Alzheimer's ABC's: Understanding The Symptoms

This is the second post in a blog series by Dr. John Dougherty, intended to simplify and demystify Alzheimer’s disease, and help you better recognize the signs and symptoms.

In the last post we learned that the single most important place to begin our understanding of Alzheimer’s is history. I start the process by building a timeline from symptom onset with the individual (and family members).  In the next few posts we’ll take a look at Alzheimer’s symptoms. We begin the list today with some of the more widely known symptoms, but we examine more closely how to distinguish signs of normal aging from those of possible impairment within them.

Repeated and persistent signs of forgetfulness
As people age they frequently complain of losing keys, losing a wallet or purse, a checkbook, or some other staple item.  With normal aging you may forget where you parked your car after shopping, or you may forget a turn or two in the car but not be lost. You may even go to the pantry, only to forget what you went for, but you can retrace your steps, or think for a moment and recall. The concept of forgetting briefly but then being able to reason out a way to the memory in the mind is very normal.

This is not so for people with AD.  Someone with AD may be incapable of remembering where the car is parked, or may find themselves driving with no idea where they are or how to navigate from there.  The inability to eventually pull out the recent memory is not normal.

Diminishing success using everyday items
People with AD frequently have trouble operating a microwave (not just adding 30 second increments, but having the ability to set cook time and power, program defrost, etc.).  They may also have trouble using kitchen utensils or everyday tools (especially for folks who typically perform household projects with ease).

Someone with worsening symptoms may be putting clean dishes away and have trouble recalling where the dishes are supposed to go.  They may have a very difficult time getting the dishes put in the right place.

Memory problems
Problems with memory tend to worsen over the course of a year or so, which is very typical progression for AD.  After one year there will be much more difficulty with recent memory and recalling conversations, trouble remembering to tell a spouse of a phone message they took for them, or to recall what was discussed in a call they just had. Recent memories are the key here.  Past memories tend to be fully intact for people with AD.  They may have no idea what they ate for breakfast but will be able to recount early times in their lives with ease.  Anxiety over memory loss can exacerbate these problems.

One of my patients was telling me about a block party they had in their neighborhood.  There were some guests coming whom he did not know well and he was very nervous about recalling their names as they arrived. He spent time going over their names and practicing before the party. As guests began to arrive he was very anxious about his performance and ability to introduce people, which naturally made recall more difficult for him.  Then he had a glass of wine, relaxed a bit and found he was more fluid in recalling names. This anxiety can complicate the issue for our next symptom as well: word recall.

Word recall
People in the slow progression of cognitive decline often have trouble recalling every day words, or have difficulty selecting the right word to use.

If you are experiencing normal aging, you may see a clock on the wall and recognize that it has hands and numbers, but momentarily lose the word clock. The word clock will eventually come to you, however. You may forget the names of people that you do not see on a regular basis – this can be completely normal. People with normal aging often joke about their memory – they intuitively understand it is not a serious problem.

People with AD have trouble recalling the names of people they do see regularly.  They may not be able to eventually pull the word clock out of their memory, no matter how well they can describe the device itself.  As mentioned above, anxiety over this issue can be an extenuating factor.

These are some of the very typical early symptoms of AD versus normal aging.  In the next post we’ll go into greater detail on symptoms that may not be as well known.



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