Preclinical Alzheimer’s Disease

Research suggests that complex changes in the brain associated with Alzheimer’s disease, such as the formation of amyloid plaques or tau tangles, start a decade or more before memory and thinking problems occur. This stage, where brain changes occur before dementia symptoms appear, is called preclinical Alzheimer’s disease. It’s important to note that not every person with these brain changes will develop dementia.

Alzheimer’s disease usually begins with very mild changes in the person’s abilities or behaviour and is often unrecognizable at the beginning. It is difficult to distinguish between early-stage Alzheimer’s and normal age-related changes. Below are some early signs that could potentially indicate Alzheimer’s disease.

1. Memory Loss Affecting Daily Activities. One of the most common early signs of Alzheimer’s is forgetting recently learned information. Some people may start to forget more frequently, and they might not remember important dates or events, asking for the same information over and over.
2. Difficulty in Planning and Solving Problems. Some people with Alzheimer’s may experience changes in their ability to follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills.
3. Difficulty Completing Familiar Tasks at Home or at Work. People with Alzheimer’s often find it hard to complete daily tasks. They might have trouble driving to a familiar location, managing a budget at work, or even remembering the rules of a favorite game.
4. Confusion about Time or Place. People with Alzheimer’s can lose track of dates, seasons, and the passage of time. They may have trouble understanding something if it is not happening immediately, and sometimes may forget where they are or how they got there.
5. Trouble Understanding Visual Images and Spatial Relationships. For some people, vision problems can be a sign of Alzheimer’s. They may have difficulty reading, judging distance, and determining color or contrast, which may cause problems with driving.
6. New Problems with Words in Speaking or Writing. People with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue, or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word, or call things by the wrong name.
7. Misplacing Things and Losing the Ability to Retrace Steps. A person with Alzheimer’s may put things in unusual places. They may lose things and be unable to retrace their steps to find them again. Sometimes, they may accuse others of stealing their belongings.
8. Decreased or Poor Judgmen. People with Alzheimer’s may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money or pay less attention to grooming or cleanliness.
9. Withdrawal from Work or Social Activities. A person with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects, or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced.
10. Changes in Mood and Personality. The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful, or anxious. They may be easily upset at home, at work, with friends, or in places where they are out of their comfort zone.

It’s important to remember that Alzheimer’s disease is a progressive disorder, and early signs and symptoms can be subtle. If you notice any of these changes, it is advisable to consult a doctor or a healthcare professional for a comprehensive assessment.

Symptoms of Moderate Alzheimer’s Disease

In this stage, more intensive supervision and care are needed. These changes and increased needs can be challenging for many spouses and families. Symptoms can include:

• – Increased confusion and memory loss, such as forgetting events or personal history
• – Withdrawal from social activities
• – Inability to learn new things
• – Difficulties with language and problems with reading, writing, and working with numbers
• – Difficulty organizing thoughts and logical reasoning
• – Shortened attention span
• – Trouble coping with new situations
• – Changes in sleep patterns, such as sleeping more during the day and restlessness at night
• – Difficulty performing familiar, multi-step tasks, such as dressing
• – Occasional trouble recognizing family and friends
• – Hallucinations, illusions, and paranoia
• – Impulsive behavior, such as undressing at inappropriate times or places, or using vulgar words
• – Inappropriate emotional outbursts
• – Restlessness, agitation, anxiety, tearfulness, wandering – especially in the late afternoon or evening
• – Repeating statements or movements, occasional muscle twitches

Symptoms of Severe Alzheimer’s Disease

People with severe Alzheimer’s disease cannot communicate and are completely dependent on others for their care. Near the end of life, the person may spend most or all of the time in bed as their body shuts down. Symptoms often include:

• – Inability to communicate
• – Lack of awareness of recent experiences or surroundings
• – Weight loss with little interest in eating
• – Seizures
• – General physical decline, including dental, skin, and foot problems
• – Difficulty swallowing
• – Groaning, moaning, or grunting
• – Increased sleep
• – Loss of control over bowel and bladder

A common cause of death in people with Alzheimer’s disease is aspiration pneumonia. This type of pneumonia develops when a person can’t swallow properly and inhales food or liquid into their lungs instead of air.

While there is currently no cure for Alzheimer’s disease, there are medications that can help treat the symptoms of the disease. Also, changes can be made to the home environment and daily activities that can help the person manage changes in thinking.

Diagnosis of Alzheimer’s Disease

To diagnose Alzheimer’s, doctors may:

• Ask the person experiencing symptoms, as well as a family member or friend, questions about general health, use of prescription and over-the-counter medications, diet, past medical problems, ability to perform daily activities, and changes in behavior and personality.
• Conduct tests of memory, problem solving, attention, counting and language.
• Order blood, urine, and other standard medical tests that can help identify other possible causes of the problem.
• Conduct a psychiatric evaluation to determine whether depression or another mental health problem is causing or contributing to the person’s symptoms.
• Collect cerebrospinal fluid (CSF) via spinal puncture and measure protein levels associated with Alzheimer’s disease and related dementias.
• Perform brain scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to support a diagnosis of Alzheimer’s disease or rule out other possible causes of symptoms.

Doctors may want to repeat these tests to best determine how a person’s memory and other cognitive functions change over time. The tests can also help diagnose other causes of memory problems, such as stroke, tumor, Parkinson’s disease, sleep disorders, side effects of medications, infection, or another type of dementia. Some of these conditions are treatable and potentially reversible. People with memory problems should return to their doctor every six to 12 months.