Derek Burnett
Derek Burnett is a Contributing Writer at Bottom Line Personal, where he writes frequently on health and wellness. He is also a contributing editor with Reader’s Digest magazine.
It’s a common experience for people of a certain age to wonder, after walking into a room, just what it was they’d gone in there for. Or to suddenly and inexplicably be unable to think of a common word when they need it. Or to realize that they don’t have their reading glasses with them and can’t imagine where they’ve left them. In such moments, it’s perfectly natural to entertain the terrifying thought, “Good God. Could these be early symptoms of Alzheimer’s?”
Usually, luckily, the answer is going to be, “No.” As annoying as such occurrences are, they’re perfectly in keeping with normal age-related loss of short-term memory. But certainly when Alzheimer’s does begin to set in, it must be marked by similar episodes, right?
Perhaps. But to better help you sort out these instances of normal brain aging from something much more serious, it’s good to learn a little about Alzheimer’s signs and symptoms.
The key to bear in mind is that Alzheimer’s disease is progressive; it gets worse and worse, and its symptoms exist on a continuum, meaning that the cognitive abilities of someone in the early stages of the disease appear quite different than those of someone in later stages. If you’ve experienced forgetfulness at roughly the same frequency and severity for the last five, 10, or 15 years, that doesn’t fit with the pattern of Alzheimer’s, which progresses quickly enough that most people don’t survive beyond eight years.
The brain changes that occur in people with Alzheimer’s—especially the buildup of amyloid plaques and neurofibrillary tau tangles—may begin up to 20 years before any symptoms are detected. Researchers can test for biomarkers of such changes, but this is not now a part of routine medical care. Most people who end up with an Alzheimer’s diagnosis have no forewarning. They discover the problem by experiencing rapidly worsening cognition, not by screening while they’re young and healthy.
The first symptomatic stage of Alzheimer’s is called Mild Cognitive Impairment (MCI) due to Alzheimer’s. Someone in this stage will begin to notice cognitive deficits, especially in short-term memory, since the disease often first affects the part of the brain called the hippocampus, which plays a direct role in short-term memory. The cognitive decline experienced by people with MCI is not severe enough to prevent them from living independently. Nor is MCI necessarily a precursor to Alzheimer’s. Only about a third of those diagnosed with MCI go on to develop dementia.
Once someone believes they’re experiencing cognitive lapses more severe than those attributable to normal aging, they should talk to their doctors to investigate further. After performing a basic evaluation, the primary care doctor may refer the person to a specialist for more sophisticated cognitive examinations and imaging tests to make or rule out an Alzheimer’s diagnosis.
When the cognitive problems associated with Alzheimer’s disease become unmistakably more severe than those associated with MCI, we say that the person is in the early, or mild, stage of Alzheimer’s itself. As just one example, someone with MCI might struggle to remember where they left their car keys, whereas someone with early Alzheimer’s might not only not know where their keys are, but might have put them someplace strange, like in their bathroom medicine cabinet, and then forgotten about them.
Early Alzheimer’s symptoms typically involve problems with memory, thinking, and language. During this stage, most long-term memories will remain intact while it becomes increasingly challenging to retain new information. For example, this person will remember things from long ago—even complex things like how to use a computer—but struggle to recall what happened earlier in the day. A classic early sign of Alzheimer’s is asking the same question multiple times in the space of a couple of minutes. He or she hears and understands the response each time it’s given, but it is not retained.
People in this stage find it considerably easier to take in and understand language than to generate it. They often struggle to come up with the right words for things, and sometimes talk their way around them (for example, saying, “The thing you write with,” rather than, “pen”). Note that this is quite different from someone with normal age-related brain changes who struggles to produce a more abstract word like “antagonistic” or “capriciously.”
The thinking problems in people with early Alzheimer’s tend to center on trouble orienting oneself in time and place. They may forget the day, the hour or the year, and they might struggle to find their way around unfamiliar settings. Although people in the mild stages can usually handle some household tasks, their ability to manage finances quickly diminishes.
During this stage of the disease, the language, thinking, and memory problems worsen. Solidly fixed information, like the person’s birthday or how to use a toaster, may remain, but he or she may begin confusing the names of friends or relatives. During this stage, it’s not unusual to begin to observe what appear to be personality changes, as the person’s judgment in social situations begins to lapse. For example, someone who’s been prudish their whole life might now begin making lewd remarks in inappropriate social settings, or may begin to withdraw from gatherings out of embarrassment. Communication becomes increasingly difficult as they struggle to recall the names of objects or has trouble formulating sentences. As a fallback, they may start to repeat rote phrases. Often, people in the moderate stage of Alzheimer’s become irritable or depressed.
When a person reaches the final stages of Alzheimer’s, they require supervision or hands-on help for most, and then virtually all, of the activities of daily living. They may have forgotten, for example, what a toothbrush is for. Often, they become agitated, aggressive, and disoriented—especially around evening time, a phenomenon known as “sundowning.” Some of these behaviors stem from delusions and hallucinations.
Most people with late-stage Alzheimer’s can remember their own names, but struggle to recognize even their closest family members, especially if those people are not part of their daily routine. How much language ability remains in severe Alzheimer’s is highly variable, with some people continuing to speak, albeit with difficulty, and others becoming nonverbal. Even the long-term memories and skills that remained intact throughout much of the course of the disease begin to fade away during the final stages.
