“Is it senile dementia or is it Alzheimer’s?” This question, asked in countless medical offices, waiting rooms, and family meetings, reveals a profound confusion that affects millions of families worldwide. If your loved one is experiencing memory problems, you’ve probably asked yourself this same question, desperately trying to understand what’s happening to them, oscillating between hope that it’s something benign and fear of a more serious diagnosis.

This confusion isn’t just a matter of vocabulary. It reflects decades of medical misunderstanding, stigmatization of aging, and collective fear of cognitive decline. Even today, many healthcare professionals use the term “senile dementia,” perpetuating an obsolete and potentially dangerous view of these conditions.

The confusion between these terms isn’t trivial. It can delay diagnosis by several years, during which early interventions could have made a significant difference. It can lead to inappropriate treatments, exposing patients to unsuitable or even dangerous medications. It generates unnecessary anxiety in some (“it’s inevitable with age”) and false security in others (“it’s just senility”). More seriously still, it can deprive you of appropriate care strategies that could considerably improve your loved one’s quality of life and your own.

Today, we will dispel this confusion once and for all. Through an in-depth and accessible exploration, you will finally understand what these terms actually cover, their fundamental differences, their practical implications, and above all, why this distinction is absolutely crucial for caring for your loved one. We will demystify misconceptions, explore the latest scientific advances, and give you the keys to navigate this medical maze with confidence and clarity.

Dementia: A Misunderstood Umbrella Term

Definition and Clarification

Let’s start by clarifying the most misunderstood yet most important term: dementia. Contrary to what many think, and contrary to what everyday language suggests, dementia is not a disease in itself. It’s a syndrome, meaning a set of symptoms that can be caused by different diseases, just as chest pain can be caused by a heart attack, pneumonia, or even simple anxiety.

Imagine dementia like fever. Fever isn’t a disease, it’s a symptom that can be caused by flu, bacterial infection, inflammation, or even certain cancers. When your doctor finds you have a fever, their first question is: “What’s causing it?” Similarly, dementia is a set of cognitive symptoms that can have multiple causes, some treatable, others not, some progressing rapidly, others very slowly.

This distinction is fundamental because it completely changes the medical approach. Saying “it’s dementia” without looking further is like saying “it’s fever” and going home. It’s insufficient, potentially dangerous, and deprives the patient of appropriate care.

What Really Characterizes Dementia?

For dementia to be medically diagnosed, several strict criteria must be met. It’s not just “having memory problems”:

1. Significant cognitive decline in at least two cognitive domains:

• Memory (inability to retain new information)
• Language (finding words, understanding, expressing oneself)
• Visuospatial abilities (orientation, object recognition)
• Executive functions (planning, organizing, judging)
• Attention and concentration
• Praxis (ability to perform gestures)

2. Significant and measurable impact on daily life:

• Loss of autonomy in instrumental activities (managing finances, taking medications, shopping)
• Then in basic activities (washing, dressing, eating)
• Need for increasing external help

3. Progressive evolution that doesn’t reverse spontaneously:

• Not a sudden state like delirium
• Symptoms persist and worsen without treatment
• Trajectory is generally downward, though pace varies

4. Generally preserved consciousness initially:

• Person isn’t in a coma or stuporous
• May be aware of difficulties (variable anosognosia)
• Alertness is normal (unlike delirium)

The Scale of the Phenomenon: Staggering Numbers

Dementia currently affects 55 million people worldwide, a figure expected to triple by 2050 according to WHO, reaching 152 million. In France, an estimated 1.2 million people are affected, with 225,000 new cases each year. But behind these impressive statistics lie very different human realities, unique trajectories, devastated families.

Every 3 seconds, someone in the world develops dementia. The global cost is estimated at over $1.3 trillion annually, exceeding the GDP of many countries. But the real cost, human and emotional, is immeasurable.

Different Types of Dementia: A Complex Spectrum

Dementia can have over 100 different causes, from the most common to the rarest, from the most studied to the most mysterious. Understanding this diversity is essential for appropriate diagnosis and treatment. Here’s a detailed exploration of the main forms:

1. Alzheimer’s Disease (60-70% of cases): The Silent Giant

The most common dementia, Alzheimer’s disease is a complex neurodegenerative condition that initially affects brain areas responsible for memory before gradually spreading.

