variant, the focus is on personality changes and disorders in social interaction. In the linguistic variant (primary progressive aphasia), there is a progressive loss of the ability to speak. The disease is often only recognized late, as the symptoms can initially be mistaken for mental disorders. The burden for relatives is particularly high, as the person appears to change fundamentally. Early diagnosis, psychological support and practical everyday support are therefore particularly important.

Diagnosis: How does the doctor recognize Alzheimer's and dementia?

Timely and accurate diagnosis of Alzheimer's or other forms of dementia is an important step in providing clarity and initiating appropriate support measures. As the symptoms begin gradually and can initially be mistaken for normal signs of ageing, a structured medical assessment is particularly important.

It not only helps to determine the correct form of dementia, but also to rule out other possible causes such as depression, thyroid disease or vitamin deficiency. For those affected and their relatives, the diagnosis is often an emotional turning point - but at the same time an important prerequisite for seeking targeted help and developing perspectives together.

Diagnostic procedures

The diagnosis of dementia or Alzheimer's disease is made in several steps. It begins with a medical history: the doctor asks the person affected and their relatives about the changes they have observed, how they have developed over time and their everyday life. This is followed by neuropsychological tests that systematically examine the person's ability to think, remember, pay attention and understand language. Standardized test procedures such as the Mini Mental Status Test (MMST) or the clock test provide indications of cognitive impairments.

Blood tests are used to rule out other diseases such as vitamin deficiencies, thyroid disorders or infections that can cause similar symptoms. Imaging procedures such as CT or MRI provide information about changes in the brain, such as shrinkage or circulatory disorders. If special forms such as Lewy body dementia are suspected, nuclear medicine imaging (PET, SPECT) can also be used.

Treatment options and therapies

After being diagnosed with Alzheimer's or another form of dementia, the question often arises for those affected and their relatives: what can be done? Even if a cure is currently not possible, there are numerous therapeutic approaches aimed at alleviating the symptoms, slowing down the progression of the disease and improving quality of life.

Treatment usually consists of medication and non-medication measures. An individual combination of these approaches, tailored to the respective life situation, can make everyday life considerably easier for those affected and maintain their independence for longer. Find out more about dysphagia (swallowing disorders) in this guide! 

Drug therapy

Certain active ingredients can help to temporarily slow down the progression of Alzheimer's or other forms of dementia and alleviate the symptoms. These drugs interfere with the signal transmission of nerve cells or inhibit the breakdown of neurotransmitters such as acetylcholine, which is important for memory and learning. The most commonly used medications include

• Acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine, galantamine): They improve communication between nerve cells by slowing down the breakdown of acetylcholine.
• NMDA antagonists (e.g. memantine): They regulate the glutamate metabolism in the brain and can thus prevent overstimulation of the nerve cells.
• Concomitant medication: Antidepressants or sedative medication may also be used in cases of severe restlessness, sleep disorders or depressive moods. However, these should be prescribed with caution and always under medical supervision.

Non-drug therapies

In addition to medication, non-drug therapies play an important role in the treatment of people with dementia. They aim to maintain and promote cognitive, emotional and social skills. Proven therapeutic approaches include

• Occupational therapyHelps to maintain practical everyday skills such as dressing, eating or household activities.
• Music therapy: Music has an emotionally stabilizing effect, awakens memories and promotes a sense of community.
• Memory trainingStimulates short-term and long-term memory through exercises, puzzles or conversations about past experiences.
• Exercise therapy: walking, gymnastics or dancing not only improves physical fitness, but also improves mood.
• Biography work: Dealing with one's own life promotes identity and self-esteem.

The selection of suitable therapies should always be based on the individual needs, interests and possibilities of the person concerned.