Recognising Early Symptoms of Alzheimer’s Disease

Alzheimer’s disease develops through stages; early ones include subjective cognitive impairment, where only the subject would recognise anything was awry. Next comes mild cognitive impairment, where family members and close acquaintances might begin to notice occasional cognitive deficits usually related to memory.

There are signs and symptoms that will identify early stages and once recognised they need to be acted upon immediately to slow or reverse the progression. Recognising these early stages is probably one of the most important as further decline is not inevitable, especially if preventive measures are taken. Only between 10%-20% of these cases will progress to further symptoms of the disease.

First, what’s the difference between signs and symptoms?

Well, in medical terms they are distinct terms used to describe different aspects of a patients condition. Signs include evidence of a disease that can be measured by a third party, such as a nurse or a doctor through clinical examinations or tests, and examples include blood pressure, heart rate, skin rash and blood analysis. Whereas symptoms are more subjective experiences noticed by a person but can’t be observed directly by others. They are what a person may feel or experience, such as a headache, fatigue, pain or nausea. When brought together a doctor can form a diagnosis.

The medical world is still trying to develop tests for signs that will accurately predict the onset of Alzheimer’s disease.

Brain scans can identify the existence of damaged proteins associated with the disease but many people that have these damaged proteins in their brains never develop the disease. Blood tests are also being developed but they aren’t sufficiently accurate yet either. So, doctors are left with symptoms and cognitive tests as a way to diagnose Alzheimer’s disease or any other form of cognitive decline. And in a lot of cases they get it wrong confusing the disease with a natural decline in cognition that often accompanies age.

Just because Alzheimer’s disease is associated with age it doesn’t mean that it is as a result of chronological age but rather as a result of the accumulation of various health issues and signs of disease that dictate biological age. Ageing successfully, by keeping disease at bay through the 50s and 60s will help provide a protection against Alzheimer’s disease in older age.

Successful ageing has been defined as encompassing five key components:

• The absence of major chronic diseases such as diabetes, cancer, chronic lung diseases, heart disease, and stroke.
• No physical impairments, assessed by the ability to independently perform daily activities like dressing, bathing, and eating.
• High cognitive function, evaluated through cognitive tests including the MoCA or MMSE, picture drawing and word recall tasks
• Good mental health, indicating no significant symptoms of depression
• Active engagement with life, demonstrated by participation in social activities such as socialising with friends, playing games like cards or chess, and attending community events
• Normal stable sleep patterns of approximately 7.5 hours or 8 hours is associated with the most successful ageing

There is a common misconception that our brains are recording devices recording and storing everything that happens to us. But our brains are not designed to remember the names of everyone we meet or exact dates and conversations. They are designed to keep information necessary for our future and dispose of all non-essential facts and details deemed to be a waste of space. So forgetting names is not always a symptom of cognitive decline. We don’t need to remember everything that happens but we do need to remember the things that are important and that matter to us. The degree to which we focus and pay attention to new facts can determine whether or not we remember them. We are bombarded with information daily, most of which will never be needed, and so our brains prune, much the way a good gardener would get rid of deadwood and excess, to make way for good functioning and new growth. Practices such as mindfulness, exercise, eating healthy foods and good sleep will all help ensure a healthy vascular system, focused attention and good metabolic waste clearance making way for good brain function.

Examples of early symptoms include:

• Difficulties with language should be seen as an early symptom such as an ability to interpret syntax, or the ability to follow story lines that contain many characters or different plots.
• Navigation abilities can start to deteriorate in people at greater risk for Alzheimer’s disease up to 25 years before the normal age for onset. Difficulties navigating space or judging distances could predict the onset of the disease.
• Location and time are used to orientate memories. With Alzheimer’s disease people will start to lose the relationship with time and possibly start to get lost in familiar settings.
• Might start to notice slight difficulties functioning at the usual level at work or when shopping or in social groups.
• Starting to lose interest in life at home or abandoning interests and hobbies
• Consistent but slight to moderate forgetfulness. Not fully recollecting recent events which may begin to interfere with daily activities.
• Frailty, which can include weak grip strength, slowing pace and shorter strides when walking, muscle loss, weight loss and fatigue.
• Social isolation as a result of feelings of depression or pessimism about the future.
• Gastrointestinal problems can be an early symptom of Parkinson’s disease and dementia with Lewy bodies.
• Loss of one or more of the senses - loss of hearing or sense of smell can appear many years before memory impairment.