by local guest writer Brittany Klaassen van Oorschot, ARNP
Alzheimer’s disease is characterized by a progressive decline in cognition or a slow loss of memory and other mental abilities. Patients initially seem mildly forgetful, but eventually, they lose their ability to care for themselves, and sometimes they can’t even recognize their loved ones. Understandably, many people deeply fear this disease, and although there is currently no cure, we do our best in primary care to catch Alzheimer’s disease as early as possible. You may have been subject to different screening tools used during annual physicals or wellness visits; perhaps you’ve been asked to remember three specific words, for example.
Beyond these once-yearly screenings, recognizing the signs and symptoms of Alzheimer’s disease at home or among loved ones can help promote early detection and diagnosis. However, it is also important to realize not all memory loss is indicative of Alzheimer’s disease. Normal aging and other mental disorders can also cause a degree of memory loss, and living in fear of Alzheimer’s is not a solution, but empowering yourself with the knowledge to recognize the symptoms and seek medical care is.
Early on in my career as a primary care nurse practitioner, I saw a patient in his late fifties concerned about his work performance. He was a woodworker, and his ability to finish building the furniture he sold had slowly declined over the past 6 months to a year. He couldn’t finish his projects, he was missing deadlines, and even with a clear template, he just couldn’t seem to finish building his tables and chairs. Initially, I was puzzled by his history until his wife chimed in and said he was constantly asking the same questions over and over again. He was quite young to have Alzheimer’s disease, but fortunately, we were able to connect him with appropriate resources and do our best to prepare him and his family once he was diagnosed with dementia.
Early Symptoms of Alzheimer’s Disease
The inability to learn and remember new information can be one of the earliest signs of dementia. In the case of my patient, he was constantly asking the same question because he could not remember what his wife had just told him. This loss of short-term memory can be characterized by forgetting recent conversations, events, appointments, and asking for the same information repeatedly. Long-term memory is preserved, so people with dementia can often recall what they were doing on their 16th birthday but forget what they had for dinner last night.
Difficulty handling complex, multi-step processes is another early symptom of Alzheimer’s disease. People may struggle to cook their favorite family recipe they’ve made countless times before, despite having the recipe right in front of them. This can also be characterized by difficulty with finances. Some people may be unable to balance their checkbooks or routinely forget to pay bills. Sometimes patients even forget how to pay bills. Step-by-step tasks become nearly impossible. For example, my patient built furniture for his entire adult life, but over time he could not build his most basic table.
Disorientation and lack of spatial awareness happen fairly early on in the disease process of Alzheimer’s. Patients may lose track of where they are and how they got there, despite being in a familiar area. If this occurs while driving, people can become lost in their own neighborhood or while driving to their local grocery store. Driving, even in familiar areas, is unsafe for most patients with Alzheimer’s disease.
These symptoms can also manifest as difficulty finding or organizing objects around the home, and people with Alzheimer’s often cannot retrace their steps to find misplaced things. Perhaps people lose their keys in the refrigerator or forget where their own silverware drawer is. Along with this disorientation, patients may lack depth perception and spatial awareness. They may have trouble judging distances and recognizing flat versus three-dimensional objects. This can present as an inability to use stairs or difficulty pinpointing the location of something heard or seen.
Language becomes particularly challenging as Alzheimer’s disease progresses. Patients often have a hard time expressing themselves and lose the ability to understand or express speech. We call this aphasia in medical terms. They struggle to find the right word, they repeat themselves, and they often have difficulty following or joining in on conversations. Sometimes this leads to social withdrawal and frustration for both the patient and their family.
Our bodies age. Skin might wrinkle, joints might ache, and vision may fade as we grow older. Similarly, our brains age. The actual volume, or amount of brain tissue we have, can decline as we grow older. On brain imaging, we often call this cerebral atrophy or volume loss. Cerebral volume loss often occurs more rapidly in those with certain diseases, but it can also be considered normal aging. As our brains age, we might have difficulty learning new things, or we may experience occasional memory loss.
