Let’s Talk About Alzheimer’s Signs and Symptoms
With Alzheimer's, changes in thinking and capabilities tend to become more obvious every six months or so. by Linda Rodgers Health Writer
The first signs of Alzheimer’s disease can be subtle—you spend a lot of time searching for things you’ve misplaced or repeat stuff over and over. About one in ten people over 65 have Alzheimer’s disease, or nearly 6 million people, according to the Alzheimer’s Association. All have one thing in common: Over time, their memory gets worse and they require more and more help to go about their lives.*
Our Pro Panel
We went to some of the nation’s top experts in Alzheimer’s to bring you the most up-to-date information possible.
Zoe Arvanitakis, M.D.
Medical Director; Professor of Neurological Studies
Rush Memory Clinic; Rush Medical College
Andrew E. Budson, M.D.
Professor of Neurology
Veterans Affairs Boston Healthcare System and Boston University School of Medicine
Suzanne Craft, Ph.D.
Professor of Gerontology and Geriatric Medicine
Wake Forest School of Medicine
Forgetting things is common, especially the older you get, since it sometimes takes a while for your brain to retrieve information, even info you’ve used daily for years. Poor sleep and stress can also do a number on your ability to remember. But what distinguishes memory loss in Alzheimer’s is the pattern—not an occasional struggle to remember something but something that happens daily.
Repeating stories or questions over and over is a big red flag. Of course, everyone repeats a story now and then, but halfway through, you probably say, "Oh my God, I told you that already, didn't I?" Again—it’s the pattern. When you’re telling the same stories to the same people again and again and again, or asking the same questions over and over and over again, that's not normal, and should be checked out by a doctor.
Because you can do things that will help you live a fuller life. Getting diagnosed with the disease can put you under the care of a specialist (like a neuropsychologist or geriatric psychiatrist). They can recommend drugs that can boost your memory for a year or two if you have mild Alzheimer’s, or at least bump up your day-to-day functioning if you’re in the moderate stage. Your provider can put you in touch with clinical trials, where researchers are studying the effects of drugs that may slow the decline. And just making simple changes—exercising more, eating healthier, quitting smoking—can improve your mood and your health, which in turn can improve your brain.
It may be a few years or never. Memory loss is unpredictable. Some people will remember and recognize faces, especially those of family members they saw regularly before they had dementia. If you were a big part of your grandmother’s life, then she’ll probably continue to remember your face and possibly your name (with prompting). Remember too that some days are better than others, so if she forgets who you are on one visit, she may have no problem the next one.
*So absolutely, Alzheimer’s is a sad and serious disease. And while there’s no cure or even a way to stop the progression, there are ways to slow the decline so you can have more time to live a happy and productive life. The key is to catch the disease at its earliest possible stages. If you’re worried that you’re forgetting things more than you used to, check out the signs below and then book that appointment with your doctor for a full screening. Once you know what’s driving your symptoms, you’ll know what to do next to help treat them.
What Is Alzheimer’s Disease Again?
Alzheimer’s is the most common form a dementia, a broad term doctors use to describe the loss of memory and other thinking skills caused by the many things that can damage your brain.
In Alzheimer’s disease, that damage is caused by normal proteins, called beta-amyloid and tau, that start to build up and spread in the brain as many as 20 years before symptoms show up. The beta-amyloid sticks together in clumps, called plaques, and the tau proteins link together to form long strands that tangle in the brain.
No one knows exactly why these proteins proliferate. It could be a combination of risk factors, including genes, chronic conditions like diabetes or high blood pressure, and your age—the older you are, the higher the chances of developing Alzheimer’s. Both the plaques and tangles choke off the energy supply that brain cells need to function, and they break off cells’ ability to signal to one another. At first, this affects the temporal lobes and hippocampus, the parts responsible for storing newer memories and learning information.
Eventually, as the plaques and tangles spread, more brain cells die off (because they’re not getting enough nutrients) and more parts of the brain are damaged, including the areas that control emotion, behavior, reasoning, and language.
Alzheimer’s is a progressive disease, which means it gets worse over time. Some people decline more quickly than others, but usually you can see changes in thinking and capabilities over a stretch of six-month periods and certainly year to year.
What Are the Different Stages of Alzheimer’s?
To track the progression of the disease, experts have come up with five different stages of the disease.
1. The Preclinical Stage
This is when the beta-amyloid and tau proteins start to build up in the brain. This would only be noticeable via sophisticated imaging tests called amyloid PET scans. And you’d only get one if you participated in a research study or clinical trial if, say, you’re at high risk for the disease because your parents or siblings had it. In a few years, thanks to a new blood test that can detect these proteins, people may be able to find out at this stage that their chance of developing Alzheimer’s is greater than average—and actually do something to slow the decline by years.