Distinctive characteristics:

Insidious onset and inexorable progression: The disease sets in so gradually that families often struggle to date the beginning of symptoms. “Now that we think about it, maybe it’s been 2-3 years since she was searching for words…”

Characteristic impairment of recent memory: The person forgets what they just did but remembers their childhood perfectly. This is Ribot’s law: the oldest memories resist the longest.

Unique biological signature: Accumulation of amyloid plaques between neurons and tau protein tangles inside. These lesions begin 15-20 years before the first symptoms.

Stereotyped but individually variable progression pattern:

• Phase 1 (2-4 years): Mild memory problems, anxiety
• Phase 2 (2-10 years): Disorientation, language problems
• Phase 3 (1-3 years): Total dependence, medical complications

Testimony from Marie, 62, daughter of a patient: “At first, we attributed her forgetfulness to the stress of her move. Then she forgot my birthday, something she never missed. The day she asked me who I was while looking at me with empty eyes, I understood it wasn’t just fatigue.”

Specific risk factors:

• Age (risk doubles every 5 years after 65)
• Genetics (APOE4 gene, rare familial mutations)
• Sex (women more affected, possibly linked to menopause)
• Education level (protective effect of cognitive reserve)
• Repeated head trauma

2. Vascular Dementia (15-20% of cases): When the Brain Lacks Oxygen

The second leading cause of dementia, it results from cerebral vascular lesions that deprive certain brain areas of oxygen and nutrients.

Mechanisms and manifestations:

Characteristic stepwise progression: Unlike Alzheimer’s, progression isn’t linear. “He was fine, then after his small stroke in March, he wasn’t the same. He stabilized for a few months, then another decline in September…”

Multiple causes:

• Major stroke (25% develop dementia)
• Accumulation of silent mini-strokes
• Small vessel disease (leukoaraiosis)
• Chronic hypoperfusion

Variable symptoms depending on location:

• Frontal lesions: apathy, disinhibition
• Subcortical lesions: slowing, gait problems
• Temporal lesions: memory problems
• Multiple lesions: complex mixed picture

Specific warning signs:

• Early gait problems (small-step gait)
• Emotional lability (inappropriate crying or laughing)
• Early urinary incontinence
• Pseudobulbar symptoms (difficulty swallowing)

Modifiable risk factors:

• Hypertension (major factor, 2x risk)
• Diabetes (1.5x risk)
• Smoking (1.6x risk)
• Atrial fibrillation (2x risk)
• Hypercholesterolemia
• Obesity
• Sedentary lifestyle

Typical clinical case: Georges, 72, poorly controlled hypertensive, had a stroke 6 months ago. Since then, his wife notes he no longer manages accounts, gets lost in the neighborhood, and cries at television for trivial things. MRI shows multiple lacunae and severe leukoaraiosis.

3. Dementia with Lewy Bodies (10-15% of cases): The Diagnostic Chameleon

Often unknown and confused with Alzheimer’s or Parkinson’s, this dementia has unique characteristics requiring specific management.

Distinctive clinical picture:

Major cognitive fluctuations: “In the morning, he’s confused, doesn’t recognize me. In the afternoon, he’s lucid and plays chess. It’s like there are two different people.”

Characteristic recurring visual hallucinations:

• Very detailed and elaborate (people, animals, children)
• Often non-threatening initially
• Person may have variable insight (“I know it’s not real but I see them”)
• “He sees little children in the living room playing. He talks to them, offers them cookies.”

REM sleep behavior disorder (RBD):

• Often precedes dementia by several years
• Violent movements during dreams
• Can involuntarily injure spouse
• “He threw punches in his sleep, relived his dreams”

Parkinsonian syndrome:

• Rigidity, bradykinesia, balance problems
• Tremors less frequent than in Parkinson’s
• Repeated unexplained falls

Hypersensitivity to neuroleptics:

• Severe, potentially fatal reactions
• Major worsening of symptoms
• Possible neuroleptic malignant syndrome

Delicate differential diagnosis:

• With Alzheimer’s: presence of early hallucinations
• With Parkinson’s: early cognitive problems (one-year rule)
• With vascular dementia: more marked fluctuations

Impact on families: “The hardest part is the unpredictability. We never know what state we’ll find him in. The hallucinations worry him, but if we tell him they’re not real, he gets angry.” – Testimony from Sylvie, patient’s wife.

