What Is the Difference Between Dementia and Alzheimer’s?

This is a common question from families working to learn more after an Alzheimer’s or dementia diagnosis. Alzheimer’s is the most common form of dementia, but dementia includes many other neurodegenerative diseases. In this article, we’ll discuss Alzheimer’s disease, dementia, and the many questions and concerns families have following such a diagnosis.

Alzheimer’s and dementia planning is a necessity if you or a relative has been diagnosed with these or other types of memory loss. Choosing a power of attorney, creating an estate plan, setting up an advance healthcare directive, and applying for Medicaid or other assistance are all important topics to consider. When you’re ready, the elder law team at Van Dyck Law Group is here to help. We’ll learn about your situation, review your options, and assist you with putting your plans in place.

Alzheimer’s vs. Dementia

If a person has Alzheimer’s, they have dementia, but the reverse is not always true. A person with dementia might have Alzheimer’s, but they could instead have Parkinsonian dementia, vascular dementia, or one of many other forms of the disease. We’ll discuss these other forms later in this article.

What Is Dementia?

Dementia refers to a broad category of conditions that involve a significant decline in memory, communication, reasoning, and other cognitive functions, disrupting everyday activities. Alzheimer’s disease is the leading cause of dementia, and as a result, many people use the two terms interchangeably. However, this is only sometimes correct.

What Is Alzheimer’s Disease?

Alzheimer’s disease is a degenerative condition that causes dementia symptoms to intensify over time. In the beginning, memory issues may be relatively minor, but in the advanced stages, patients often become unable to communicate or engage with their surroundings. While the typical life expectancy following an Alzheimer’s diagnosis ranges from four to eight years, some people could live up to two decades, depending on their overall health and other contributing factors.

Who Is Affected by Alzheimer’s Disease?

Approximately 6.9 million Americans aged 65 and over are currently living with Alzheimer’s disease, with individuals aged 75 and older making up over 70% of that group. Globally, out of the more than 55 million people affected by dementia, it is estimated that Alzheimer’s accounts for 60% to 70% of those cases.

While Alzheimer’s mostly affects older adults, it can occur in those younger than 65 as well. This is called early-onset Alzheimer’s.

What Causes Alzheimer’s Disease?

A small number of cases are primarily caused by genetics, but the majority occur for unknown reasons. Many researchers believe it results from a combination of genetic, lifestyle, and environmental factors.

We do know that people with this disease have brain changes, including beta-amyloid plaques and neurofibrillary tangles that likely lead to memory loss and other symptoms. Medications that target these plaques and tangles (anti-amyloid therapies) can help slow the progression for some patients, but there is currently no cure.

What Are Common Alzheimer’s Disease Symptoms?

One of the first symptoms of Alzheimer’s is struggling with memory. Typically, the issue arises with recent memories or newly acquired information. For instance, a person with early symptoms of Alzheimer’s might have no trouble remembering a trip they took several years ago, but struggle to recall a conversation they had earlier today.

Other early Alzheimer’s disease symptoms include:

• Difficulty finding the right word. We all occasionally have moments where we say, “Oh, what’s the word I’m looking for?” However, in early dementia, a person may experience these moments more frequently, often searching for a word multiple times during the same conversation.
• Challenges interpreting visual images or spatial relationships.
• Impaired reasoning or judgment.
• Any memory loss that interferes with daily activities. Sometimes, this looks like a loved one asking the same question several times in a row, even after receiving an answer, as if they hadn’t fully absorbed the new information.
• Wandering or becoming lost easily. For example, a person with early symptoms might get lost going somewhere they’ve been many times before. Or, they could be found walking around with no clear purpose.
• Mood and personality changes. If someone experiences a sudden change in personality or mood, there could be many potential causes. But in combination with other symptoms, this could point to dementia, especially in a person older than 65.
• Losing or misplacing items. Again, this happens to all of us from time to time, but when it begins happening more frequently, it could be an early sign of dementia.
• Forgetting dates and locations.
• Difficulty with planning or problem-solving.
• Spending more time on regular activities or tasks. For example, it might take longer for a person with early symptoms to complete everyday tasks such as brushing their teeth or setting the table.

What are the Treatment Options for Alzheimer’s and Dementia?

As discussed earlier, anti-amyloid drugs aimed at reducing plaques and tangles in the brain can slow the worsening of Alzheimer’s symptoms, giving patients more time in the earlier stages. However, there is a risk of serious side effects, such as swelling or bleeding in the brain, so you should carefully discuss the risks and benefits with your doctor.

Additionally, several other drugs may be used to treat Alzheimer’s disease symptoms as needed:

• Cholinesterase inhibitors. These medications help enhance communication between brain cells by maintaining the levels of a key chemical messenger that the disease typically reduces. They are often the initial treatment option, and while they don’t stop the disease, many patients experience mild symptom relief.
• Memantine. This drug works on a different brain signaling pathway and is used to slow symptom progression in people with moderate to severe Alzheimer’s disease. It is occasionally prescribed alongside a cholinesterase inhibitor.
• Antidepressants or anxiety medications. These don’t treat the disease directly but may be helpful for mental health issues like anxiety and depression, which are common with the disease. They can also be used to treat behavioral difficulties, such as aggression, in some patients.

