Symptoms of Alzheimer’s Disease

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Alzheimer’s disease is a brain disorder that can cause confusion, memory loss, and cognitive decline. It is the most common type of dementia.

Alzheimer’s is a progressive, irreversible condition, which means that symptoms gradually go from mild to worse until the person cannot communicate or function independently. The progression of this condition is categorized into four stages: pre-clinical stage, early stage, middle stage, and late stage.

Each person experiences the symptoms and progresses through the stages in their own way. However, knowing what each stage may involve can help family members and healthcare providers prepare and plan out care for a person with Alzheimer’s disease.

Signs & Symptoms

These are the signs and symptoms of each stage of Alzheimer’s disease. While the symptoms in the initial stages can be mistaken for normal signs of aging, they become more severe with time. 

Pre-clinical Stage

This is the stage before any of the symptoms appear. Though the person may not show any outward signs of the disease, their brain may have started shrinking and declining. These changes within the brain can sometimes begin 10 years before any symptoms become apparent.

Early Stage

Early-stage Alzheimer's has mild symptoms. The person may appear healthy but can often forget or struggle with some things. In the early stages, they may be aware of their forgetfulness or struggles. Loved ones like friends and family members may notice them too. The sense that something is wrong may come gradually.

These are some of the symptoms of early-stage Alzheimer’s:

  • Forgetfulness, like being unable to remember names, common objects, recent events, or appointments
  • Confusion with time and place
  • Trouble learning or remembering new things
  • Repetitive speech or questions
  • Impaired judgment and questionable decisions
  • Aggressive speech or manner
  • Reduced spontaneity or initiative
  • Delayed reactions
  • Slower speech
  • Difficulty with multistep tasks like cooking
  • Difficulty managing money or finances
  • Trouble with organizing or planning
  • Personality or mood changes

Even as symptoms worsen, the person may retain some skills, like singing, dancing, listening to music, reading, telling stories, reminiscing, or doing arts and crafts. These functions are controlled by parts of the brain that may not be affected in the early stages.

Middle Stage

Middle-stage (mid-stage) Alzheimer’s has moderate symptoms. This stage can sometimes last for many years. The person may gradually be unable to work and require the assistance of a family member or caregiver. 

The symptoms of mid-stage Alzheimer’s can include:

  • Confusion and disorientation
  • Memory loss, like being unable to remember their own name
  • Difficulty recognizing family and friends, even though they may seem familiar
  • Trouble with daily tasks, like getting dressed
  • Difficulty with language and speech
  • Difficulty with reading, writing, and numbers
  • Angry outbursts or vulgar language
  • Illogical thoughts 
  • Reduced attention span
  • Inability to cope with new situations 
  • Tendency to wander or get lost, even in familiar places
  • Unusual behavior, like getting undressed in public or keeping objects in strange places
  • Restlessness or agitation
  • Obsessive or repetitive behavior
  • Mood swings 
  • Social withdrawal
  • Tearfulness 
  • Anxiety 
  • Hallucinations
  • Delusions
  • Paranoia and distrust of family members and caretakers
  • Muscle twitches
  • Repetitive movements
  • Sleep disruptions

Some symptoms, like restlessness, agitation, anxiety, tearfulness, or the tendency to wander, can worsen in the second half of the day, i.e., between late afternoon and night. This is known as sundowning.

Late Stage

Severe symptoms characterize late-stage Alzheimer’s disease. Often, the person is unable to respond or communicate. As a result, they may require full-time care and supervision. Toward the end, they may be in bed all the time.

The symptoms of late-stage Alzheimer’s can include:

  • Difficulty eating and swallowing
  • Severe weight loss
  • Loss of bladder and bowel control
  • Trouble communicating
  • Lack of situational awareness 
  • Difficulty sitting, standing, or walking, which can lead to frequent falls
  • Inability to perform personal hygiene tasks
  • Frequent sleeping
  • Seizures
  • Skin infections
  • Grunting and groaning

The mid and late stages of Alzheimer’s can be particularly distressing for both the patient and the family and caregivers. Therefore, it’s important to practice self-care, develop a support system you can rely on, and seek therapy if you need it.

Complications & Comorbidities 

These are some of the complications and comorbidities associated with Alzheimer’s disease:

  • Mild cognitive impairment (MCI): In the early stages, a person who misplaces things, forgets appointments, or can’t recall words may be diagnosed with MCI. It can be an early warning sign of Alzheimer’s. However, everyone with MCI doesn’t necessarily develop Alzheimer’s disease; many people can take care of themselves and live an independent life with MCI.  
  • Pneumonia: People with Alzheimer’s can get aspiration pneumonia if food or liquids enter their lungs due to difficulties with swallowing. Pneumonia is a common cause of death among Alzheimer’s patients. 
  • Other complications: Stroke, infections, delirium, and certain medications can worsen the symptoms of Alzheimer’s.

Frequently Asked Questions

These are some of the frequently asked questions about the symptoms of Alzheimer’s disease.

When do the symptoms of Alzheimer’s disease typically start?

People who have late-onset Alzheimer’s may start to see symptoms in their mid-60s; however, people with early-onset Alzheimer’s may start to see symptoms as early as their 30s.

How can you differentiate normal forgetfulness from the symptoms of Alzheimer’s disease?

It’s natural to forget things occasionally, especially as you get older. For instance, you may forget where you’ve parked your car or a few details from an event. You may even forget someone’s name and then remember it later.

With Alzheimer’s however, you may forget what your car looks like or that an event took place altogether. You may not be able to remember ever knowing a person.

If you're frequently forgetful, you should inform your healthcare provider. They can review your symptoms and conduct tests in order to determine whether it's due to the normal course of aging or a health condition like Alzheimer's. Other health conditions can also cause memory loss.

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