4. Frontotemporal Dementia (5-10% of cases): When Personality Changes

This form affects younger people and first disrupts behavior and personality before memory.

Three main variants:

Behavioral variant (bvFTD):

• Dramatic personality changes
• Social disinhibition (inappropriate comments, sexual behaviors)
• Profound apathy or sterile hyperactivity
• Dietary changes (bulimia, preference for sweets)
• Flagrant loss of empathy
• “My husband, so polite and reserved, started making comments about people’s appearance on the street”

Primary progressive aphasia (PPA):

• Non-fluent variant: difficulty producing words
• Semantic variant: loss of word meaning
• Logopenic variant: laborious word searching
• “She asked ‘what’s a fork again?’ while holding it in her hand”

Variant with motor symptoms:

• Association with amyotrophic lateral sclerosis (ALS)
• Corticobasal syndrome
• Progressive supranuclear palsy

Diagnostic challenges:

• Onset before 65 in 60% of cases
• Often confused with depression or bipolar disorder
• MRI may be normal initially
• Genetic component in 40% of cases

5. Mixed Dementia: The Complex Reality

More frequent than previously thought, it combines several pathologies, making the clinical picture complex.

Common combinations:

• Alzheimer’s + vascular (most common)
• Alzheimer’s + Lewy bodies
• Vascular + Lewy bodies
• Sometimes three pathologies coexist

Practical implications:

• Less predictable evolution
• Variable response to treatments
• Need to constantly adapt management
• Generally less favorable prognosis

6. Other Causes of Dementia: The Spectrum Widens

Parkinson’s disease-associated dementia:

• Occurs after several years of motor evolution
• 80% of Parkinson’s patients after 20 years
• Predominant executive disorders

Normal pressure hydrocephalus:

• Triad: gait problems, incontinence, dementia
• Potentially reversible through shunting
• Characteristic “magnetic” gait

Alcoholic dementia (Korsakoff syndrome):

• Thiamine (B1) deficiency
• Characteristic confabulations
• Partially reversible if early management

Creutzfeldt-Jakob disease:

• Rapid evolution (months)
• Myoclonus, ataxia
• Characteristic EEG

HIV-related dementia:

• Less frequent with triple therapies
• Subcortico-frontal disorders
• Potentially reversible

The Myth of “Senile Dementia”: Deconstructing a Dangerous Idea

The History of an Obsolete Term

Here’s the surprising and shocking truth: “senile dementia” doesn’t exist as a modern medical diagnosis. It’s an obsolete term, a vestige of an era when medicine poorly understood brain aging and pathologized old age itself.

Why Does This Term Persist in Common Language?

Historical context and evolution of knowledge:

Before the 1970s, classification was simplistic and ageist:

• “Presenile dementia” (before 65): considered pathological
• “Senile dementia” (after 65): seen as a “normal” consequence of aging

This artificial distinction was based on the false idea that the brain inevitably deteriorated with age. It was then believed that losing memory after 65 was as normal as hair turning gray. This view is completely outdated and scientifically wrong.

Discoveries that changed everything:

In the 1960s-1970s, several discoveries revolutionized our understanding:

• Dr. Alois Alzheimer’s work was rediscovered and understood
• Anatomopathological studies showed lesions were identical regardless of age
• Population studies demonstrated many centenarians kept their cognitive abilities intact
• Brain imaging revealed normal aging and dementia were fundamentally different

The Concrete Dangers of This Term

Using “senile dementia” isn’t just a vocabulary error. It’s an error with potentially dramatic consequences:

1. It normalizes the abnormal and delays diagnosis:

• “It’s normal at his age” = consultation delayed by 2-3 years on average
• Loss of optimal therapeutic window
• Avoidable worsening of symptoms
• “If I had known it wasn’t normal, I would have consulted earlier” – frequent family regret

2. It deprives of specific treatments:

• Each type of dementia has therapeutic particularities
• Some medications effective for one are dangerous for another
• Non-pharmacological approaches differ according to type

3. It doubly stigmatizes:

• Association old age = inevitable decline
• Therapeutic fatalism (“nothing can be done”)
• Devastating psychological impact on person and family

4. It prevents search for reversible causes:

• 10-15% of “dementias” are reversible
• The “senile” label stops investigation
• Tragic cases of people institutionalized for simple B12 deficiency

Testimony from Dr. Martin, neurologist with 30 years’ experience: “When families tell me ‘it’s just senile dementia,’ my heart sinks. I know we’ve lost precious time. Behind this catch-all term always lies a specific pathology that must be identified. I’ve seen patients labeled ‘senile’ regain their abilities after treatment for hydrocephalus or severe depression. Every time I hear this term, I think of all those we could have helped if we had looked for the real cause.”

