Signs and Symptoms of Alzheimer’s Disease

Alzheimer’s disease is a neurological disorder that significantly affects people’s cognitive functions, including memory, reasoning, and language. More than 6 million people over the age of 65 have Alzheimer’s in the United States.

You may also know the word “dementia,” which is often used to describe Alzheimer’s disease. However, these terms are not interchangeable. Dementia is a general term to describe cognitive decline (issues with memory, thinking, and reasoning), whereas Alzheimer’s is a specific disease.

Early on, people with Alzheimer’s may experience issues with memory, finding the words they want to say, and making small lapses in judgment. From mild (aka early-stage) disease, they typically progress to moderate and then severe (aka late-stage) Alzheimer’s.

Assessing Symptoms

The hallmark symptoms of Alzheimer’s include disruptions in cognitive functions. The major categories of symptoms used to make an Alzheimer’s diagnosis are the following: 

• Memory: In the early stage, you may start forgetting recent events or getting lost in familiar places. Eventually, you may have trouble finding words, learning new concepts, and performing daily tasks. 
• Executive functions, judgment, and problem-solving: Executive functions include setting goals, planning, and completing activities. Issues may arise with shifting from one task to another, regulating your response to different situations, and needing to complete small tasks towards a larger objective. You may not know you have these problems until a person close to you notices.  
• Visual-spatial: Visual problems occur in some people with Alzheimer’s, including experiencing difficulties reading, determining distance, and identifying color or contrast.
• Language: You are more likely to experience issues with speech and writing later in the disease, such as not being able to find the words you’re trying to say.
• Behavioral and psychologic: These symptoms are typically more noticeable in people with moderate and severe AD. You may feel irritable, disinterested, and socially disengaged. You may show aggression and wander away from home. 

People may also experience the following types of symptoms: 

• Difficulty performing motor tasks they know well, like getting dressed
• Issues with detecting smells
• Sleep problems, such as restless sleep 
• Seizures 
• Motor symptoms like reflex issues and incontinence (loss of bladder control)

Early Warning Signs

It’s normal to experience memory changes as you grow older. However, if you or people around you notice the following issues appearing more frequently, consider speaking to a healthcare provider to get a full evaluation: 

• Memory loss that interferes with daily life: You may forget important events, frequently repeat yourself, or constantly require reminders to stay on track. 
• Difficulty planning or problem-solving: You may forget to pay your bills or struggle to plan and complete a multi-step activity. 
• Difficulty completing familiar tasks: You may briefly forget how to do things you do all the time, such as cooking, picking an outfit, or using your phone.
• Confusion about where or when things happen: You may have a hard time distinguishing how long ago something happened or where it happened.
• Visual-spatial problems: You may have trouble estimating distance or drop objects or stumble often.
• New language issues: You may experience more difficulty with finding the right words to say or you may make more writing mistakes. 
• Misplacing things: You may misplace things in odd places and not remember how or why.
• Worsening judgment: You may have a harder time managing money, noticing scams, or taking care of yourself. 
• Worsening social life: You may not want to participate in your usual social activities or not be able to follow things you enjoy, such as sports or the news. 
• Mood and personality changes: You may get upset or fearful more easily and feel suspicious of others. 

Mild (Early-Stage) Alzheimer’s Disease Symptoms

People often get a diagnosis at the early stage of Alzheimer’s. With mild disease, symptoms mainly affect cognition, behavior, and personality, and people experience them a lot of the time—enough to interfere with normal life.

Cognition

Memory loss can affect a variety of things, appearing in some of the following ways: 

• Repeating questions
• Forgetting or having trouble finding words—making it more difficult to keep a conversation
• Losing things often 
• Getting lost in familiar places
• General confusion
• Losing track of dates and times of the year

Other cognitive issues can include the following: 

• Problem-solving
• Planning
• Completing daily tasks like paying bills, shopping, or bathing
• Judgment and decision-making

Behavior

People with mild Alzheimer’s may start exhibiting the following behaviors:

• Wandering away from home
• Pacing a lot
• Hitting or slapping others
• Engaging in out-of-character sexual activity
• Bathing less or wearing the same clothes every day
• Withdrawing from social activity (sometimes because of loss of interest or difficulty following activities and conversations)

Personality

At the early stage of Alzheimer’s, people may experience the following for the first time or more than usual:

• Anxiety
• Sadness
• Anger
• Apathy (loss of interest in things they used to enjoy )
• Hallucinations and paranoia (being suspicious or mistrusting others without a cause)
• Aggression

Moderate Alzheimer’s Disease Symptoms

During moderate Alzheimer’s, areas of the brain that control language, reasoning, thought, and processing of the senses are further affected. People with moderate Alzheimer’s require more help and supervision.

New concerns can come up as symptoms of the early stage—like memory loss and confusion—worsen. People may experience cognitive, behavioral, and psychological changes, including issues with:

• Reading, writing, and using numbers
• Thinking logically
• Paying attention
• Dealing with new situations
• Completing usual tasks
• Recognizing people
• Regulating emotions, which can lead to inappropriate outbursts
• Regulating impulses, which can lead to using vulgar language or undressing when it’s not appropriate
• Participating in social activities
• Detecting and identifying sights and smells

People may also experience the following physical issues: 

• Repetitive movement
• Muscle twitches
• Sleep changes, like sleeping more throughout the day and being restless at night

Severe (Late-Stage) Alzheimer’s Disease Symptoms

The late stage of Alzheimer’s sets in when the disease causes changes to the brain—the brain tissue physically shrinks. People with severe Alzheimer’s are typically unable to communicate and take care of themselves. They experience far more physical concerns. They rely on their caregivers completely and stay in bed all or most of the time. 

Specifically, people with late-stage Alzheimer’s are often unable to or have difficulties doing the following: 

• Communicating
• Remaining aware of their surroundings or recent experiences
• Swallowing
• Controlling their bowel and bladder

Not being able to swallow properly can cause food or liquid to get into a person’s lungs instead of air, leading to aspiration pneumonia—the most common cause of death for people with Alzheimer’s. 

The following physical issues can also occur:

• Weight loss (along with little interest in eating)
• Dental, tooth, and foot problems
• Increased sleeping
• Seizures (this occurs in 10-20% of all Alzheimer’s cases)

When to See a Healthcare Provider

If you experience memory or other cognitive issues that start interfering with your daily life, make sure to speak to a healthcare provider. 

The people around you may notice changes in your mood, personality, and ability to complete tasks earlier than you do. If they tell you something is different, consider talking to a healthcare provider as well. 

You can start by seeing a primary care doctor, who may refer you to a neurologist (a doctor who specializes in conditions affecting the brain and spinal cord) or a geriatrician (a doctor who specializes in aging and care for older adults). A neuropsychologist can test your memory and thinking and a geriatric psychiatrist can evaluate any emotional problems you’re experiencing.

Seeing a healthcare provider as soon as you or others notice changes lead to earlier and more effective Alzheimer’s treatment. You may also discover that you have another, more treatable (or even curable) condition. For example, vitamin D deficiency or medication side effects can cause similar symptoms.  

A Quick Review

Many people experience occasional memory or other cognitive issues as they age, but those with Alzheimer’s develop dementia—cognitive loss that interferes with daily life. Alzheimer’s first affects your cognition (including memory), personality, and behavior. It progresses to difficulties completing basic tasks and eventually an inability to communicate and take care of yourself. 

If you or the people around you notice changes in your thinking, personality, or mood, don’t hesitate to speak to a healthcare provider (primary care doctor, neurologist, or geriatrician). They may rule out other issues or put you on an early path to Alzheimer’s treatment and planning.