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Is it Alzheimer's or Normal Aging?

Here’s how to tell the difference.

An elderly woman sits outside on a bench outside. She is wearing a orange shirt with a black vest over it and looks off into the distance. Beside her is her walker parked right next to he bench and on her other side is a table with a jug filled with water.
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A young woman with dark curly hair is using mobile phone. Female is smiling while holding smart phone. She is lying on sofa at home.

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Dear Doctor,

I’m worried about my mother. She’s 75, and in relatively good physical health. But lately, she has been more and more forgetful—she’s having trouble remembering her grandchildren’s names and she’s sometimes unable to remember conversations that took place just a few hours before. Could she have dementia, or is this just the normal aging process at work?


“Concerned Daughter”

Dear Concerned Daughter:

Your question is one that I hear often from family members. Dementia is a clinical syndrome, which involves the loss of memory as well as the loss of other cognitive functions, such as the ability to speak or understand speech, move around in your environment, use objects, and abstract thinking. There are many types of dementia—Alzheimer's disease is the most common.

Dementia is very different from the so-called “normal aging process,” where a person becomes a little bit forgetful. Older people can still solve problems, but “fluid intelligence”—the ability to learn new tricks—declines. For instance, it’s much more difficult to learn how to use a computer at 65 than it is at 30.

The brain’s processing speed changes, as well. A person can still get things done, but it takes longer, and it’s harder to multitask. As long as your mother can go about her day independently—perform daily tasks, shop and use credit cards, etc.—then these changes are all pretty normal. When someone has Alzheimer’s or another form of dementia, they eventually become unable to do those things.

When family members come in with their loved one, my first questions are, “How did it start? What was the first sign of a problem? Is it a problem with language, memories, or executive functions?” The answers to these questions will guide me as to which tests to perform for more information.

An MRI of the brain is a very important diagnostic tool. It provides information about the possibility of Alzheimer's disease, but it can also tell if the patient has had strokes and how many they’ve had. An MRI can also identify a treatable condition called hydrocephalus, which is when an enlargement of the spaces in the brain and an excess of fluid disturbs brain function.

We also have to rule out vitamin deficiencies, because vitamin B1 and B12 deficiencies can sometimes cause dementia-like symptoms, as can hypoactive thyroid. There is also a very extensive list of medications that can cause cognitive defects, including anti-anxiety medications. And the quantity and quality of a person’s sleep is fundamental for everyone, especially as we get older. People with a condition called obstructive sleep apnea, which reduces oxygen to the brain in a chronic way, can show signs of cognitive impairment.

There is no cure right now for Alzheimer’s disease, but there are medications that can make the symptoms better by improving the function of the brain. And there are several clinical trials going on—here at Northwell as well as at other centers around the country—involving experimental medications that are being tested as potential cures. So it’s important to find out quickly if a person does have Alzheimer’s disease so they can enroll in a clinical trial. The hope is that with more research, we’ll discover better options for treating this disease.

“Dementia is very different from the so-called 'normal aging process,' where a person becomes a little bit forgetful.”
Dr. Luca Giliberto, neurologist
A man in a blue suit, dark blue tie, and white shirt sits in the lobby of a waiting area
Dr. Luca Giliberto, neurologist | Photo credit: Donna Alberico for The Well

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Published August 21st, 2018
A young woman with dark curly hair is using mobile phone. Female is smiling while holding smart phone. She is lying on sofa at home.

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