Margaret Dayhoff-Brannifan, PhD, Kousha Mohseni, MS, Michela Leboffe Tabaku, National Center for Health Research
Dementia is a term that is used to describe a wide range of brain diseases that cause long-term problems with memory and the ability to think and reason clearly. Alzheimer’s disease is a common form of dementia, and is usually diagnosed in people over 65 years old. Although memory loss and confusion are often called Alzheimer’s by doctors, patients, and family members, the only way to confirm diagnosis is by an autopsy after the patient has died. Most of the time when a doctor says a patient has Alzheimer’s, what they really mean is that the patient has dementia that might be caused by Alzheimer’s.
There are a few types of dementia that can be cured because they are caused by specific diseases such as hypothyroidism or Lyme disease. There are no cures for the other forms of dementia, including Alzheimer’s disease. There are drugs to slow the progression of dementia and Alzheimer’s, but these have very limited efficacy.
Signs of Alzheimer’s/Dementia
Many of the common signs of early Alzheimer’s and dementia are similar. Many of these symptoms can also be typical age-related changes. For example, having difficulty finding something like a recipe can be typical age-related change, however difficulty following a recipe could be a symptom of dementia. More dramatically, forgetting where you put your car keys can be a sign of aging, whereas forgetting what the key is for is a sign of dementia. If you or a loved one has one or more of the following symptoms you may want to talk about them with a doctor.
- Memory loss that disrupts daily life
- Challenges in planning or solving problems
- Difficulty completing familiar tasks at home, at work or at leisure
- Confusion with time or place
- Trouble understanding visual images and spatial relationships
- New problems with words or in speaking or writing
- Misplacing things and losing the ability to retrace steps
- Decreased or poor judgment
- Withdrawal from work or social activities
- Changes in mood and personality
Ways to Prevent or Delay Dementia or Alzheimer’s
A family history of Alzheimer’s or other types of dementia increases the chances of developing the condition, but there are strategies that help prevent these conditions. Exercise and a healthy lifestyle can be effective ways to reduce your risk of Alzheimer’s disease and other forms of dementia. These include:
- Regular physical exercise
- Eating healthy
- Maintaining a healthy weight
- Not smoking and moderating alcohol intake (to one drink a day)
- Mental stimulation and maintaining an active social life
- Stress management and quality sleep
Exercise has been shown to have the largest impact on preserving memory and thinking skills. Exercise was shown to protect against the brain shrinking even if people with a family history of Alzheimer’s disease. Mutations in a specific gene (the APOE-e4 gene), found in 30% of the population, can make it 10 times more likely that you will develop Alzheimer’s. Brisk walking, jogging, swimming or cycling at least three times a week makes brain shrinkage less likely in people with and without the gene mutation. Although the amount or type of exercise that is best is not known, in general, physical exercise that is physically healthy will also be mentally healthy ,
Long-term exposure to pesticides and other toxins that affect the neurological system, such as DEET and organophosphates, may increase the risk of Alzheimer’s and other types of dementia. Common exposures include mothballs (and other “bug killers”), insect repellants used inside the home (such as RAID), on the lawn or farms (Round Up and DTT) and on the body (OFF and other bug repellants).
There are several theories about why Alzheimer’s disease develops, but none are proven. The leading theory is that the disease is caused by a buildup of proteins in the brain called “plaques.” One type of plaque is caused by misshapen proteins that accumulate as the person ages. When shaped normally, these proteins are important for developing and maintaining a healthy brain. These plaques are often found during autopsies of Alzheimer’s patients. One theory is that the plaques cause brain cells to weaken and die, which can cause the brain to shrink.
More research is needed to fully understand Alzheimer’s and other types of dementia. If it develops early, which happens rarely, it is probably influenced by one’s genes. The disease can take many years to start showing symptoms, and once symptoms appear, it can take many more years for the symptoms to obviously worsen.
Study Linking Dementia to Anti-Anxiety Medications
An article published online in the prestigious British Medical Journal found a link between dementia and the use of anti-anxiety medications such as Valium, Xanax and other benzodiazepines (often referred to as “benzos”). The researchers examined almost 9,000 older adults for 6 years after the use of the medication for insomnia or anxiety. People in their study were 51% more likely to develop dementia if they had ever taken benzodiazepines, and the longer they took the drugs the more likely they were to develop it. However, anxiety and sleep disorders could be early symptoms of dementia, rather than caused by dementia. This study didn’t examine whether using the drugs occurred before or after dementia started. Since dementia usually takes years to develop, and this study only followed patients for 6 years, it is very likely that many of these patients were already developing the disease before taking benzodiazepines. The study was also missing information about other risk factors that the patients may have had for Alzheimer’s, such as smoking and alcohol use.
A study compared more than 70,000 Finnish non-institutionalized women and men from 2005-2010 who had been clinically diagnosed with dementia with an even larger number of men and women who were matched for demographic traits but did not have dementia. The researchers concluded that persons taking benzodiazepines and other related drugs were at a modestly increased risk for developing dementia. There was no difference in dementia associated with which benzos they were taking. However, many of the people taking benzos were also taking anti-depressants or antipsychotic drugs, so the authors stated that these other medications might have contributed to dementia as well. The authors concluded that people should avoid taking benzos, especially older people. 
There are many reasons to be cautious about taking benzodiazepines, particularly if other treatments are available. For example, in September 2020, the FDA announced that they will update the black box warning for benzodiazepines to include information about the risks of physical dependence, withdrawal reactions, misuse, abuse, and addiction. This is in addition to a previous black box warning about the risks of taking benzodiazepines at the same time as opiates, which can include death. However, further research is needed before concluding that benzodiazepines cause dementia.
More information about pesticide use and Alzheimer’s can be found here.
More information about these signs and symptoms can be found here.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
- Smith, J. C., Nielson, K. A., Woodard, J. L., et al. (2014). Physical activity reduces hippocampal atrophy in elders at genetic risk for Alzheimer’s disease. Front Aging Neurosci 6, 61.
- Zaganas, I., Kapetanaki, S., Mastorodemos, V., et al. (2013). Linking pesticide exposure and dementia: what is the evidence? Toxicology 307, 3-11.
- Billioti de Gage, S., Moride, Y., Ducruet, T., et al. (2014). Benzodiazepine use and risk of Alzheimer’s disease: case-control study. BMJ 349, g5205.
- Tapiainen, V., Taipale, H., Tanskanen, A., et al. (2018). The risk of Alzheimer’s disease associated with benzodiazepines and related drugs: a nested case-control study. Acta Psychiatrica Scandinavia 138: 91-100 doi: 10.1111/acps.12909
- U.S. Food & Drug Administration. FDA Drug Safety Communication. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Includes potential for abuse, addiction, and other serious risks. September 2020. Retrieved from https://www.fda.gov/media/142368/download.
- U.S. Food & Drug Administration. Safety labeling change notification. 2016. Retrieved from: https://www.fda.gov/media/99689/download.