Alzheimer’s Disease

People often wonder about the difference between Alzheimer’s and dementia. Dementia is an “umbrella term” and not a specific disease. Dementia is a descriptive term for symptoms of mental and cognitive decline that are severe enough to interfere with an individual’s ability to perform everyday functions and activities.

Worldwide, 50 million people have Alzheimer’s and other dementias. Vascular dementia, which occurs after a stroke or with vascular disease in the brain, is the second most common type of dementia.

However, there are many other conditions that can cause dementia symptoms, including some that are reversible, such as thyroid issues or various vitamin deficiencies. Alzheimer’s disease causes problems with memory, thinking and behavior and is often referred to as Alzheimer’s dementia.

Most commonly, Alzheimer’s disease and associated dementia impacts people over the age of 65. However, a small percentage of instances, younger people can be affected by the disease when it is called early onset Alzheimer’s disease or younger onset Alzheimer’s disease. Alzheimer’s disease symptoms may begin in their 30s and 40s with the patient reaching the advanced stages of dementia in their 40s and 50s.

While all contributing factors to Alzheimer’s disease causes are not known, it is thought that, particularly in early onset Alzheimer’s, there is a genetic component.

Early signs of Alzheimer’s include:

• Memory loss or impairment, such as difficulty remembering names, dates, events, appointments and details of conversations.
• Difficulty concentrating, planning or developing an appropriate solution to a problem.
• Problems with completing tasks in a timely and efficient manner at home or at work.
• Confusion or disorientation with details of place, situation or the passage of time.
• Visuo-spatial difficulties, such as geographical disorientation with driving, problems judging specific distances, or losing/misplacing items around the home.
• Language difficulties, such as word-finding problems, constricted/limited vocabulary or changes in the fluency of speech or writing.
• Demonstrating compromised reasoning or judgment in decision-making.
• Withdrawal from work or social activity, increased apathy and decreased interest in social engagements or events.
• Changes in mood, personality or behavior including signs of depression and anxiety.

Alzheimer’s disease typically progresses slowly. There are three basic Alzheimer’s stages classified as:

• Mild (early stage)
• Moderate (middle stage)
• Severe (late stage)

Each patient’s progression through Alzheimer’s is unique, and the disease can present in a variety of ways in different individuals. Because of the progressive and neurodegenerative nature, each person will experience the advancement of signs and symptoms of Alzheimer’s dementia, but the specific timing and presentation of these will vary among different individuals.

The initial assessment may be performed by one or more of the following specialists:

• Geriatrician – trained to treat older adults
• Neurologist – trained to treat brain/neurocognitive disorders
• Geriatric psychiatrist – trained in mental and cognitive disorders of older adults

During this stage, we carefully review the patient’s medical and physical history, medication history, and presenting cognitive or behavioral symptoms. Based on these findings, we recommend appropriate follow-up tests.

During the patient’s visit, an Alzheimer’s evaluation includes assessing:

• Whether there are impaired cognitive, memory, or thinking skills compared to others in the same age group.
• Whether there are changes in mood, personality, or behavior.
• The extent of cognitive, memory, or thinking impairments.
• How cognitive or thinking difficulties affect everyday life and function.
• The underlying cause of symptoms through further testing and assessments

We may also order additional laboratory tests, including brain scans or detailed memory assessments such as formal neurocognitive or neuropsychological testing. These results can provide valuable information for diagnosis, including ruling out other conditions that may mimic Alzheimer’s symptoms, such as thyroid dysfunction or vitamin deficiencies.

To ensure an accurate diagnosis, we conduct comprehensive testing, including:

• Blood work, imaging studies, and formal neurocognitive testing by a licensed neuropsychologist.
• Detailed physical examinations to evaluate for other health conditions, such as:
  • Signs of past strokes
  • Parkinson’s disease
  • Depression
  • Other underlying medical conditions

We complete a comprehensive history and information assessment, gathering input from the patient, family, friends, caregivers, and previous healthcare providers. Through our memory evaluation process, we can confidently determine whether a patient’s brain is experiencing:

• Normal changes associated with healthy aging
• Neurodegenerative disease such as:
  • Alzheimer’s disease
  • Cerebrovascular disease
  • Parkinson’s disease–related dementia
  • Lewy body dementia
  • Frontotemporal dementia

When indicated, we incorporate advanced neurodiagnostic tools, such as:

• Quantitative EEG brain mapping
• Evoked response potential (ERP) testing
• Brain imaging, including volumetric magnetic resonance imaging (MRI)

When additional insight is needed, we may include biomarker testing including:

• Cerebrospinal fluid (CSF) sampling via lumbar puncture
• Positron emission tomography (PET) scans using radio-biomarkers, such as:
  • Glucose
  • Amyloid
  • Dopamine

Further diagnostic tools may include:

• Mental status tests: To evaluate memory, thinking, and problem-solving skills
• Brain mapping: To assess overall cognitive deficits associated with dementia.
• Mood assessment: To detect signs of depression, anxiety, or other mood disorders that may worsen cognition or mimic dementia.
• Genetic testing: While some genes increase the risk of Alzheimer’s disease, routine genetic testing is not currently recommended for all cases.
• Brain imaging: Structural imaging to rule out other causes of symptoms; research is ongoing for amyloid and tau imaging to enhance diagnosis and track disease progression.
• Blood and cerebrospinal fluid (CSF) biomarker tests
• Hormone testing, balancing and adjustment
• Transcranial magnetic stimulation (TMS)
• Cognitive remediation and neurofeedback

One class of drugs used for the symptomatic treatment of Alzheimer’s disease includes acetylcholinesterase inhibitors, which decrease the breakdown of the neurochemical acetylcholine — important for proper nerve signaling in memory and learning.

