Memory Impairment May Not Be First Sign of Alzheimer's

Because Alzheimer’s disease is thought to develop for years before symptoms become evident, the earliest possible detection is very important, so that the onset of the disease may be delayed and the overall care improved through the years.

Because Alzheimer’s disease is thought to develop for years before symptoms become evident, the earliest possible detection is very important, so that the onset of the disease may be delayed and the overall care improved through the years, and hopefully, as therapies are developed, reversed. But how do you know if you or your loved one may have it?

The 2016 Alzheimer's Association International Conference in Toronto provided a gold mine of new information about how Alzheimer’s Disease develops. One of the studies presented at the conference upended much of the prevailing thought that memory problems were the first sign.

Indeed, the new study showed that behavioral changes affected 80 percent of those who were diagnosed with mild cognitive impairment (MCI) which for many people is a precursor to Alzheimer’s. These behavioral changes often became evident well before noticeable problems with memory.

The Cumming School of Medicine, University of Calgary, Canada, presented the report at the conference saying that changes to personality and behavior may arise even before MCI is diagnosed. The researchers feel that these changes can provide an early sign of Alzheimer's-related neurodegeneration.

Study co-author Zahinoor Ismail, M.D., and his colleagues at Cumming School of Medicine have developed a 38-point checklist, which they call the mild behavioral impairment checklist (MBI-C), to help doctors identify these changes and measure their progression over time. The MBI-C is based on modifications to the current neuropsychiatric inventory questionnaire (NPI-Q) which is currently used to assess the presence of personality and behavioral changes among people thought to be developing dementia.

The questions in the MBI-C fall into five categories:

  • Apathy/drive/motivation

  • Mood/affect/anxiety

  • Impulse control/agitation/reward

  • Social appropriateness

  • Thoughts/perception

The researchers have expressed hope for the future of the MBI-C, that after vetting and further research among the Alzheimer's community, families may be able to gain access to help monitor symptom changes in their loved one. As a veteran family caregiver, I can see enormous value in educating people from middle age on about these possible early signs of AD.

Yes, personality changes can be a sign of many things, including mental illness or drug abuse. However, spouses and adult children can use this new tool to record subtle changes in a journal, noting whether they seem to be increasing in frequency or intensity. This could provide, a doctor with useful information about the patient’s history, to guide further testing.

More Possible Signs of Alzheimer’s

  • Changes in gait (slowing down): As far back as 2012, five studies presented at the Alzheimer’s Association International Conference in Vancouver showed that changes in gait can be an early sign of developing Alzheimer’s disease. William Thies, chief medical and scientific officer of the Alzheimer's Association, told Medical News Today:

    "These studies suggest that observing and measuring gait changes could be a valuable tool for signaling the need for further cognitive evaluation… For busy doctors who have limited time with their patients, monitoring deterioration and other changes in a person's gait is ideal because it doesn't require any expensive technology or take a lot of time to assess. It is relatively simple and straightforward."

  • Changes in sense of humor: Researchers at the University College London’s Dementia Research Centre have found that a change in sense of humor could be an early sign of dementia. The findings, published in the 2016 Journal of Alzheimer’s Disease, could help improve dementia diagnosis by highlighting changes not commonly thought to be linked to the condition.

    “As sense of humour [sic] defines us and is used to build relationships with those around us, changes in what we find funny has impacts far beyond picking a new favourite TV show," said Camilla Clark, M.D., who led the research at the UCL Dementia Research Centre. "We’ve highlighted the need to shift the emphasis from dementia being solely about memory loss. Cognitive, mental, and personality changes don’t necessarily signal Alzheimer’s disease. Dementia-like behavior can be caused by myriad health issues, including infections, medication dosages and interactions, thyroid issues, and other problems. Disturbing changes should prompt a visit to the doctor.

Also remember that Alzheimer’s is only one of many types of dementia. Worrisome symptoms should be checked by a doctor skilled in determining what is happening with a patient,and if dementia is suspected, what type of dementia it may be.

Tools that can be made available to family members can be valuable to both families and doctors when people are concerned about a loved one’s cognitive health.

Carol Bradley Bursack
Meet Our Writer
Carol Bradley Bursack

Carol Bradley Bursack is a veteran family caregiver who spent more than two decades caring for a total of seven elders. This experience provided her with her foundation upon which she built her reputation as a columnist, author, blogger, and consultant. Carol is as passionate about supporting caregivers work through the diverse challenges in their often confusing role as she is about preserving the dignity of the person needing care. Find out much more about Carol at