Some of these treatments may be helpful for other forms of dementia, but this is not always the case. There are multiple types of dementia besides Alzheimer’s, including:

• Creutzfeldt-Jakob Disease, or CJD. Although rare, this neurodegenerative illness moves quickly in causing significant dementia symptoms. There is no cure, but a doctor can prescribe medication to treat symptoms, including seizures and behavioral changes.
• Down Syndrome is a chromosomal disorder caused by an extra copy of Chromosome 21. It is not a form of dementia, but people who have Down Syndrome are at a much higher risk of developing the disease as they age. This memory loss is usually considered a form of Alzheimer’s and may be treated with cholinesterase inhibitors or other medications to manage symptoms.
• Vascular dementia. This form of the disease is caused by a lack of blood flow in the brain, usually brought on by one or more strokes (including mini-strokes) or damaged blood vessels. The beta-amyloid protein does not cause it, so anti-amyloid drugs are ineffective. Treatments are focused on reducing issues that contribute to blood vessel disease and stroke risk, such as high blood pressure, high cholesterol, and high blood sugar.
• Normal Pressure Hydrocephalus, or NPH. Although it can sometimes be confused with Alzheimer’s or other forms of dementia, NPH is a different condition caused by a buildup of cerebrospinal fluid in the brain. The main treatment is shunt surgery to carry the fluid away from the brain. This often helps alleviate physical symptoms, such as changes in gait, and is sometimes, but not always, effective in relieving cognitive symptoms.
• Posterior cortical atrophy (PCA). This neurological disorder results from the gradual deterioration of the brain’s outer layer, mostly in the posterior (back) part of the brain. As with Alzheimer’s, there are often plaques and tangles in this area as well. Cholinesterase inhibitors and Memantine may help treat symptoms.
• Huntington’s Disease. A rare genetic disorder, Huntington’s often begins earlier in life than Alzheimer’s but progresses more slowly. Treatments are focused on physical symptoms like movement difficulties and mental health challenges.
• Dementia with Lewy Bodies derives its name from the formation of abnormal protein clumps in the brain, specifically caused by the alpha-synuclein protein. It is treated with cholinesterase inhibitors, Memantine, Levodopa for movement issues, and mental health medications.
• Parkinson’s dementia. Common in people who live with Parkinson’s disease, this disorder is treated with cholinesterase inhibitors, Levodopa, deep brain stimulation (DBS), antidepressants, and clonazepam for sleep difficulties.
• Frontotemporal dementia, or FTD. In this form of the disease, the frontal or temporal lobes are affected. Treatments are mostly aimed at reducing mood and behavioral symptoms like anxiety and depression. Speech therapy may also be beneficial for patients who experience language challenges.

What Legal Steps Should You Take After an Alzheimer’s or Dementia Diagnosis?

After learning about your or your loved one’s condition and exploring treatment options, your thoughts may turn to the future. There are several legal decisions that a person with dementia should make as soon as possible. We recommend making an appointment to speak with an experienced elder law attorney about the following issues:

Who Will Make Medical and Financial Decisions for You in the Future?

It can be difficult to think about, but the reality is that many people with dementia reach a point where they are no longer able to manage their affairs. A significant cognitive decline can make it hard to think clearly or even keep track of the subject at hand. If this occurs, you might need someone to step in and handle legal decisions.

The best way to maintain some control of your situation is to decide now who you trust to handle things for you. Once you do this, your attorney can establish a power of attorney allowing that person, called an agent, to sign documents and make choices on your behalf.

If you don’t select a power of attorney yourself and become incapacitated, the court will have to appoint someone, and it may not be the person you would choose. For this reason, we recommend that you select a power of attorney right away.

What are the Different Types of Power of Attorney Documents?

It’s important to recognize that there are various types of Power of Attorney, each serving a different purpose. Your lawyer will explain each of these options and help you understand which is best suited to your particular situation.

• General Power of Attorney: This form gives the designated agent wide-ranging authority to act on behalf of the grantor as their cognitive function declines. The agent may be responsible for managing finances, overseeing investments, signing contracts, conducting banking transactions, paying bills, buying or selling property, and coordinating with service providers.
• Limited Power of Attorney: More narrowly defined, this version authorizes the agent to carry out only specific tasks or decisions. Because it’s restricted in scope, other areas of decision-making may require separate documents or agents. For instance, one person might be authorized to manage financial matters, while another is granted authority over healthcare decisions. Alternatively, a limited POA could apply to a single event, such as finalizing a real estate transaction.
• Springing Power of Attorney: This form of POA is signed ahead of time but only becomes active once the individual is officially declared mentally incapacitated. Activation usually requires documentation from medical professionals and may involve a legal review, which can make the process lengthy or disputed. Due to these complexities, some people opt not to use a springing POA.
• Durable Power of Attorney: Unlike the springing type, a durable POA takes effect as soon as it is signed and remains valid even if the principal becomes mentally impaired. This provides seamless continuity in managing the person’s affairs, especially important in conditions like dementia, where capacity may diminish over time.
• Healthcare or Medical Power of Attorney – This document grants the agent authority to make medical decisions on behalf of the grantor when they are unable to do so. Since health emergencies can happen at any stage of life, it’s wise to have this POA in place regardless of a dementia diagnosis.
• Financial Power of Attorney – This POA delegates authority to an agent for handling financial matters. It can be set up with either comprehensive authority or limited to specific duties. Some people prefer to assign different agents for distinct responsibilities, while others entrust one person with complete control over their finances.

