Alzheimer's ABC's: Understanding Early Warning Signs

In the last post we began to take a closer look at some of the more widely known symptoms of Alzheimer’s disease (AD), as well as to explore the differences between normal aging and cognitive impairment within those symptoms.  In this post I am going to provide you a list of areas in your day-to-day life where symptoms of AD appear, to help you better distinguish normal aging from the signs of something more serious.

When I’m evaluating a new patient I try to see if I can develop a scenario of progressive worsening over time.  Perhaps two years ago they were experiencing symptoms of forgetfulness and then one year ago they began to repeat themselves (asking the same questions, for example, even when they have already received an answer).  This is a typical progression for AD.

I always ask if they have difficulty with balance/coordination, problems with bladder/bowel control, gait disorders – these are usually signs of vascular dementias, not AD, so it’s important to differentiate right up front.

Other symptoms and potential warning areas for people with early AD
Many people with early AD will have trouble with processing tasks such as: the ability to balance a checkbook, pay bills, cook meals (if they did so before).  Specifically I delineate between cooking something simple (or in the microwave) and planning/cooking a full meal (meat, vegetable, bread, etc.).  Pulling together an entire meal is usually much harder for someone with AD.

Handling cash, making change and calculating the tip in a restaurant are examples of everyday processing tasks with which people suffer in early AD.  Driving behavior is often affected and it’s important to speak with someone who had ridden with them recently.  We need to understand their ability to control the car, maintain speed (do they drive more slowly or recklessly?), and keep the car within the lines of the road.

Specifically, have they gotten lost in the car?  One problem with AD patients is they generally have the ability to steer the car, but experience significant visual-spatial impairment.  This leads to people going the wrong direction on the interstate, which is not uncommon in AD patients.

Other symptoms to look for in the home: handling the TV remote (not just the ability to turn it on or off, but can they go into the listing guide and select the station they want to watch from the list).  Can they handle the microwave (as we’ve discussed – not just start/stop but programming tasks: set it to thaw food, dial in the exact cook time)?  I ask the same questions for the stove – can they cook without burning the food, do they remember to turn off the burner, can they use pre-heat and timed cook settings on the oven?

I ask about cell phone usage.  Even with relatively early AD people can know who is associated with speed dial settings.  If they receive a call are they able to enter that number into the address book on the phone?  Many seniors are now computer literate.  For these folks – are they able to send emails to grandchildren, can they search the web successfully (this is a difficult task, requiring use of successive programs – it is one area that an AD patient may begin to have problems early on).

In the next post we will begin to look at the cognitive changes associated with Alzheimer’s disease.  Please use the comment form to submit your thoughts, questions or personal experiences.  If you are interested in taking the ALZselftest, the early warning, online screening test for AD which I developed, please visit the website here.

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