A report by Bloomberg indicates that Alzheimer’s disease—currently considered the sixth-leading cause of death in the US—is being under-reported and is, in fact, the third-leading cause of death.

The report is based on a study published by Neurology that found the discrepancy is largely due to paperwork, with far too few death certificates listing the memory-robbing disease as the cause of death. Bloomberg notes that death certificates often list the immediate cause of death, as opposed to accounting for context—in this case, dementia.

The Alzheimer’s Association’s fact sheet acknowledges this discrepancy, noting that “if you do not die from Alzheimer’s disease, you die with it.” The association says 33% of seniors die with Alzheimer’s or another form of dementia.