Neurologists share signs of Alzheimer’s disease that sufferers often forget

When we talk about Alzheimer’s disease, significant memory loss is the symptom that usually comes to mind. In reality, the disorder can manifest itself in many other ways.

“Most people expect Alzheimer’s disease to start with forgetting names or misplacing keys,” Dr. Majid Fotuhi, a neurologist and assistant professor in the department of neuroscience at Johns Hopkins University, told HuffPost. “Often the first changes are more subtle.”

These smaller signs are often overlooked or attributed to other causes.

“The first changes may be gradual and easily explained by stress, fatigue, aging or pushing yourself,” said neurologist Dr. Shaheen Lakhan. “People also fear the consequences of an assessment on their independence. »

We expect changes in the way we think and behave as we age, so it’s easy to erase things little by little over time.

“People find ways to compensate, and family members may start helping with certain tasks without even realizing it,” said Davide Cappon, director of neuropsychology at Tufts Medical Center. “Sometimes you only realize when you look back how much things have changed.”

And the person experiencing the changes may not even see them.

“In some people, the illness affects the awareness of their own difficulties,” Lakhan said. “This is called anosognosia. A person may sincerely believe that nothing has changed. Treating this as stubbornness can turn a neurological symptom into a family argument.”

None of the signs below necessarily mean a person has Alzheimer’s disease, and each has other possible causes. But experts say it’s worth paying attention.

“A previously cautious person starts missing payments, paying the same bill repeatedly, or making financial decisions that don’t work for them,” Lakhan said. “A new type of difficulty, especially alongside other changes, deserves our attention.”

They may become more vulnerable to scams, start making weird purchases, or even give out money in a way that’s unlike them.

“Someone who has always been very organized may suddenly have trouble planning things or keeping up with their daily responsibilities,” Cappon said.

Previously, they could easily multitask, but now it is difficult.

“Planning becomes more difficult, with more mistakes in coordinating plans and more mistakes in the numbers: missed bills, incorrect tip calculations,” said Dr. Yasmin Mohiuddin, a neurologist at Orlando Health.

Complex tasks also seem more difficult, if not downright impossible.

“A person who has always paid the bills, managed investments or cooked holiday meals starts to make mistakes or quietly pass those tasks off to someone else,” Fotuhi said. “Families often see this as aging or loss of interest. »

“People’s social lives are starting to shrink,” Lakhan said. “Someone stops hosting gatherings, avoids a favorite game, or withdraws from conversations they once enjoyed. Keeping up with multiple speakers or remembering the rules may have become more difficult.”

Withdrawal from friends and social situations may stem from their difficulty finding words or following conversations.

“Someone may become less motivated, withdraw socially, or lose interest in things they previously enjoyed,” Cappon said. “The problem is that these changes can easily be confused with depression, stress or just aging. And of course, they don’t necessarily mean someone has Alzheimer’s disease.”

“Personality and mood changes — apathy, withdrawal from friends and hobbies, new irritability or anxiety — may appear before obvious memory problems,” Fotuhi said. “These are often confused with depression or stress.”

Dr. Michael Stanley, a neurologist at Tufts Medical Center, said mood changes are an increasingly recognized early clue.

“There is growing evidence that supports changes in mood and behavior, rather than what we traditionally think of as ‘cognitive’ symptoms as being early precursors,” he said. “Older adults with newly discovered depression, anxiety, and apathy without an obvious and clear environmental or social trigger are also prime candidates to consider being evaluated by a PCP for cognitive impairment.”

Mood testing is important for many reasons.

“The relationship between mood and memory is both anatomical and physiological,” Stanley said. “So if you directly address your mood, you can often see improvements or stabilization in attention, concentration, and memory functions.”

“An overlooked clue is that ordinary life begins to require extraordinary effort,” Lakhan said. “People are starting to struggle with familiar technology. Someone who previously banked online, sent messages, or comfortably used the same remote starts to need repeated help.”

