By Michele Simon, JD, MPH

Reviewed by Miriam Komaromy, MD and Mignon Fogarty, MS
Last updated September 5, 2000

Learning that a loved one has been diagnosed with Alzheimer's disease can be difficult, and an additional frustration stems from the uncertainty of the diagnosis. Although accuracy continues to improve, doctors still cannot be 100 percent sure of an Alzheimer's diagnosis. To complicate matters further, many other disorders — some of which are treatable — have similar symptoms.

Treatable Disorders Confused With Alzheimer's

In a group of people showing minor memory problems, Alzheimer's disease was the cause in fewer than half of the cases; in fact, about 20 percent had problems that could be reversed with treatment

A recent report from the World Alzheimer Congress 2000 stated that in a group of people showing minor memory problems, Alzheimer's disease was the cause in fewer than half of the cases; in fact, about 20 percent had problems that could be reversed with treatment. Depression, thyroid disease, high blood pressure, and alcohol dependence are among the treatable problems that can mimic Alzheimer's disease. Being aware of these and other illnesses will help you seek appropriate care.

Depression by itself can mimic dementia; a situation sometimes called pseudodementia

Depression. Because depression is often part of Alzheimer's disease, it can be tricky to sort out what's going on. Depression by itself can mimic dementia; a situation sometimes called pseudodementia. When people are depressed, they can have difficulty concentrating, and this leads to forgetfulness. Making matters worse, many people are reluctant to seek help because they fear they are developing dementia, when in fact they are delaying a diagnosis for a treatable condition. For this reason, it makes sense for any person who is being evaluated for Alzheimer's to also be evaluated for depression, and perhaps treated for possible depression to see if the signs of dementia are alleviated.

The side effects of many drugs widely used by elderly people can be mistaken for dementia

Medications. The side effects of many drugs widely used by elderly people can be mistaken for dementia, leading to even more drugs being prescribed. Examples of dementia-like symptoms caused by medications are confusion, memory loss, and disorientation. Many prescription drugs can cause these side effects, including drugs used for treating

• Parkinson's disease
• Depression
• Allergies
• Migraine
• Irritable bowel syndrome.

Also, over-the-counter drugs that could cause dementia-like symptoms include:

• Hay fever treatments
• Cold and flu medicines
• Sleeping pills
• Anti-diarrhea treatments
• Herbal and other alternative medicines

In addition, taking too much or too little of prescribed medications, or combining certain medications, can cause adverse side effects.

It's helpful to give your doctor a list of all medication you or your loved one is taking — both prescription and over-the-counter. Your doctor may be able to reduce or eliminate medications that are causing mental deficiencies.

Alcohol impairs mental function more and more with increasing age. So over time, even a few drinks a day might be enough to cause noticeable mental problems

Substance Abuse. Alcoholic dementia accounts for an estimated ten percent of dementia. Typically, someone with alcoholic dementia has a long history of alcohol abuse. However, even if one is not an alcoholic, alcohol impairs mental function more and more with increasing age. So over time, even a few drinks a day might be enough to cause noticeable mental problems. Because people who have a drinking problem may try to hide evidence of their alcohol use, it is easy to miss alcoholism as a possible cause of dementia.

If you suspect a decline in mental functioning in a loved one, encourage them to drink less or to stop altogether. Once they stop drinking, alcohol-related dementia sometimes gradually clears up over a few weeks to two months.

Nutritional Deficiencies. Nutritional deficiency accounts for about five percent of dementia. The nutrient deficiencies most closely associated with dementia are deficiencies of the B vitamins:

• Thiamin (B-1)
• Niacin (B-3)
• Folate (folic acid)
• Vitamin B-12

Any assessment for Alzheimer's disease should include blood tests to check for these nutrient levels

Of these, folate and B-12 deficiencies are most common. Any assessment for Alzheimer's disease should include blood tests to check for these nutrient levels. People with dementia related to B-12 deficiency can recover with B-12 injections. Also, people with folate and niacin deficiencies may improve after receiving supplemental vitamins.

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Less Treatable Disorders Confused With Alzheimer's

Vascular or Multi-Infarct Dementia. Experts estimate that vascular or multi-infarct dementia (MID) accounts for about 15 percent of mental impairment, making it the nation's second leading cause of dementia.

MID occurs when blood clots block small blood vessels in the brain and destroy brain tissue. Older people and those with high blood pressure are at increased risk. MID typically begins between the ages of 60 and 75 and affects more men than women.

Symptoms of MID are similar to those of Alzheimer's and include:

• Confusion
• Recent memory loss
• Wandering or getting lost
• Incontinence
• Emotional problems such as laughing or crying inappropriately
• Difficulty following instructions
• Problems handling money

Usually the damage is so slight that the change is only noticeable over time. A gradual mental decline occurs as more small vessels become blocked.

Symptoms that distinguish MID from Alzheimer's are stroke-related physical problems such as partial paralysis or slurred speech, which are not features of Alzheimer's disease. Also, MID usually develops more quickly than Alzheimer's

Symptoms that distinguish MID from Alzheimer's are stroke-related physical problems such as partial paralysis or slurred speech, which are not features of Alzheimer's disease. Also, MID usually develops more quickly than Alzheimer's. However, it may be confusing to sort out because someone can have both Alzheimer's disease and multi-infarct dementia. In such cases, low-dose aspirin can help reduce the MID part of the problem.

Pick's Disease. Pick's disease is characterized by a progressive deterioration of social skills and changes in personality leading to impairment of intellect, memory, and language. Symptoms include loss of memory, lack of spontaneity, difficulty in thinking or concentrating, and speech disturbances. It usually affects individuals between ages 40 and 60. The cause of the disease is unknown and there is no available treatment, other than to alleviate some of the symptoms.

People with Pick's have less disorientation and memory loss early on, but more personality changes and loss of social restraints

The progression of symptoms in Pick's disease is somewhat different from Alzheimer's. People with Pick's have less disorientation and memory loss early on, but more personality changes and loss of social restraints. As the disease progresses, profound dementia develops until people with Pick's disease are mute, immobile, and incontinent. Often someone is first diagnosed with "probable Alzheimer's," and later the diagnosis is changed to Pick's.

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When it Probably Is Alzheimer's

Current tests and assessments for Alzheimer's disease are about 90 percent accurate

Current tests and assessments for Alzheimer's disease are about 90 percent accurate when compared with an eventual diagnosis made on autopsy after the patient's death, meaning that about 1 out of 10 people diagnosed with Alzheimer's don't actually have it. That's why it's important to be aware of the other disorders that can mimic Alzheimer's, especially if they are treatable, and make sure that they have been ruled out before you accept an Alzheimer's diagnosis. However, once other possibilities are ruled out, it's most likely that the diagnosis of Alzheimer's disease is accurate. The sooner your family is confident of the Alzheimer's diagnosis, the sooner you can begin treatment to help alleviate the symptoms and possibly slow the progression of the disease.

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For More Information

Alzheimer's Association

National Institute on Aging's Alzheimer's Disease Education and Referral Center

References

Advances. The Alzheimer's Association Newsletter. (1995).

Fall. Gray, G.E. (1989). Nutrition and Dementia. Journal of the American Dietetic Association 89:1795.

Joynt, R (ed). (1990) Clinical Neurology, J.B. Lippincott Co., Philadelphia.

Mahler, M, and Cummings, J. (1991). Behavioral Neurology of Multi-Infarct Dementia Alzheimer Disease and Associated Disorders, 5:2; 122-130.