For this reason, forgetfulness can be a normal part of aging. This can present as forgetting dates occasionally, forgetting to pay one bill, losing something important, or struggling to learn a new skill. For example, older adults often find technology incredibly difficult, if not impossible, to learn. They may need help updating their smartphones, navigating the newest social media platform, or avoid technology altogether. This is considered normal and not a symptom of dementia.
Fortunately, there are key differences between normal aging and Alzheimer’s disease. Forgetting a date but remembering it later on is normal. Routinely forgetting the month, season, or year is not normal. Losing important objects occasionally is normal. Constantly losing things and then being unable to find them is not normal. Even forgetting proper nouns, like names or places, can be normal, especially if you eventually remember them later.
The theme here is the frequency and persistence of symptoms. Constantly struggling to complete complex tasks, habitually missing bill payments, and frequently forgetting the word or phrase you are looking for are signs of Alzheimer’s disease. The other key theme here is progression. The symptoms will be gradually worsening and not intermittent or occasional. In the case of my woodworking patient, he progressively built furniture slower and slower until he could no longer complete a table or chair at all.
When to Seek Medical Care and What to Expect
When you notice persistent and recurring symptoms over the course of months, then you should pursue medical attention. Scheduling an appointment with a primary care provider is a great place to start. Typically, they will obtain a detailed history, perform cognitive testing, complete a full physical exam, including a neurological exam, and obtain some laboratory work to rule out any other medical causes. If there are concerns, many primary care providers will refer and consult with neurology.
Neurologists can help to confirm the diagnosis of Alzheimer’s disease or perhaps another form of dementia. It is important for friends or family to accompany the patient whenever possible, as sometimes patients with Alzheimer’s disease lack insight into their condition or symptoms. Fortunately, there are some lifestyle measures, medications, and a level of preparedness that ease the burden of Alzheimer’s disease, and for this reason, early detection is extremely helpful.
More recently, in my primary care practice, I had a patient present to our clinic in an outright panic. She forgot to attend a close friend’s birthday party, and she forgot her granddaughter’s name in conversation. She was fully convinced she had Alzheimer’s disease. We did a screening assessment, a physical including a neurological exam, and blood work to assess for causes of cognitive impairment. Fortunately, everything came back normal and she did not have dementia.
These memory loss symptoms understandably felt inexcusable to my patient, but intermittently forgetting appointments or even proper nouns like names can be considered normal. The theme to note here is the frequency of symptoms. Other conditions such as depression, anxiety and even stress can also cause some memory changes, and are important to be aware of. My patient was actually coping with the loss of another friend at the time, and eventually, we concluded the stress and grief associated with this contributed to her memory loss, and her symptoms did not reoccur.
Ultimately, if you or a loved one is having consistent, frequent symptoms of memory loss, including loss of short-term memory, difficulty completing complex tasks, disorientation, difficulty with language, or social withdrawal, I recommend getting seen by a healthcare professional for further evaluation. Aging with or without Alzheimer’s dementia can be difficult, but recognizing when symptoms are normal versus worrisome can make the transition easier.
About the Author
Brittany Klaassen van Oorschot is a primary care nurse practitioner in Washington State. She has 10 years of experience in the medical field, initially as an exercise physiologist, then a registered nurse, and most recently as a nurse practitioner. In her clinical practice, Brittany is passionate about empowering patients through education. She finds medical writing to be the perfect creative outlet to continue fulfilling this passion, and aims to educate an even larger audience with her articles. In her spare time, Brittany enjoys skiing, mountain biking, backpacking, playing soccer, or paddle boarding throughout the Pacific Northwest with her close family and friends.
If you are a caregiver or an individual living with Alzheimer’s, you don’t have to do this alone. The Alzheimer’s Association offers free support groups throughout the region. To learn more, visit alzwa.org/support.
You can also find support and resources by calling our 24/7 Helpline at 800.272.3900. Our helpline is available around the clock, 365 days a year. This free service is staffed by specialists and master’s-level clinicians and offers confidential support and information to people living with dementia, caregivers, families, and the public.