Normal vs Pathological Aging: Learning to Distinguish

What’s normal with age:

• Slowing of processing speed (need more time)
• Difficulty with multitasking
• Need for more concentration to learn
• Occasional forgetfulness with recovery
• More frequent “tip of the tongue” phenomenon

What is NOT normal:

• Forgetting entire events
• Disorientation in familiar places
• Marked personality changes
• Inability to follow a conversation
• Loss of autonomy in daily activities

How to Distinguish Alzheimer’s from Other Dementias: Detailed Practical Guide

Recognizing the specific type of dementia is crucial for appropriate care. Here’s an in-depth guide to key clues:

Clues Strongly Suggesting Alzheimer’s

Typical initial presentation:

• Extremely gradual onset: Families often say “now that we think about it, maybe something has been wrong for 3-4 years”
• Predominant memory complaint: “I lose everything,” “I can’t remember anything”
• Progressive anosognosia: Minimization then denial of problems
• Initial anxiety: Painful awareness of difficulties at onset

Characteristic cognitive pattern:

• Episodic memory affected first (recent events)
• Semantic memory preserved long (general knowledge)
• Language: word-finding difficulty then circumlocutions
• Orientation: temporal then spatial
• Recognition of relatives preserved until advanced stage

Stereotyped evolution:

• Prodromal phase (MCI): 2-5 years
• Mild phase: overall autonomy maintained
• Moderate phase: help needed for complex activities
• Severe phase: dependence for basic activities

Typical complementary examinations:

• MRI: bilateral hippocampal atrophy
• Amyloid PET: diffuse positivity
• CSF: characteristic AT(N)+ profile
• Neuropsychology: hippocampal profile

Clues Suggesting Vascular Dementia

Context and risk factors:

• Heavy cardiovascular history
• Poorly controlled hypertension for years
• Diabetes, dyslipidemia, smoking
• Identifiable vascular event

Clinical presentation:

• More abrupt onset: “Since his stroke in February…”
• Stepwise evolution: Plateaus punctuated by worsening
• Predominant dysexecutive disorders: Planning difficulties, judgment
• Marked psychomotor slowing

Associated neurological signs:

• Early gait problems (small steps, “magnetic” gait)
• Pseudobulbar signs (spastic laughter and crying)
• Focal signs (hemiparesis, aphasia according to territory)
• Lacunar syndrome (dysarthria, clumsiness)

Cognitive profile:

• Predominant frontal-subcortical impairment
• Memory: recall difficulties > encoding
• Very slowed processing speed
• Fluctuating attention

Clues Suggesting Dementia with Lewy Bodies

Central diagnostic triad:

Major cognitive fluctuations:

• Variations within the day or even hour to hour
• Episodes of confusion alternating with lucidity
• Unexplained excessive daytime sleepiness
• “It’s like there are two different people”

Recurring visual hallucinations:

• Very detailed and formed (people, animals)
• Often children or small people
• Sometimes preserved insight (“I know it’s not real but I see them”)
• Generally non-threatening initially

Spontaneous parkinsonism:

• Rigidity > tremor
• Early postural instability
• Repeated unexplained falls
• Hypomimia (fixed face)

Important supportive signs:

• REM sleep behavior disorder (precedes by 5-10 years)
• Severe hypersensitivity to neuroleptics
• Dysautonomia (orthostatic hypotension, urinary problems)
• Hyposmia (loss of smell)

Clues Suggesting Frontotemporal Dementia

Early and marked behavioral changes:

• Flagrant social disinhibition
• Stereotyped or ritualized behaviors
• Hyperorality (mouthing, dietary changes)
• Apathy or conversely unproductive hyperactivity
• Loss of empathy and social awareness

Particular neuropsychological profile:

• Relatively preserved episodic memory
• Major executive disorders
• Language problems (according to variant)
• Personal hygiene neglect

Suggestive context:

• Early onset (45-65 years)
• Family history in 30-40% of cases
• Faster evolution than Alzheimer’s
• Often initial erroneous psychiatric diagnosis

Why the Correct Diagnosis is Absolutely Crucial

A precise diagnosis isn’t just intellectual satisfaction or a box to check. It’s the key that opens the door to appropriate care and can literally change the course of the disease and quality of life.

