Forgetting things momentarily is normal - like where you parked the car or put your keys down - and as we age, it's perfectly normal for your memory to not be quite as it used to be. But if you don't feel like your or a loved one's memory loss is normal, if it's come on relatively suddenly and is happening more often than not, and it's affecting the ability to do normal tasks, then it's time to take action as the early signs of Alzheimer's are more common than we think.
It's thought that there are over 900,000 people living with dementia, which is caused by Alzheimer's disease, in the UK. Women are disproportionately affected, being twice as likely to develop the condition than men. Although research on why this is the case is in progress, some factors like hormonal changes (as estrogen has a protective effect on the brain and encourages healthy brain function), differences in sex chromosomes, brain structure, and life expectancy are thought to play a role why someone might enter the stages of Alzheimer's, per research published in the journal of Alzheimer's Research and Therapy.
Other health conditions can also increase the risk, such as diabetes, high blood pressure, and depression, along with lifestyle factors like smoking and drinking alcohol.
What are the early signs of Alzheimer’s?
While some of the symptoms of Alzheimer's may seem obvious, they can also appear as symptoms of other conditions - such as symptoms of menopause - which is why, no matter your age, it's important to know the early signs of Alzheimer's disease.
Forgetting things you've just said or heard
We're all prone to repeating ourselves sometimes but if this is happening all the time, it could be one of the early signs of Alzheimer's. Dr Lucy Andrews, an ageing expert and specialist in dementia services with BrainGuard System International, says this includes not remembering something someone has just said, repeating the same story multiple times, or asking the same question over and over again.
It's symptomatic of one of the more common signs of Alzheimer's in general: issues with short-term memory. Along with these social problems, someone might forget where they've left something and put everyday items in the wrong place - such as the hairdryer in the fridge or keys in the washing machine.
"Simple episodes of forgetfulness and confusion are frequently the first signs of dementia," says London NHS GP Dr Semiya Aziz. "With Alzheimer's though, the symptoms may not be severe enough to stop the individual from carrying out their daily activities." When the symptoms become severe, the condition is then categorised as dementia.
Dr Lucy Andrews specialises in brain health, aging, and brain diseases like Alzheimer’s. Throughout her career, she has been dedicated to promoting brain health and caring for the aging population. As the founder of the Brain Guard System, she has developed a groundbreaking preventive brain health system for those at risk of dementia or Alzheimer's disease.
Dr. Semiya Aziz BSc (Hons) MBBS MRCGP, founder of Say GP, has over 20 years of experience in General Practice in both the NHS and the private sector. Dr. Semiya Aziz has a specialist interest in women's health, lifestyle medicine, and mental health.
Getting lost
Getting lost regularly when otherwise someone would know where they're going, finding themselves wandering around, and not knowing what time of day it is are all early symptoms of Alzheimer's.
"A person might be driving and pull up to a familiar stop sign, yet have no idea which way to turn," says Dr Dale Bredesen, a neuroscience researcher and neurodegenerative disease expert. Equally, people with early signs of Alzheimer's may find judging distances difficult or mistake patterns and reflections for other objects, making it dangerous to drive or be outside independently.
This can be really upsetting and worrying for both the person with the disease and those who care for them. It can also have a real impact on a person’s self-confidence and ability to trust their own judgement.
An internationally recognised expert in the mechanisms of neurodegenerative diseases, Dr. Bredesen earned his M.D. from Duke University Medical Center and served as Chief Resident in Neurology at the University of California, San Francisco (UCSF), before joining Nobel laureate Stanley Prusiner’s laboratory at UCSF as an NIH Postdoctoral Fellow. He held faculty positions at UCSF, UCLA, and the University of California, San Diego. Before joining the Buck Institute in 1998 as founding President and CEO, Dr Bredesen directed the Program on Aging at the Burnham Institute as well.
Changes in sleep patterns
Changes in sleep patterns and quality are normal as we get older, especially as menopause can cause insomnia, but it's always worth checking in with your doctor if this is an issue. Many people with early-stage Alzheimer's find they wake up more during the night or spend large parts of the night completely awake.
The build-up of protein (amyloid) in the brain, one of the other physical signs of Alzheimer's, is the cause of this. It's a vicious circle though, says Dr Bredesen, as "the amyloid that collects in Alzheimer's impacts sleep negatively and, in turn, poor sleep increases cognitive decline."