2. Mild Cognitive Impairment (MCI)
Doctors consider this a transitional phase that affects between 10% and 20% of people over 65. When you have MCI, you have more problems with your memory than someone of your age and education level, but the issues are still relatively isolated and you’re able to go about your life without help. Roughly 50% of people with MCI eventually develop Alzheimer’s or another form of dementia. But even with MCI there’s a good chance you’ll stay at this stage and may even recover your memory. That’s because your MCI may be caused by a treatable condition (like low thyroid, Lyme disease, or even depression) but also because lifestyle changes like diet and exercise as well as managing chronic conditions like high blood pressure can lower your chances of developing dementia.
3. Mild Alzheimer’s
Most people get diagnosed at this stage, which is the first stage of dementia, since memory issues have become noticeable enough to interfere with daily life. That’s how doctors define dementia—when your memory loss and decline in thinking make day-to-day tasks like shopping or driving more difficult to do independently. But even at this stage you can take medications and do things that will boost your memory, at least for a year or two.
4. Moderate Alzheimer’s
This stage lasts the longest, and it’s the phase that most people associate with the disease. At this point, your symptoms interfere with many everyday activities and you’ll need help for things like meal prep, getting dressed, and getting around. That help may come from professional aides, but most of the time, it’s family members who step up to provide the care and attention their parents, spouses, or relatives need. In fact, more than 16 million Americans provide roughly 18.6 billion (yup, billions) of hours of unpaid care a year—and 57% of them provide it for at least four years, if not more.
5. Severe Alzheimer’s
This is the last phase, and people usually require care 24/7. By the end, most patients are pretty much confined to their beds since walking becomes harder.
What Are the Signs of Alzheimer’s Disease?
Our thinking abilities exist on a spectrum, so it’s not like you’re going from remembering everything to missing meetings and getting lost while driving. In the very earliest stages of the disease the changes will be so slow and subtle you may not even pay attention to them. That’s why it helps to know what’s normal as you get older and what’s not.
In a nutshell, as we get older we might forget things—why we just walked into the kitchen or where you stowed your reading glasses (again!)—but after a prompt or two or by retracing our steps we remember. When you have Alzheimer’s, you can’t remember at all, no matter how many hints you get. That’s because the brain cells in your hippocampus are damaged and can no longer store short-term memories and information.
Not everyone with Alzheimer’s experiences the same symptoms at the same time or even all of these symptoms—and in truth, the boundaries between stages aren’t clear-cut. The disease may take years to progress or you may decline more quickly. What comes next is going to be tough reading. This is a tough disease to experience—and an even harder one to watch happen to someone you love.
Here's one thing to remember, though, if this is happening to someone close to you: At first, they may have a basic understanding that their memory and ability to think clearly is slowly getting worse, and they may even downplay their problems. Later on, when the disease is worse, this awareness fades.
Signs of Mild Cognitive Impairment
A cognitive test can catch MCI and a doctor will give you one because you or someone close to you has noticed you’re much more forgetful these days. The difference between this stage and mild dementia is that these early symptoms don’t get in the way with your regular life that much. You can still drive, still carry on conversations, and still work. It’s just that you might not be as fast or efficient as you once were.
What this looks like:
You take longer to do chores that require several steps, like paying bills or hooking up a new printer to your computer.
You forget to pick up your prescriptions or miss appointments more often.
You start to misplace things like keys and your glasses more frequently.
You occasionally have trouble finding the right word or where you parked your car.
You feel apathetic, depressed, or irritable.
Signs of Mild Alzheimer’s
Doctors distinguish mild dementia from MCI because mild dementia typically affects more than one area of thinking (say memory and language abilities); there’s a pattern to the decline that you can see year to year (or even every six months); and you just can’t do as many activities as you used to by yourself anymore.
What this looks like:
You lose important objects, like your cell phone, wallet, or credit cards.
You get lost while driving, even when you’re going to a familiar place like the supermarket.
You repeat questions or stories without realizing you’re doing so. For instance, you ask your spouse what day of the week it is several times a day or tell the same tale to the same people.
You really need to search for words and your conversation contains more pauses.
You’re no longer able to cook meals from even familiar recipes and struggle to keep track of the bills and household expenses.
You have trouble learning something new, like a card game.
You get overwhelmed when you plan an event, like your yearly holiday open house.
You make bad decisions about important things, like where to invest your money or giving crucial information to someone over the phone.
You get angry more often or feel depressed or lack the motivation to finish a project.