1. Drug Treatment: Sometimes a Matter of Life or Death

For Alzheimer’s:

• Cholinesterase inhibitors (donepezil, rivastigmine, galantamine): modest but real efficacy
• Memantine for moderate to severe stages
• New monoclonal antibodies (aducanumab, lecanemab): controversial but promising
• Clinical trials: possible access if early and confirmed diagnosis

For vascular dementia:

• No specific treatment for dementia itself
• Crucial aggressive control of cardiovascular risk factors
• Antiplatelets or anticoagulants according to etiology
• Statins, ACE inhibitors, beta-blockers according to profile
• Cognitive and physical rehabilitation

For dementia with Lewy bodies:

• Rivastigmine: only specifically approved treatment
• NEVER typical neuroleptics (haloperidol = mortal danger)
• If necessary: low-dose quetiapine or clozapine
• Melatonin for sleep disorders
• Cautious L-DOPA if disabling parkinsonism

For frontotemporal dementia:

• No curative treatment
• SSRIs for behavioral disorders
• Avoid anticholinesterases (may worsen)
• Essential behavioral approaches
• Intensive family support

2. Expected Evolution: Anticipating for Better Care

Typical trajectories:

Alzheimer’s:

• Slow and relatively predictable progression
• Average duration: 8-12 years (3-20 years depending on cases)
• Cognitive decline of 3-4 MMSE points/year
• Well-defined phases allowing anticipation

Vascular:

• Unpredictable, depends on new events
• May stabilize with good vascular control
• Or worsen abruptly (new stroke)
• Median survival: 5-7 years

Lewy bodies:

• Generally faster evolution than Alzheimer’s
• Average duration: 5-8 years
• Fluctuations making prognosis difficult
• More frequent complications (falls, pneumonia)

Frontotemporal:

• Variable evolution according to variant
• Generally faster: 6-8 years
• Variant with ALS: 2-3 years
• Often earlier institutionalization

3. Care Strategies: Personalizing the Approach

Each type of dementia requires specific adaptations that make all the difference:

Approach for Alzheimer’s:

• Environment: Strict routines, omnipresent visual cues
• Communication: Simple sentences, one idea at a time
• Activities: Gentle cognitive stimulation, reminiscence
• Management: Phase anticipation, long-term planning
• Support: Support groups, caregiver training

Approach for vascular dementia:

• Prevention: Daily blood pressure monitoring
• Rehabilitation: Intensive physiotherapy, occupational therapy
• Adaptation: Secure environment (bars, non-slip)
• Vigilance: Stroke signs (FAST: Face, Arms, Speech, Time)
• Stimulation: Cognitive exercises targeted on attention

Approach for Lewy bodies:

• Night safety: Bed barriers, mattress on floor
• Hallucination management: Validation without confrontation
• Lighting: Permanent night lights, avoid shadows
• Medications: List of contraindicated drugs visible
• Activities: Calm, low-stimulating, ritualized

Approach for frontotemporal:

• Supervision: Constant for risky behaviors
• Structure: Rigid routine, simplified environment
• Communication: Direct, concrete, no abstraction
• Behavioral management: Redirection techniques
• Family support: Intensive, often family therapy

The Modern Diagnostic Process: A Mapped but Complex Journey

If you suspect dementia in a loved one, understanding the diagnostic process will help you better prepare and get the most out of it.

1. Initial Consultation: The Gateway

Essential preparation:

• Keep a symptom journal for several weeks
• Note medications (all, even self-medication)
• Gather medical history
• If possible, accompany the person (crucial testimony)

What the family doctor will do:

• Detailed anamnesis (disease history)
• General clinical examination
• Simple cognitive tests (MMSE, clock test)
• Basic biological workup
• Specialist referral if necessary

Pitfalls to avoid:

• Minimizing symptoms out of loyalty
• Accepting a vague diagnosis
• Not asking for specialist referral

2. Neuropsychological Assessment: Mapping Deficits

Duration and process:

• 2 to 4 hours of evaluation
• Calm and benevolent environment
• Breaks if necessary
• Sometimes over several sessions

Domains evaluated in detail:

• Memory: episodic, semantic, working, procedural
• Language: expression, comprehension, naming
• Executive functions: planning, flexibility, inhibition
• Attention: sustained, divided, selective
• Praxis: gestures, construction
• Gnosias: visual recognition
• Processing speed

Expected results:

• Detailed cognitive profile
• Comparison to norms (age, educational level)
• Diagnostic hypotheses
• Recommendations for follow-up

3. Complementary Examinations: Seeing the Invisible

Brain MRI (systematic):

• Search for atrophy (hippocampus, cortex)
• Vascular burden evaluation
• Exclusion of other causes (tumor, hydrocephalus)
• Specific sequences according to suspicion

Biological analyses (systematic):

• CBC, electrolytes, kidney and liver function
• TSH, T4 (thyroid)
• Vitamin B12, folates
• Serology if indicated (HIV, syphilis)
• Sometimes autoantibody search

Specialized examinations (case-by-case):

PET scan:

• Amyloid (Alzheimer’s)
• FDG (metabolism, FTD)
• Tau (research)

Lumbar puncture:

• Alzheimer’s biomarkers (Aβ42, tau, p-tau)
• Exclusion of infections, inflammation

EEG: If suspicion of Creutzfeldt-Jakob or epilepsy

DATscan: Differentiate Lewy bodies and Alzheimer’s

Genetics: If early onset or family history

4. Multidisciplinary Synthesis: The Collegial Verdict

The actors:

• Neurologist or geriatrician
• Neuropsychologist
• Sometimes psychiatrist
• Paramedical team

The process:

• Pooling of results
• Diagnostic discussion
• Consensus on most likely diagnosis
• Personalized care plan

Diagnostic announcement:

• Crucial moment, not to be rushed
• Family presence desirable
• Clear but empathetic information
• Written documents provided
• Resource guidance

Reversible Dementias: Hope Still Exists

The Hope-Bearing Reality

About 10-15% of dementia presentations are potentially reversible if treated in time. This statistic should motivate systematic thorough investigation.

Frequent Reversible Causes and Their Treatment

Normal pressure hydrocephalus (NPH):

• Classic triad: Gait problems + incontinence + dementia
• Diagnosis: MRI, subtractive puncture
• Treatment: Ventriculo-peritoneal shunt
• Prognosis: 60-80% improvement if treated early
• Testimony: “After the shunt, my father regained 70% of his abilities. He walks again, recognizes everyone. It’s a miracle.”

Vitamin deficiencies:

B12 (cobalamin):

• Frequent in vegetarians, gastrectomy patients, elderly
• Picture: dementia + anemia + neuropathy
• Treatment: weekly then monthly IM injections
• Recovery: 50-80% if treated < 6 months

B1 (thiamine):

• Alcoholism, malnutrition
• Wernicke-Korsakoff syndrome
• Therapeutic emergency

B9 (folates), D: Simple supplementation

Thyroid disorders:

Hypothyroidism:

• 5% of “dementias” in > 65 years
• Global slowing, pseudo-dementia
• Levothyroxine: improvement in 3-6 months

Hyperthyroidism: Rarer, confusion, agitation

Drug causes:

• Anticholinergics: Very frequent, cumulative effect
• Benzodiazepines: Confusion, amnesia
• Antiepileptics, antidepressants
• Polypharmacy: Multiple interactions
• Solution: Drug review, gradual withdrawal

Severe depression (pseudo-dementia):

• 10-20% of initial “dementias”
• Major psychomotor slowing
• Cognitive complaints > objective deficits
• Antidepressants + psychotherapy: possible remission

Chronic infections:

• Neurosyphilis (rare but curable)
• HIV (associated dementia)
• Chronic Lyme disease (controversial)

Brain tumors:

• Frontal meningiomas
• Low-grade gliomas
• Surgery/radiotherapy according to case

Documented hope story: “My 78-year-old mother had all the symptoms of Alzheimer’s for 18 months. MMSE at 18/30, disorientation, apathy. The workup revealed profound B12 deficiency (50 pg/ml). After 3 months of weekly, then monthly injections, she recovered 80% of her abilities. MMSE at 27/30. She lives alone again, manages her accounts, drives. If we had accepted the diagnosis of ‘senile dementia,’ she would be in an institution today.” – Paul, 52

Living with the Diagnosis: Beyond the Announcement

The Impact of the Announcement

Whatever type of dementia is diagnosed, the announcement constitutes an existential earthquake that upsets all reference points.