These drugs are symptomatic, meaning they may slow the rate of progression of the disease but do not correct or reverse it.

Common side effects are usually mild and may include diarrhea, vomiting, nausea, fatigue, insomnia, loss of appetite, and weight loss.

There are three main drugs in this class:

• Donepezil (Aricept):
  • The only treatment approved by the FDA for all stages of Alzheimer’s disease (mild, moderate, severe).
  • Available as a tablet or a wafer that dissolves in the mouth.
• Galantamine (Razadyne):
  • Formerly called Reminyl.
  • FDA approved for mild to moderate Alzheimer’s.
  • Available as regular-release tablets, extended-release capsules, or liquid forms.
  • Safety review: In two clinical studies involving mild cognitive impairment (an earlier condition than Alzheimer’s), galantamine was associated with a higher death rate compared to placebo. The FDA has asked the manufacturer to revise labeling accordingly. However, in clinical trials conducted in patients with diagnosed Alzheimer’s disease, mortality was not increased—in some analyses, it was lower in treated groups.
• Rivastigmine (Exelon):
  • For mild to moderate Alzheimer’s.
  • Available as a skin patch (transdermal), capsule, or liquid form.

In addition, Namenda (memantine) is FDA approved for moderate-to-severe Alzheimer’s disease.

This medication reduces the actions of glutamate, a brain chemical that may contribute to Alzheimer’s symptoms. Namenda has been associated with a moderate decrease in clinical deterioration and only a small positive effect on cognition, mood, behavior, and the ability to perform daily activities in moderate to severe Alzheimer’s disease. It does not appear to be of benefit for mild disease. The drug may work best when taken with Aricept, Exelon, or Razadyne.

Side effects may include tiredness, dizziness, confusion, constipation, and headache.

Namzaric (memantine hydrochloride extended-release and donepezil hydrochloride) combines two drugs into one.

It is suggested for people with moderate to severe Alzheimer’s who are already taking both medications separately. This formulation has the convenience of a single pill with once-daily dosing.

Doctors may also prescribe other medicines for coexisting medical concerns such as depression, anxiety, sleep disturbances, and behavioral problems like agitation and aggression.

Eligible patients may participate in clinical trials if available, where they have access to the leading-edge diagnostics and treatment options. If you are interested in any of our current studies on Alzheimer’s disease or if you are interested in participating in a research study but don’t currently see one that suits you, you can join our research registry to be placed on a list for future studies.

Alzheimer’s disease is a progressive neurodegenerative condition, meaning symptoms gradually worsen over time. While progression rates vary, most people experience increasing memory loss, changes in thinking and behavior, and ultimately the need for daily care. Early diagnosis, supportive therapies, structured routines, and lifestyle strategies may help maintain quality of life for longer. Prognosis depends on age, overall health, and the stage at diagnosis.

Common early signs of Alzheimer’s may include:

• Memory loss that disrupts daily life
• Difficulty planning or solving problems
• Challenges completing familiar tasks
• Confusion with time or place
• Trouble understanding visual images or spatial relationships
• Problems with words, naming, or following conversations
• Changes in mood, behavior, or personality

These symptoms can have multiple causes, so proper medical evaluation is important.

Experiences vary, but many people with Alzheimer’s describe early symptoms as feeling forgetful, disoriented, or mentally “foggy.” Tasks that once felt simple—such as remembering appointments, finding words, following conversations, or navigating familiar places—can become more challenging. As the disease progresses, individuals may need increasing support with daily activities. Emotional responses such as frustration, anxiety, or withdrawal are also common.

A major red flag is persistent memory loss that interferes with everyday activities, such as forgetting recent conversations, repeating the same questions, or misplacing items and being unable to retrace steps. Other red flags include difficulty managing finances, getting lost in familiar places, struggling with word-finding, or noticeable changes in judgment or behavior.

Life expectancy varies widely, but most people live four to eight years after diagnosis, while some live 10 years or longer. Outcomes depend on the age at onset, overall health, presence of other medical conditions, and how quickly symptoms progress. Alzheimer’s is ultimately a life-limiting illness, and support from caregivers and clinicians plays an important role throughout the disease course.

There is no guaranteed way to prevent Alzheimer’s disease, but research suggests that certain lifestyle habits may help lower risk. These include regular physical activity, heart-healthy nutrition patterns (such as the MIND or Mediterranean diets), staying mentally and socially engaged, managing cardiovascular risk factors, getting quality sleep, and avoiding smoking. Early evaluation of memory concerns may also support brain health and long-term planning.