How Will You Manage the Costs of Treatment and Long-Term Care?

The expense of long-term care can drain even robust retirement savings, but there may be other options available if you can no longer afford the care you need. Here are some programs that might help, depending on your circumstances:

• Medicaid. Funded by federal and state resources, Medicaid is called NJ FamilyCare in this state. You will need to meet certain income and asset criteria based on the Federal Poverty Level (FPL), which changes annually. If you don’t qualify now, you may be able to “spend down” some assets and try again.
• Medicare. Similar to Medicaid, this program is available to adults aged 65 and older, as well as some younger adults with disabilities. Most people who qualify for Medicare don’t pay for Part A coverage, but might have a monthly premium for Part B, C, or D, depending on which plan they choose. Medicare will pay for hospitalization and skilled nursing in the short term, but it doesn’t cover long-term care, such as a nursing home.
• Social Security Disability Insurance (SSDI). This program helps people who are unable to work due to a disability. Alzheimer’s is most prevalent in people over 65, many of whom have already retired, but about 5 percent of people with Alzheimer’s develop the disease at a younger age. Additionally, some other forms of dementia are more common in younger people, and not everyone is financially ready to retire at 65. For any of these reasons, a person might find they can no longer work due to cognitive decline. When this happens, SSDI eligibility is based on a person’s work history and other relevant factors.
• Supplemental Security Income. SSI differs from SSDI in that it does not require prior work experience. However, as with Medicaid, you will need to meet fairly low income and resource requirements.

It can be challenging to ascertain which program you might qualify for on your own. At the same time, many people have questions about their financial situation. They may want to protect or transfer some assets to meet requirements.

If this is the case for you, you must seek legal advice before attempting to transfer assets. Transferring assets incorrectly can sometimes disqualify you for certain types of coverage.

Additionally, some people believe they have been incorrectly denied Medicaid, SSDI, or other assistance. If you believe this has happened to you, please consult with your lawyer immediately. In some cases, we may be able to appeal the decision.

Dementia & Alzheimer’s Planning FAQ

What Can You Do with a Healthcare Advance Directive?

While you can choose someone to manage your healthcare decisions, you may also want to make your wishes clear now. Clients often tell us they prefer to avoid certain treatments, or they don’t want a relative to grapple with difficult decisions. An advance healthcare directive (AHD) can help in these situations.

In New Jersey, an advance healthcare directive typically includes two essential components: a living will and a durable power of attorney for healthcare. Together, these legal tools enable a person to outline their medical care preferences and designate someone they trust to make healthcare decisions on their behalf. Creating an AHD ensures that your choices about medical treatment are honored, even if you’re unable to voice them at the time they’re needed. It can also help the person you choose as your POA have peace of mind that they’ve made the right choices.

What is the Difference Between a Living Will and a Durable Power of Attorney?

As discussed earlier, a POA allows you to designate another person to make decisions when you can’t—in this case, medical decisions. The durable POA is effective as soon as it is signed and stays that way even if the grantor becomes incapacitated. However, the grantor often continues to make their own medical decisions while they have capacity.

A living will outlines your specific preferences about receiving or declining life-sustaining medical treatments if you become incapable of making those decisions yourself. It serves as a clear set of instructions for your healthcare providers and loved ones, helping them follow your wishes when you’re no longer able to communicate with them.

How Do You Set Up an Advance Healthcare Directive in New Jersey?

First, you’ll need to establish that you can still make decisions and communicate effectively. For most people in the earlier stages of dementia or Alzheimer’s, this is not difficult, but you may need a medical exam or a letter from your doctor.

Once you’ve established capacity, you can discuss the situation with your attorney and explain your wishes. Your lawyer will draft the documents for you to sign and review them to ensure everything is clear and as you intended.

When you’re ready to sign, you’ll need two witnesses who meet the following criteria:

• They are at least 18 years old.
• They are not the agent assigned in your POA.
• They are not related to you and are not an heir to your estate.

Alternatively, a notary public can serve as a witness. Even if you have witnesses, notarizing your documents is recommended (although not strictly required by law).

Learn More About Legal Planning After a Dementia Diagnosis With Van Dyck Law Group

Dealing with the legal complexities that follow a dementia diagnosis can be stressful, but Van Dyck Law Group is ready to support you in taking the next steps. Our experienced elder law attorneys are committed to helping you navigate your choices, answer your concerns, and draft legal documents that reflect your unique needs and priorities.

We recognize how overwhelming this journey can be, and we’re here to offer knowledgeable, compassionate guidance at every stage. For more information, don’t hesitate to contact us at (609) 293-2621.