Familiar digital routines can offer useful insights into a person’s daily brain functioning.

“Difficulties learning a newly redesigned app are common,” Lakhan said. “A persistent loss of previously comfortable skills is more concerning. A phone can offer a clue, but it cannot make a diagnosis.”

“Repeating the same story or the same question is another,” Fotouhi said. “They ask what time dinner is three times an hour, with no memory of asking. This is different from a casual forgetting, because the whole conversation is gone, not just one detail.”

Lakhan said people can also remember the distant past while losing recent information.

“A person can tell a vivid story from 40 years ago and still have difficulty remembering a conversation from 40 minutes ago,” he said. “Repeated questions, forgotten plans, or the need for the same explanation may be dismissed because the person still seems articulate and knowledgeable. Preserved old memories do not rule out a problem with learning and retaining new information.”

Majid Fotuhi also pointed out potential indicators such as “taking a wrong turn on a route he’s been taking for 20 years or feeling briefly disoriented in a familiar store.”

Reduced vision can be a factor, but it can also indicate a serious cognitive cause like Alzheimer’s disease.

“People are developing new problems navigating or judging space,” Lakhan said. “Getting lost on a familiar route or misjudging distances while driving can be considered a vision problem.”

Research also suggests that a diminished sense of smell could be an early clue. A recent study found that in Alzheimer’s disease, immune cells in the brain can mistakenly attack the nerve fibers that carry olfactory signals. This could explain why loss of smell can appear years before a diagnosis.

“If you start to notice a decrease in your olfactory ability, seek medical attention,” Dr. Dale Bredesen, a neurologist at Apollo Health who focuses on Alzheimer’s disease, told HuffPost. “Don’t assume this is a benign illness.”

He suggested that people over 35 with a family history of cognitive impairment could ask their neurologist for smell testing. But he stressed that passing a smell test doesn’t mean someone is safe.

Sometimes the sign is the workaround itself. People may take steps to hide or compensate for changes, whether they are fully aware of them or not.

“People are remarkably good at compensating,” Fotuhi said. “They rely on post-its, let their spouse answer questions, or laugh off a slip-up and say ‘I’ve always been bad with names’.”

The brain’s great reserve can make this possible.

“People with a good education, an active social life and a demanding career can compensate for the years, making early changes harder to spot,” Fotuhi added.

Loved ones may also end up compensating.

“People often attribute these symptoms to age, stress or lack of sleep, until a more critical problem or error occurs,” Mohiuddin said. “Social skills and general knowledge are preserved early, so short interactions can seem completely normal. Family members gradually compensate without realizing it, as the spouse takes over driving, paying bills, and cooking.”

But this gradual evolution towards dependence is worth noting.

“This help is valuable,” Lakhan said. “The growing need for this information also provides useful information for the doctor.”

“First of all, I wouldn’t panic, but I also wouldn’t ignore it,” Cappon said. “A good place to start is to talk with your primary care provider and share some specific examples of what has changed. »

Preparation can make your assessment with a healthcare professional even more useful.

“Bring a family member to the visit who knows the person well and sees them regularly,” advised Mohiuddin. “Have specific examples with approximate dates.”

Along with examples and a timeline, prepare a list of medications and over-the-counter products you take.

“Ask for a thorough assessment rather than reassurance or a quick label,” Fotuhi said. “A good workup includes a cognitive assessment, blood tests (including thyroid function, vitamin B12, and blood sugar), review of all medications, and screening for sleep problems, depression, and hearing loss.”

Brain imaging and blood tests to detect proteins linked to Alzheimer’s disease can also help doctors get a clearer idea of ​​what’s going on.

“They should evaluate modifiable risk factors like sleep, substances, medications, toxins, electrolytes, hormones, vitamins and even some infections,” Stanley said. “They should also do a neurological screening test. And they should refer to an occupational therapist or speech therapist to help a person find…