The brain changes that lead to cognitive and behavioral changes referred to as dementia have multiple potential etiologies; not all dementia is Alzheimer disease.
Dementia is not a single disease and not all dementia is Alzheimer disease, a common misconception in the general public and likely among patients in your practice. The clinical syndrome called dementia is characterized by progressive decline in one or more cognitive domains, ie, memory, executive function, language, visuospatial ability, and behavior, that is sufficient to cause difficulty with daily functioning. The underlying neuronal loss and dysfunction in nerve transmission are the result of neurodegeneration and/or cerebrovascular injury.
The pathophysiology, symptomatology, and progression of dementia will vary by individual and by the underlying etiology. Mixed pathologies are common and particularly in older adults, but most people will present with symptom patterns that are characteristic of a major dementia subtype.
The slide show above, based on the Alzheimer's Association report, 2025 Alzheimer's disease facts and figures, summarizes the brain changes, estimated prevalence, and the symptoms for dementia resulting from 7 common etiologies:
Dementia is not a normal part of aging; although cognitive changes are expected in later adulthood, they are typically more subtle than the disruptive deviations of dementia.
The progression of dementia, across all types, is typically described in 3 stages: early (mild), middle (moderate), and late (severe). Changes in the early stage are generally subtle, especially in memory or language, and often attributed to the aging process. As the neurodegenerative process continues, individuals need increasing assistance with instrumental and eventually basic activities of daily living. Behavioral and psychiatric symptoms, such as apathy, depression, disinhibition, and even delusions, may emerge, and in late-stage disease, patients often lose functional independence entirely.
Symptoms do frequently overlap but a precise diagnosis is essential as ongoing treatment, both pharmacologic and behavioral, may may have differential efficacy depending on the underlying etiology.
Alcohol Use at Any Level Linked to Higher Dementia Risk, Large Study Finds
September 24th 2025A study of more than 559 000 adults and 2.4 million genetic samples found that alcohol consumption of any amount increases dementia risk, challenging prior evidence of protective effects from light drinking.