What the Diagnosis Concretely Allows

Finally emerging from uncertainty:

• Putting a name on symptoms paradoxically relieves
• End of exhausting medical wandering
• Validation of family observations
• “At least now we know what we’re fighting”

Planning the future with lucidity:

• Anticipating probable evolution
• Advance directives while possible
• Legal protection (guardianship, conservatorship)
• Financial organization
• Choice of living place

Specifically adapting the environment:

• Targeted arrangements according to type
• Appropriate technical aids
• Personalized security
• Adapted stimulation

Accessing existing aids:

• APA (Personalized Autonomy Allowance)
• Day care, temporary accommodation
• Home help services
• Specialized support networks
• Caregiver training

Therapeutic trials

Preserving human dignity:

• Understanding it’s a disease, not a failure
• Maintaining person’s identity
• Respecting their choices as long as possible
• Avoiding infantilization

Tragic Errors to Absolutely Avoid

Not consulting under pretext that “it’s normal at their age”:

• Loss of precious time
• Avoidable worsening
• Missed therapeutic opportunities

Accepting a vague diagnosis like “senile dementia”:

• Deprives of specific care
• Maintains in ignorance
• Prevents appropriate adaptation

Not asking for a second opinion if in doubt:

• 20-30% of diagnoses are wrong or incomplete
• Variable expertise according to centers
• Total legitimacy to seek confirmation

Hiding the diagnosis from the person concerned:

• Right to know (except exception)
• Possibility to participate in decisions
• Respect for autonomy
• Psychological preparation

Abandoning all hope:

• Each dementia has its possibilities
• Quality of life always possible
• Preserved moments of joy
• Maintained affective bonds

The Vital Importance of Adapted Care

Why Specificity is Crucial

Each type of dementia requires a radically different approach. What helps in one case can harm in another. Generic “one size fits all” care is doomed to failure.

Detailed Concrete Examples by Pathology

For Alzheimer’s – Compensation and Routine Strategy:

Environment:

• Absolutely maintain strict routines (wake up 8am, breakfast 8:30am…)
• Large format calendar with only one visible day
• Labeled photos on all cupboards
• Objects always in same place
• Progressive elimination of choices (max 2 outfits)

Communication:

• One instruction at a time
• Repetition without annoyance
• Emotion validation (“I see you’re worried”)
• Avoid open questions
• Use touch and eye contact

Therapeutic activities:

• Chronological photo albums
• Music from their youth
• Reassuring repetitive activities (folding laundry)
• Simple gardening
• Animal presence

For vascular dementia – Prevention and rehabilitation:

Medical surveillance:

• Blood pressure 2x/day with logbook
• Strict medication compliance
• Stroke warning signs displayed
• Emergency number visible

Intensive rehabilitation:

• Daily physiotherapy
• Speech therapy if language problems
• Occupational therapy for autonomy
• Targeted cognitive stimulation

Specific adaptations:

• Grab bars everywhere
• Non-slip flooring
• Walker if needed
• Shower seat
• Raised toilet

For Lewy bodies – Safety and validation:

Hallucination management:

• Never confront (“It’s not real!”)
• Validate emotion (“That must be disturbing”)
• Gently redirect attention
• Improve lighting
• Eliminate shadows and reflections

Night safety:

• Mattress on floor if falls
• Adapted bed barriers
• Permanent night light
• Lighted path to bathroom
• Video surveillance if necessary

Drug precautions:

• List of forbidden drugs on fridge
• Medical alert bracelet
• Information to all caregivers
• Reference pharmacist informed

For frontotemporal – Structure and supervision:

Behavioral management:

• Ignore minor inappropriate behaviors
• Redirection without confrontation
• Sparse environment (fewer stimuli)
• Physical activities to channel
• Inflexible routine

Constant supervision:

• Never alone in public
• Card in pocket with contact information
• GPS tracker if wandering
• Maximum home security
• Sometimes gentle restraint necessary

Adapted communication:

• Very short and concrete sentences
• No irony or second degree
• Direct instructions
• Avoid complex explanations
• Use distraction rather than reasoning

When the Distinction Remains Unclear: Navigating Uncertainty

The Frustrating but Frequent Reality

In 20-30% of cases, despite all examinations, the exact type of dementia remains uncertain, especially in early stages. This gray area is frustrating but shouldn’t paralyze action.

