Most People With Alzheimer's Feel This First, Including Difficulty Planning
A 2022 study shows 1 in 10 Americans over 65 have dementia, and 22% experience mild cognitive impairment, one of the earliest signs of senility. An estimated 6.5 million Americans over 65 have Alzheimer's, the most common form of dementia—a figure that is expected to more than double. "Close to 13 million Americans will have Alzheimer's by 2050, if we don't have a cure or a treatment that slows the disease down," says neurologist James Leverenz, MD. "A lot of our research is focused on identifying correctly whether people have Alzheimer's, but then also we know the changes in the brain that we see with Alzheimer's tend to occur many years before symptoms start. So we're starting to think that we can identify people who are at high risk for moving on to memory loss and other Alzheimer's related changes."
While there is no cure for dementia, certain lifestyle factors can make a difference. "Whatever is good for your heart's going to be good for your brain," says Dr. Leverenz. "So exercise, a good diet. We're increasingly seeing that people who stay socially active and stay active in their lives in other ways, will do much better with the disease. And it may even stave off the earliest onset of the symptoms. So the usual things, be active, stay out there, be social if you're up to it. And it's very common for people when they first get Alzheimer's, one of the first symptoms besides the memory loss, is that loss of interest in being active. And so if you know somebody, a spouse, a relative, where they're becoming more and more withdrawn, besides things like depression, it's good to see if they're struggling with memory loss, it may be helpful to get them involved in activities."
Early detection and diagnosis is key for treatment and support. "The earlier that Alzheimer's and other dementias are diagnosed, the sooner people and their families can receive information, care, and support," says the CDC. "As the compelling data indicate, many Americans are not being diagnosed early or told about their diagnosis." Here are the earliest symptoms of Alzheimer's disease, according to experts. Read on—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.
Mild Cognitive Impairment
People with mild cognitive impairment are fully capable of living independent lives but struggle with memory issues and confusion and may not remember where they are supposed to be or what they are supposed to be doing. "What they have to go through to do so is exhausting," says Laura Baker, a professor of gerontology and geriatric medicine at Wake Forest University School of Medicine in Winston-Salem, North Carolina. "'Let me check my calendar. Oh, I forgot to write on this calendar. Let's check another calendar. Oh, I can't find that calendar. I've lost my phone. Where is the key? I can't find the key.' They're able to regroup in the early stages and accomplish things, but the toll is immense."
Research shows 10-20% of people over 65 with mild cognitive decline will go on to develop dementia and Alzheimer's. Early diagnosis is crucial, as sometimes MCI can be caused by something that can be reversed. "For example, someone's thyroid could not be functioning properly. That's something we can treat, and then they get better," says Carolyn Fredericks, MD, a Yale Medicine neurologist who specializes in cognitive and behavioral conditions, including dementia. "Or someone might have severe sleep apnea, which is shocking in terms of how much cognitive impairment it can cause."
Memory loss that gets progressively worse is one of the earliest and most common signs of Alzheimer's. "The earliest symptoms of the illness generally involve short-term memory loss, such as forgetting conversations or appointments," says Laura Goldstein, MD, a neurologist at Northwestern Medicine. "Regular exercise, healthy diet, remaining cognitively and socially engaged can protect against age-related cognitive loss. Control of vascular risk factors — for example, obesity, hypertension and diabetes — can also help. Recognition and treatment of depression may also be of value."
"So far, research suggests people who live a healthy lifestyle may be at a lower risk of being diagnosed with Alzheimer's disease," says Marla Bruns, MD, PhD, a neurologist at the Unity Memory Center at Rochester Regional Health. "A healthy lifestyle includes regular physical activity, a balanced and nutritious diet, limiting alcohol consumption, and not smoking."
Unexplained personality changes could be a sign of Alzheimer's disease. "Many times, when people develop Alzheimer's disease, their personality traits sort of become exaggerated," says neurologist Ronald Petersen, MD. "So if they're a genuinely nice person and have been quite affable throughout most of their life, that continues into the disease process. Occasionally, it happens that people do a 180. That is, the nice, little old grandmother throughout her whole life develops the disease and then starts talking like a sailor later on in life using words that she had never used throughout her life. If the disease process tends to affect, say, the frontal lobes of the brain, the frontal lobes are involved in our behaviors, our personalities, our right and wrong, inhibition, disinhibition. If that part of the brain becomes affected, then all of those features, all of those behaviors, start to change."
"Recognizing a big change in your own behavior or a loved one's behavior should warrant a conversation with a primary care provider," says Dr. Bruns. "Again, having access to assistance as early as possible can make a significant difference – both for the person living with Alzheimer's and their friends and loved ones."
Difficulty With Everyday Tasks
Struggling with tasks that used to be easy and/or constant could be a symptom of Alzheimer's. "Another part of the brain often affected by the Alzheimer's pathology is called the parietal lobe, which is located at the back of our brain," says Tianxu Xia, MD. "It is the key component for the processing of visual-spatial information, language, and higher cognitive functions such as calculation, attention, and executive functioning. Therefore, aside from memory difficulty, a patient with Alzheimer's disease may or may not experience early challenges in navigating, word-finding, planning, and figuring out complex day-to-day tasks, like how to manage their own finances and medical care."
Depression and mood swings are another symptom of Alzheimer's. "Our research found that even modest levels of brain amyloid deposition can impact the relationship between depression symptoms and cognitive abilities," says Jennifer Gatchel, HMS assistant professor of psychiatry and a geriatric psychiatrist at Mass General. "This raises the possibility that depression symptoms could be targets in clinical trials aimed at delaying the progression of Alzheimer's disease. Further research is needed in this area."
"Symptoms of Alzheimer's disease include the progressive loss of working- and long-term memory, confusion and disorientation, changes in fluency with regard to speech or writing, lowered ability to concentrate, compromised judgment and reasoning leading to questionable decision making, and changes in mood such as apathy, anxiety and depression which can result in social withdrawal," says Dr. Verna Porter, Director of the Dementia, Alzheimer's Disease and Neurocognitive Disorders Program at Pacific Brain Health Center. Depression, if left untreated, can exacerbate confusion and forgetfulness."