Signs and Symptoms of Alzheimer’s Disease

Alzheimer’s disease is a neurological condition that profoundly impacts cognitive functions such as memory, reasoning, and language. In the United States, over 6 million individuals aged 65 and above are affected by this disease.

It’s important to distinguish between Alzheimer’s disease and the term "dementia." While dementia is a broad term encompassing cognitive decline, including memory, thinking, and reasoning issues, Alzheimer’s specifically refers to a distinct disease.

In the early stages of Alzheimer’s, individuals may encounter difficulties with memory, word retrieval, and occasional lapses in judgment. The disease typically progresses from mild (early-stage) to moderate and eventually severe (late-stage) Alzheimer’s.

Symptoms

The symptoms of Alzheimer’s disease primarily involve disruptions in cognitive functions. When diagnosing Alzheimer’s, healthcare professionals consider the following major categories of symptoms:4

• Memory: In the early stage, individuals may experience difficulties remembering recent events and getting lost in familiar places. As the disease progresses, problems may arise in word retrieval, learning new concepts, and performing daily tasks.
• Executive functions, judgment, and problem-solving: This category involves difficulties in tasks such as setting goals, planning, and completing activities. Individuals may struggle with shifting from one task to another, regulating their response in different situations, and accomplishing small tasks that contribute to a larger objective. Often, these problems may go unnoticed until someone close to the person notices them.
• Visual-spatial: Some individuals with Alzheimer’s may experience visual problems, including difficulties in reading, judging distance, and identifying colors or contrasts.
• Language: Issues with speech and writing may become more apparent in the later stages of the disease, with individuals struggling to find the right words.
• Behavioral and psychological: These symptoms are typically more noticeable in moderate and severe stages of Alzheimer’s. They can include irritability, disinterest, social withdrawal, aggression, and wandering away from home.

In addition to these major symptom categories, individuals with Alzheimer’s may also experience the following:

• Difficulty performing motor tasks they previously knew well, such as getting dressed.
• Problems with detecting smells.
• Sleep disturbances, such as restless sleep.
• Seizures.
• Motor symptoms, including reflex issues and incontinence (loss of bladder control).

Early Warning Signs

As you age, it’s normal to experience some memory changes. However, if you or those around you notice the following issues occurring more frequently, it’s important to consider speaking to a healthcare provider for a comprehensive evaluation:6

• Memory loss that interferes with daily life: Forgetting important events, repeating oneself frequently, or needing constant reminders to stay on track.
• Difficulty planning or problem-solving: Struggling to manage tasks like paying bills or experiencing challenges in completing activities that involve multiple steps.
• Difficulty with familiar tasks: Briefly forgetting how to perform routine tasks like cooking, selecting an outfit, or using familiar technology.
• Confusion about time or place: Having difficulty determining when or where events occurred, such as not knowing how much time has passed or becoming disoriented in familiar surroundings.
• Visual-spatial problems: Trouble with estimating distances, frequently dropping objects, or experiencing frequent stumbling or tripping.
• New language difficulties: Struggling to find the right words when speaking or making more writing errors than usual.
• Misplacing items: Putting things in unusual or illogical places and being unable to recall how or why.
• Declining judgment: Experiencing challenges in managing finances, being more susceptible to scams, or having difficulty taking care of personal needs.
• Changes in social engagement: Losing interest in previously enjoyed social activities or having difficulty following conversations related to hobbies, sports, or current events.
• Mood and personality changes: Becoming easily upset, fearful, or displaying increased suspicion towards others.

Mild (Early-Stage) Alzheimer’s Disease Symptoms

During the early stage of Alzheimer’s disease, individuals often receive a diagnosis as symptoms become noticeable. In this mild stage, cognitive, behavioral, and personality changes begin to affect daily life on a frequent basis

Cognition:

• Memory loss is a common manifestation in various ways, including:
• Repeating questions
• Difficulty finding or recalling words, leading to challenges in conversations
• Frequent misplacement of objects
• Getting lost in familiar surroundings
• General confusion
• Losing track of dates and times

Other cognitive issues may include difficulties with:

• Problem-solving
• Planning
• Completing daily tasks such as managing finances, shopping, or personal care
• Making sound judgments and decisions

Behavior:

Individuals with mild Alzheimer’s may display the following behaviors:

