What’s Normal, What’s Not: Changes Associated with Alzheimer’s Disease and Related Dementias
One of the most common questions I receive from my senior patients and their caregivers is what changes in cognition and behavior are normal as we age and what’s not. Dementia is defined as changes in cognition or behavior that disrupt daily life and are not explained by other medical conditions. Mild cognitive impairment refers to mild cognitive changes such as short-term memory loss that do not interfere with daily life. Not all those with mild cognitive impairment will go on to develop dementia but this population is at higher risk and should be carefully monitored. Let’s explore examples of normal and potential concerning changes in memory and behavior.
What’s Normal, What’s Not
01. Memory
✗ WARNING SIGNS: Forgetting important appointments or dates, asking the same questions over and over, relying on reminders more and more, and still struggling to remember.
✓ NORMAL: Occasionally forgetting someone’s name or a word, but remembering later.
02. Challenges in Problem-Solving
✗ WARNING SIGNS: No longer being able to organize monthly bill paying or plan a family meal.
✓ NORMAL: Occasionally forgetting to pay a bill
03. Difficulty completing routine tasks
✗ WARNING SIGNS: Difficulty following a familiar recipe, playing a familiar game or musical instrument or inability to use a familiar appliance like a microwave.
✓ NORMAL: Difficulty figuring out how to use a brand-new TV remote control.
04. Confusion with time or place
✗ WARNING SIGNS: Losing track of the day of the week, season of the year, or even year. Being uncertain if an event has happened or when it happened in the past.
✓ NORMAL: Occasional being unsure of the exact date, but remembering later
05. Difficulty with visual-spatial relationships
✗ WARNING SIGNS: Struggling with judging distances or navigating in familiar areas while walking or driving which may result in getting loss or having automobile accidents or falls. Difficulty seeing color contrasts.
✓ NORMAL: Visual changes such as blurry vision due to cataracts, or changes in depth perception due to bifocals.
06. Difficulty with language – speaking or writing
✗ WARNING SIGN: Struggling with participating in conversations or finding the right words. Difficulty in composing a letter or e-mail.
✓ NORMAL: Occasionally having difficulty finding a word but remembering later.
07. Misplacing things and not being able to retrace your steps
✗ WARNING SIGN: Placing items in odd places -like putting keys in the refrigerator and not being able to retrace steps to find things. Becoming suspicious that items are being stolen or purposely hidden.
✓ NORMAL: Occasionally misplacing an item but able to retrace your steps and find it.
08. Poor judgment
✗ WARNING SIGN: Making poor decisions or having poor judgment in dealing with money or legal affairs or taking excessive risks like climbing a tall ladder when balance is impaired.
✓ NORMAL: Occasionally making a poor business decision or forgetting to make a mortgage payment
09. Withdrawing from work or social engagements
✗ WARNING SIGN: No longer wanting to participate in previously joyous social events or family gatherings.
✓ NORMAL: Occasionally not wanting to go to a social event or avoiding a noisy social event due to difficulty hearing.
10. Changes in mood and personality
✗ WARNING SIGN: Increase in a depressed or anxious mood. Becoming more suspicious of others and becoming easily angered or agitated with minor changes in routine.
✓ NORMAL: Occasionally feeling sad or lonely. Being less able to deal effectively with unexpected changes in schedule.
If you notice these changes in yourself or a loved one, SEEK MEDICAL EVALUATION.
These changes are just some of the symptoms you may notice with dementia, but other medical conditions like depression or anxiety, substance use, medications, or infections may also cause changes to the way we think and feel. Your medical team will be able to investigate these other causes and develop a brain health plan with you.
Early diagnosis of dementia and mild cognitive impairment is very important! Developing your own brain health plan helps to slow down the progression of cognitive changes. Make your own decisions and inform your care team about your wishes for the future. The earlier you seek treatment, the better. The newest medications that have been FDA-approved for Alzheimer’s disease (Aducanumab, Lecanemab) are only effective in the earliest stages of the disease. Also, you will have more opportunities to participate in research studies that will potentially give you access to treatments that are not yet available to the public and help be a part of the effort to find the cure for Alzheimer’s disease.
Here is a list of my top resources for learning more about Alzheimer’s Disease and related dementias.