Signs of Moderate Alzheimer’s
All the symptoms above exist in a continuum, so with moderate Alzheimer’s, which can last years, you gradually lose the ability to do everyday things by yourself. Your confusion, memory issues, thinking skills, and personality changes also get worse or significantly different as the years go by. That’s because the disease is spreading to more areas of the brain and more of your thinking and behavior is being affected.
What this looks like:
You’re confused about where you are and may wander away from the car or the house.
You have trouble following a TV show or conversation.
You don’t understand what a lot of words mean, so it’s harder to read a book or do a crossword puzzle.
You can’t make the simplest meals, like a sandwich, unless someone’s there to help you.
You have problems dressing yourself.
You have outbursts, or your personality changes—you become suspicious or even paranoid or more apathetic.
You struggle to recognize people you don’t see often and have issues remembering things from the past.
You don’t sleep well or your circadian rhythm goes off track—you sleep more during the day and you’re up at night.
Your motor skills start to decline—you hunch over, you shuffle more, you lose your balance and fall.
You occasionally have bathroom accidents.
Signs of Severe Alzheimer’s
The last stage is the one people fear the most—and with good reason. You need constant care because there’s so much you can’t do—and it’s nearly impossible to have a conversation. It’s harder to walk around or even get out of bed. And as your brain shrinks more, you forget basic skills, including how to swallow near the end.
What this looks like:
You can’t dress or bathe yourself.
You stay in bed more often because it’s hard to get around without help.
You may have delusions or psychotic episodes.
You lose a lot of weight.
You can’t swallow or eat well.
You don’t know where you are.
You have trouble recognizing the faces of your partner, children, or close friends.
What to Do If You’re Worried About Memory Loss
Can’t figure out after reading this if your memory issues are normal or not? Book an appointment with your provider. Your primary care doctor will do the following to get to the root of the problem:
Take a complete medical history and ask you and a close family member about your symptoms
Get blood work that checks for vitamin deficiencies or underlying conditions that may be affecting your memory
Give you pencil-and-paper exams that put your thinking and memory skills to the test. You can score a possible 30 out of 30, but anything lower than 26 is a sign of impairment.
Give you a CT scan to rule out brain tumors or evidence of mini strokes
Depending on the results, your primary provider may refer you to a specialist, like a neurologist or a geriatric psychiatrist.
Living With an Alzheimer’s Diagnosis
It can seem as if your world is ending, but it’s never too late to get help. Medications like Aricept (donepezil) can boost brain chemicals involved in memory and learning so you’re able to remember the way you had six months or even a year before. And while these drugs (called cholinesterase inhibitors) can’t restore memory for people with severe Alzheimer’s, they can improve behavior and allow them to do more things independently.
There’s a lot you can do besides take medications, though. Diet, exercise, and staying involved in the community or with friends can help your brain as well as your overall health, as researchers involved in a large study in Finland (called Fingers) have discovered. For people with mild cognitive impairment it can cut their risk of declining further, but even those with Alzheimer’s can improve their mood and overall quality of life by staying as active as possible.
Researchers are also hard at work to find treatments that can slow the progress of the disease—and one drug is already close to being approved that can do just that. There’s hope for those with Alzheimer’s, so don’t give up yours.
Statistics on Alzheimer’s: Alzheimer’s and Dementia (2020). “2020 Alzheimer’s Disease Facts and Figures.” doi.org/10.1002/alz.12068
Stats on Alzheimer’s Caregivers: Centers for Disease Control and Prevention (2019). “Caregiving For a Person with Alzheimer’s Disease or a Related Dementia.” cdc.gov/aging/caregiving/alzheimer.htm
MCI Statistics: Practitioner (2017). “Diagnosing and Managing Mild Cognitive Impairment.” pubmed.ncbi.nlm.nih.gov/29120563/
MCI and Mood Changes: JAMA Psychiatry (2008). “Prevalence of Neuropsychiatric Symptoms in Mild Cognitive Impairment and Normal Cognitive Aging.” jamanetwork.com/journals/jamapsychiatry/fullarticle/482846
Differences Between MCI and Mild Dementia: Mayo Clinic Proceedings (2014). “Mild Cognitive Impairment and Mild Dementia: A Clinical Perspective.” ncbi.nlm.nih.gov/pmc/articles/PMC4185370/
Effects of Lifestyle Changes on Dementia Risk: Alzheimer’s and Dementia (2018). “Multidomain lifestyle intervention benefits a large elderly population at risk for cognitive decline and dementia regardless of baseline characteristics: The FINGER trial.” doi: 10.1016/j.jalz.2017.09.006