It’s also important to note that some individuals with MCI revert to normal cognition or do not have additional cognitive decline. In other cases, such as when a medication inadvertently causes cognitive changes, MCI is mistakenly diagnosed and cognitive changes can be reversed. Identifying which individuals with MCI are more likely to develop dementia is a major goal of current research. Dementia due to Alzheimer’s Disease Dementia due to Alzheimer’s disease, or Alzheimer's dementia, is characterized by noticeable memory, thinking or behavioral symptoms that impair a person’s ability to function in daily life, combined with biomarker evidence of Alzheimer’s-related brain changes. As Alzheimer's progresses, individuals commonly experience multiple types of symptoms that change with time. These symptoms reflect the degree of damage to nerve cells in different parts of the brain. The pace at which symptoms of dementia advance from mild to moderate to severe differs from person to person. Mild Alzheimer’s Dementia In the mild stage of Alzheimer’s dementia, most people are able to function independently in many areas but are likely to require assistance with some activities to maximize independence and remain safe. They may still be able to drive, work and participate in favorite activities. Moderate Alzheimer’s Dementia In the moderate stage of Alzheimer’s dementia, which is often the longest stage, individuals may have difficulties communicating and performing routine tasks, including activities of daily living (such as bathing and dressing); become incontinent at times; and start having personality and behavioral changes, including suspiciousness and agitation. Severe Alzheimer’s Dementia In the severe stage of Alzheimer’s dementia, individuals need help with activities of daily living and are likely to require around-the-clock care. The effects of Alzheimer's disease on individuals’ physical health become especially apparent in this stage. Because of damage to areas of the brain involved in movement, individuals become bed-bound. Being bed-bound makes them vulnerable to conditions including blood clots, skin infections and sepsis, which triggers body-wide inflammation that can result in organ failure. Damage to areas of the brain that control swallowing makes it difficult to eat and drink. This can result in individuals swallowing food into the trachea (windpipe) instead of the esophagus (food pipe). Because of this, food particles may be deposited in the lungs and cause lung infection. This type of infection is called aspiration pneumonia, and it is a contributing cause of death among many individuals with Alzheimer’s (see Mortality and Morbidity section, page 28). When Dementia-Like Symptoms Are Not Dementia It is important to note that some individuals have dementia-like symptoms without the progressive brain changes of Alzheimer’s or other degenerative brain diseases. Causes of dementia-like symptoms include depression, untreated sleep apnea, delirium, side effects of medications, Lyme disease, thyroid problems, certain vitamin deficiencies and excessive alcohol consumption. Unlike Alzheimer’s and other dementias, these conditions often may be reversed with treatment. Consulting a medical professional to determine the cause of symptoms is critical to one’s physical and emotional well-being. Normal Age-Related Cognitive Changes or Symptoms of Dementia? The differences between normal age-related cognitive changes and the cognitive changes of Alzheimer’s dementia can be subtle (see Table 2, page 10). People experiencing cognitive changes should seek medical help to determine if the changes are normal for one’s age, reversible or a symptom of Alzheimer’s or another dementia. The Medicare Annual Wellness Visit, available to all Medicare enrollees each year at no cost, includes a cognitive evaluation and is an opportune time for individuals age 65 or older to discuss cognitive changes with their physician. Signs of Alzheimer’s Dementia Typical Age-Related Changes Memory loss that disrupts daily life: One of the most common signs of Alzheimer’s dementia is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events, asking for the same information over and over, and increasingly needing to rely on memory aids (for example, reminder notes or electronic devices) or family members for things that used to be handled on one’s own. Sometimes forgetting names or appointments, but remembering them later.