• Wandering away from home
• Restlessness and excessive pacing
• Aggressive behaviors, such as hitting or slapping others
• Engaging in atypical sexual activities
• Reduced frequency of bathing or wearing the same clothes repeatedly
• Withdrawal from social activities, either due to loss of interest or challenges in following conversations and activities

Personality:

In the early stage of Alzheimer’s, individuals may experience new or intensified manifestations of:

• Anxiety
• Sadness
• Anger
• Apathy, characterized by a loss of interest in previously enjoyed activities
• Hallucinations and paranoia, leading to unfounded suspicions or mistrust of others
• Aggression

Moderate Alzheimer’s Disease Symptoms

In moderate Alzheimer’s disease, the areas of the brain responsible for language, reasoning, thought processes, and sensory perception are further affected. Individuals at this stage require increased assistance and supervision.

As the symptoms that were present in the early stage progress, new concerns arise. Cognitive, behavioral, and psychological changes become more pronounced, including difficulties in:

• Reading, writing, and using numbers
• Logical thinking and problem-solving
• Maintaining attention and focus
• Adapting to new situations
• Performing familiar tasks independently
• Recognizing familiar faces and people
• Emotion regulation, leading to inappropriate outbursts
• Impulse control, resulting in the use of vulgar language or inappropriate undressing
• Engaging in social activities
• Sensory perception, such as detecting and identifying sights and smells

Additionally, individuals may experience physical symptoms, including:

• Repetitive movements
• Muscle twitches
• Changes in sleep patterns, such as increased daytime sleepiness and restlessness at night

Severe (Late-Stage) Alzheimer’s Disease Symptoms

In the late stage of Alzheimer’s disease, significant changes occur in the brain, resulting in physical shrinkage of brain tissue. Individuals with severe Alzheimer’s are typically unable to communicate effectively and require full assistance with their daily care. They experience a wide range of physical concerns and rely entirely on their caregivers. They are often bedridden or spend most of their time in bed.

At this stage, individuals with late-stage Alzheimer’s may struggle or be unable to perform the following tasks:

• Communication: They have difficulty expressing themselves and understanding others.
• Awareness of surroundings and recent experiences: They may have limited or no awareness of their environment or recent events.
• Swallowing: Difficulties in swallowing may arise, leading to complications such as aspiration pneumonia.
• Bowel and bladder control: They are unable to control their bowel and bladder functions.
• It is important to note that aspiration pneumonia, caused by food or liquid entering the lungs instead of the airway, is a common cause of death in people with Alzheimer’s disease.

In addition to the cognitive and functional challenges, individuals in the late stage of Alzheimer’s may also experience various physical issues, including:

• Weight loss and decreased appetite
• Dental, tooth, and foot problems
• Increased sleeping
• Seizures (occurring in 10-20% of all Alzheimer’s cases)

When to See a Healthcare Provider

If you are experiencing memory or cognitive issues that are interfering with your daily life, it is important to seek guidance from a healthcare provider. Additionally, if people around you have noticed changes in your mood, personality, or ability to complete tasks, it is worth considering a conversation with a healthcare professional.

To begin, you can schedule an appointment with a primary care doctor who can assess your condition and provide initial guidance. Depending on their evaluation, they may refer you to a neurologist, who specializes in brain and spinal cord conditions, or a geriatrician, who specializes in aging and care for older adults. A neuropsychologist can conduct memory and cognitive assessments, while a geriatric psychiatrist can evaluate any emotional difficulties you may be experiencing.

Seeking medical attention as soon as you or others observe changes in your cognitive abilities can lead to earlier and more effective Alzheimer’s treatment. It is also possible that the symptoms may be caused by another treatable or curable condition, such as vitamin D deficiency or medication side effects.

Remember, consulting with a healthcare provider will help provide a proper evaluation, diagnosis, and appropriate care for your specific situation.

Rapid recap

While occasional memory or cognitive issues are common with aging, Alzheimer’s disease leads to dementia and significant cognitive loss that interferes with daily life. Initially, Alzheimer’s affects cognition, personality, and behavior, eventually progressing to difficulties with basic tasks and a loss of communication and self-care abilities.

If you or those around you notice changes in thinking, personality, or mood, it is important to seek advice from a healthcare provider. This can include a primary care doctor, neurologist, or geriatrician, who can help rule out other potential causes and initiate early Alzheimer’s treatment and planning as necessary. Taking action and seeking professional guidance can lead to appropriate support and care.