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Dementia is a group of irreversible illnesses that progressively rob people of the ability to remember, think, speak, walk, or care for themselves, ultimately rendering them bedbound, mute, and incontinent before taking their lives. Caused by degeneration and loss of brain tissue, dementia is among the most dehumanizing of the many diseases seen by hospice workers, attacking the cognitive functions that make us unique – funny, loving, accomplished, smart, kind -- and able to manage our day to day lives at work, home, transportation, dining, socializing.., everything.
Alzheimer’s Disease is a neuropathologic disease of the brain; Alzheimer’s Dementia is the resulting clinical syndrome. Alzheimer’s Dementia is most common form of dementia in the United States, accounting for 60–80% of cases. In 2024, it affected approximately 6.9 million adults aged 65 and older, with 13.8 million cases expected by 2065. It is characterized by the insidious onset of cognitive impairment, most commonly subtle memory loss, especially the ability to retain recently acquired information. Other basic cognitive skills, such as the ability to dress, bathe, name objects, and follow simple instructions are relatively spared in the early stages. Memory loss and cognitive impairment progress over years, ultimately causing complete physical and mental incapacitation and total dependence on others.
Mild cognitive impairment (MCI) may precede all forms of dementia, including Alzheimer’s Dementia. MCI is distinguished from early dementia by the preservation of independent daily functioning, including tasks (more complex than bathing and dressing) such as managing scheduled medications, shopping, meal preparation, and household chores, though mild difficulties occur and may be noticeable to others. MCI may also include problems with semantic memory (such as difficulty naming common objects in photographs or recalling the dates of well-known events), and episodic memory (recall of recent personal events or forgetting important personal information such as appointments). These impairments may be seen in isolation or in combination, may persist or resolve spontaneously, or may progress to dementia. People with isolated episodic memory impairment have the highest risk of progression to Alzheimer’s Dementia, whereas those with impaired cognition other than memory loss are more likely to progress to non-Alzheimer’s dementias such as Frontotemporal Dementia, Dementia with Lewy Bodies, or Vascular Dementia, though this association is not definitive.
Normal aging is also associated with declines in memory and cognitive functions -- a possible cause for alarm in people with an understandable fear of developing dementia. Fortunately, the deficits that come with age do not interfere with independence and daily functioning, and are not associated with the onset of dementia. Memory changes are benign and typically involve forgetfulness for names and where common objects are located (misplaced your car keys or glasses lately?); cognitive decline is likewise benign, including, for example, difficulty with tasks requiring divided attention, multitasking, or needing more time to respond to questions. Brief memory lapses in normal aging are minor, stable over time, and do not progress. Daily functioning is preserved, and deficits may only be apparent to the individual.
Interested in learning more about dementia? This blog is excerpted in part from the contribution by Joseph Sacco, MD, CMO, The Connecticut Hospice, Inc., to Alzheimer’s Disease and Dementia: A Guide for Hospice Clinicians, published by the Hospice Foundation of America, available in March 2026.
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