Problems recognising faces
As Alzheimer's progresses, a person may start to forget people’s names or confuse those around them for someone else. This isn't the same as forgetting the name of a distant friend's child or the receptionist at the dentist, but rather someone in their own family who they are close to, the name of a close friend, or the name of someone they interact with on a daily basis.
It's an extremely upsetting symptom but, according to Alzheimer’s UK, even if the person can’t place someone anymore, they are still likely to experience feelings they associate with that person. They may still feel safe and happy with familiar people around them.
Changes in sense of smell
Sense of smell is also something that can decline with age and much like changes to sleep, it can be a sign of something else - like perimenopause or menopause. However, it can also be linked to a loss of brain volume, which typically happens when someone begins to develop a disease like Alzheimer's, the University of Pennslyvania School of Medicine says.
"There is growing evidence that people with Alzheimer's can lose their sense of smell and taste many months or even years before other symptoms, such as memory loss, become apparent," says NHS GP Dr Hana Patel, so it's something to be especially mindful of.
Dr Hana Patel is a senior NHS GP and academic lecturer with a special interest in women's health, mental health, and sleep. She is also sought for her expertise and opinion as a GP medicolegal expert, both in the UK and internationally.
Difficulty completing familiar tasks
Along the same lines, someone with early Alzheimer's disease may struggle with activities they once found easy. At first, it can come across as a distraction and difficulty concentrating on simple activities, which might include making a meal, doing the dishes, or following basic instructions of a game played many times before.
Research from the University of Alabama has shown that Alzheimer's disease can affect a person's ability to do basic mathematics, for example, which is a problem that worsens as they move beyond the early stages.
In the later stages of the disease, someone might struggle with even the most basic of activities, such as making a cup of tea or dressing themselves.
Changes in mood
When someone is experiencing early-stage Alzheimer's, they are likely to behave differently than they normally would. Typically, they may struggle to make a decision or make continuous risky decisions, being more careless than usual. They may also be more irritable, and become upset or aggressive easily.
"[Someone with Alzheimer's] may have less control over their feelings and how to express them," guidance from Alzheimer's UK says. "They may overreact to things, have rapid mood changes, appear unusually distant, or uninterested in things."
Naturally, this can be caused by other factors as well as Alzheimer's, so in this case, it's important to keep an eye out for changes in mood in combination with other symptoms, says Dr Bredesen. "When the mood or personality changes are associated with reduced memory or other cognitive function, such as organising and planning, ability to operate a new phone, ability to navigate while driving, ability to make simple calculations, [it can be a sign of Alzheimer's]. Anything that represents a change toward less effective function."
The charity Dementia UK says as the disease progresses a person will likely need help with decisions regarding their care, finances, living arrangements and more.
FAQs
What age can early Alzheimer's start?
Early Alzheimer's can start in anyone under the age of 65 as this is the turning point for when factors such as age become a risk factor for the disease. However, this only typically affects one in 20 people with Alzheimer's, according to the NHS, so it is relatively rare.
It's down to this rarity though that some of the early signs of Alzheimer's are missed by medical professionals, says Angelo Makri, Alzheimer’s Society’s senior knowledge officer for wellbeing. "Dementia is not always initially considered a cause [of symptoms] as it's [a disease] often associated with older people. This can mean that symptoms in younger people are sometimes attributed to other causes,” he says.
When Alzheimer's is mistaken for another condition, it tends to be depression, stress, or menopause, so it's a particular issue for women. Many of the symptoms of perimenopause such as brain fog, trouble finding words and concentrating and mood changes are also signs of dementia.
Yet those with early onset Alzheimer's often find that spatial awareness issues and changes in vision, as outlined above, sit among the first few symptoms and these are not associated with hormonal changes. That's why it's important to look at the full picture, says Dr Aziz. "Frequently, a number of symptoms present simultaneously, suggesting the diagnosis of Alzheimer's disease."
When it comes to spotting the early signs of Alzheimer's, some people notice a decline in their own brain function, but in other instances, it might be a spouse or adult child who is the first to notice a change.
For help and guidance about Alzheimer's disease, visit Alzheimer's UK or call their support line on 0333 150 3456
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