Here There and Everywhere

Applying the word “Alzheimer’s” to someone close to you can be uncomfortable, even if the signs or symptoms have been adding up for some time. It’s much easier to gloss over strange behavior: “Oh, Mom’s just getting older.” Or to rationalize: “Well, we all forget things sometimes.”

Only a qualified physician can conclude with high certainty that a living person has Alzheimer’s disease. But the following eight symptoms are strongly associated with the disease. If you detect these signs in someone, it would be wise to seek a medical evaluation.

Alzheimer’s Symptom: Memory Lapses
1. Does the person ask repetitive questions or retell stories within minutes of the first mention?
2. Does she forget the names of recent acquaintances or younger family members, such as grandchildren?
3. Are memory lapses growing progressively worse (such as affecting information that was previously very well known)?
4. Are they happening more frequently (several times a day or within short periods of time)?
5. Is this forgetfulness unusual for the person (such as sudden memory lapses in someone who prided herself on never needing grocery lists or an address book)?

Everyone forgets some things sometimes. But the person may have Alzheimer’s disease if you notice these kinds of lapses.

Having problems with memory is the first and foremost symptom noticed. It’s a typical Alzheimer’s symptom to forget things learned recently (such as the answer to a question, an intention to do something or a new acquaintance) but to still be able to remember things from the remote past (such as events or people from childhood, sometimes with explicit detail). In time, even long-term memories will be affected. But by then other Alzheimer’s symptoms will have appeared.

Alzheimer’s Symptom: Confusion Over Words
1. Does the person have difficulty finding the “right” word when she’s speaking?
2. Does she forget or substitute words for everyday things (such as “the cooking thingamajig” for pot or “hair fixer” for comb)? Of course, it’s normal to occasionally blank on a word, especially words not often used. But it’s considered a red flag for Alzheimer’s if this happens with growing frequency and if the needed words are simple or commonplace ones.

Trouble with words can be a very frustrating experience for the speaker. She may stall during a conversation, fixating on finding a particular word. She may replace the right word with another word. This substitute could be similar enough that you could guess at her meaning (“hair dryer” instead of “hairdresser”), especially early on in the disease process. Or it could be completely different (“bank” instead of “hairdresser”) or nonsensical (“hairydoo”).

Alzheimer’s Symptom: Marked Changes in Mood or Personality
1. Is the person who’s usually assertive more subdued (or vice versa)?
2. Does she withdraw, even from family and friends, perhaps in response to problems with memory or communication?
3. Has she developed mood swings, anxiety or frustration, especially in connection with embarrassing memory lapses or noticeable communication problems?
4. Has she developed uncharacteristic fears of new or unknown environments or situations, or developed a distrust of others, whether strangers or familiar people?
5. Do you see signs of depression (including changes in sleep, appetite, mood)?

Mood shifts are a difficult sign to link decisively to Alzheimer’s disease because age and any medical condition may spark changes in someone’s mood, personality or behavior. In combination with other Alzheimer’s symptoms, however, changes such as those described above may contribute to a suspicion of the disease. A person with Alzheimer’s may also become restless and/or aggressive, but usually in later stages of the disease.

Alzheimer’s Symptom: Trouble With Abstract Thinking
1. How well does the person handle relatively simple mathematical tasks, such as balancing a checkbook?
2. Is she having trouble paying bills or keeping finances in order, tasks she previously had no problem completing?
3. Does she have trouble following along with a discussion, understanding an explanation or following instructions?
4. Abstract thinking becomes increasingly challenging for someone with Alzheimer’s, especially if the topic is complex or if the reasoning is sequential or related to cause and effect.

Alzheimer’s Symptom: Difficulty Completing Familiar Activities
1. Has the person begun to have trouble preparing meals?
2. Is she less engaged in a hobby that once absorbed her (bridge, painting, crossword puzzles)?
3. Does she stop in the middle of a project, such as baking or making a repair, and fail to complete it?
4. Has she stopped using a particular talent or skill that once gave her pleasure (sewing, singing, playing the piano)?

Activities with various different steps, however routine and familiar, can become difficult to complete for a person with Alzheimer’s. Your parent might become distracted or lose track of where she is in the process, feeling confused. Or she might just lose interest altogether and leave a project unfinished. Alzheimer’s, or some other form of dementia, is especially suspect when the difficult or abandoned activity is something the person formerly delighted in and excelled at or used to engage in frequently.

Alzheimer’s Symptom: Disorientation
1. Has the person begun to be disoriented in new or unfamiliar environments (such as a hospital or airport)?
2. Has she become disoriented in an environment she knows well?
3. Does she wander off and get lost in public (or get lost when driving or after parking)?
4. Does she lose track of the time, day, month or year? For example, after being reminded about a future doctor’s appointment over the phone, she may start getting ready for the appointment right away. Or she may have trouble keeping appointments and remembering other events or commitments. These examples of disorientation are all typical Alzheimer’s symptoms, more so in later stages of the disease but sometimes early on as well.

Alzheimer’s Symptom: Misplacing Items
1. Does the person “lose” items often?
2. Do those items turn up in unusual places (such as a wallet in the freezer)?
3. Losing track of glasses, keys and papers happens to most adults sometimes, whether due to age or just a busy lifestyle. However, it may be a symptom of Alzheimer’s if this behavior escalates and if items are sometimes stored in inappropriate or unusual places and your parent doesn’t remember having put them there.

Alzheimer’s Symptom: Poor or Impaired Judgment
1. Has the person recently made questionable decisions about money management?
2. Has she made odd choices regarding self-care (such as dressing inappropriately for the weather or neglecting to bathe)?
3. Is it hard for her to plan ahead (such as figuring out what groceries are needed or where to spend a holiday)? Difficulty with decision making can be related to other possible symptoms of Alzheimer’s, such as lapses in memory, personality changes and trouble with abstract thinking. Inappropriate choices are an especially worrisome sign, as your parent may make unsound decisions about her safety, health or finances.

Many of these Alzheimer’s symptoms go unnoticed for a long time. That’s because they’re often subtle or well concealed by the person (or a spouse), who may be understandably freaked out by the changes she’s noticing in her own behavior. Some patterns of behavior take time to make themselves obvious.

If you suspect Alzheimer’s, keep track of what you’re noticing. Ask others who know her what they think. Encourage her to see a doctor.