Strategies in Diagnostic Uncertainty

Active and documented surveillance:

• Keep detailed symptom journal
• Videos of particular episodes (with consent)
• Monthly record of preserved/lost abilities
• Evolution often clarifies diagnosis

Pragmatic and cautious approach:

• Treat present symptoms
• Avoid potentially dangerous medications
• Non-pharmacological approaches priority
• Cautious and documented trial-and-error

Regular scheduled reassessment:

• Neuropsychological assessment every 6-12 months
• Annual follow-up MRI
• Diagnosis adjustment if new elements
• Second opinion after 12-18 months if doubt persists

Meticulous documentation:

• Daily logbook
• Dated photos/videos
• Centralized medical reports
• Sharing with all caregivers

Marie’s Example: An Evolving Diagnosis

“My mother was first diagnosed with Alzheimer’s. Then hallucinations appeared: diagnosis changed to Lewy bodies. A year later, a small stroke: we now talk about mixed dementia. It’s destabilizing, but at least we adapt treatment as we go. The important thing isn’t having THE absolute truth, but doing our best with what we know at each stage.”

The Message of Hope: Beyond Diagnosis

What Remains Possible, Always

Whether your loved one suffers from Alzheimer’s, vascular dementia, Lewy bodies or other, certain universal truths bring hope and direction:

Each person remains unique:

• Statistics are only averages
• Positive surprises happen
• Human resilience always amazes
• Love transcends disease

Progress remains possible:

• Sometimes long stabilization
• Improvement with good treatment
• Maintained quality of life
• Precious moments of lucidity

Quality of life takes priority over cure:

• Well-being possible at all stages
• Adaptations that change everything
• Small daily joys
• Preserved dignity

Support exists and works:

• Family associations
• Trained professionals
• Advancing research
• Comforting solidarity

Advances That Give Hope

Therapeutic research:

• New drugs in clinical trials
• Promising immunotherapies
• Increasingly early diagnosis
• Gene therapies on horizon

Growing understanding:

• Better understood mechanisms
• Identified modifiable risk factors
• Increasingly effective prevention
• Personalized care

Societal evolution:

• Progressive destigmatization
• “Dementia-friendly” cities
• Professional training
• Caregiver recognition

Conclusion: The Crucial Importance of Understanding and Naming Correctly

Abandoning the vague and harmful term “senile dementia” for a precise and modern diagnosis isn’t just a matter of vocabulary or medical rigor. It’s a fundamental act that:

Recognizes the person in all their uniqueness: Each form of dementia affects differently, requires unique care. Your loved one isn’t “a demented person” but a person with a specific pathology who deserves a personalized approach.

Opens the door to the best possible care: Only a precise diagnosis allows access to appropriate treatments, avoids potentially serious medication errors, and implements the most effective care strategies.

Respects fundamental human dignity: Reducing cognitive difficulties to age (“it’s normal, he’s old”) is a form of ageist discrimination that deprives of care and hope. Each person, regardless of age, deserves investigation into the true cause of their difficulties.

Allows access to therapeutic innovations: Clinical trials, new medications, innovative approaches require precise diagnosis. Staying in the vagueness of “senility” closes these doors.

If you recognize your situation in these lines, if you’re experiencing this diagnostic uncertainty or fighting against the reductive label of “senile dementia,” wait no longer. Demand a precise diagnosis. Consult a specialist. Ask for a second opinion if necessary.

Your loved one deserves better than an obsolete label. They deserve a modern diagnosis, appropriate treatment, personalized care. You deserve to understand what’s happening, to have clear answers, to know how to act.

The road will be long, sometimes difficult, but with the right information, the right tools and the right support, it remains manageable. Each type of dementia has its specific challenges, but also its solutions, its strategies, its hopes.

Our training “Understanding Alzheimer’s Disease and Finding Solutions for Daily Life” accompanies you in this process of understanding and action. We guide you through these complex but crucial distinctions. We give you concrete tools for each situation, specific strategies for each type of dementia, resources so you don’t exhaust yourself.

Because understanding is already acting. Because each dementia requires a unique approach. Because your loved one deserves the best possible care, based on precise diagnosis and not obsolete prejudices.

Don’t stay in the fog of “senile dementia.” Enter the clarity of modern diagnosis and adapted care. Your loved one and you deserve this clarity, this precision, this enlightened hope.