When an older person starts to develop symptoms of Alzheimer's disease or another dementia, what are the earliest warning signs to look out for? Stay tuned, to find out. Hello, everyone. Welcome to Helping Older Parents with Memory Loss, a video podcast series that gives you strategies and information about assisting aging parents who are experiencing memory or thinking problems. I'm your host, Dr. Leslie Kernisan board certified geriatrician and the founder of Better Health While Aging and also of the Helping Older Parents online programs. In this episode, I'm going to address something that people often ask me about, which is what are the most common warning signs of early Alzheimer's disease. Now, the Alzheimer's association has had a list of 10 early signs and symptoms for quite some time. And actually it's quite good. So if you haven't seen it yet, I would recommend it. But when I thought about my own list of warning signs, based on my years of experience, seeing patients and coaching families, it wasn't quite the same. And that's in part because early Alzheimer's can easily affect the brain in more than 10 ways. So let me take you through 10 warning signs that often catch my attention as a geriatrician. Now, bear in mind that these are warning signs. If your parent is showing any of these signs, please don't assume that they definitely have Alzheimer's because there are other medical conditions that can cause these signs. So to get an actual diagnosis of Alzheimer's disease or a related dementia, it's always necessary to get an evaluation by a qualified health provider. That said, if you've been noticing these signs, especially if it happens regularly or often, chances are there is something going on with your parent's brain function. And so ideally your parent will get an evaluation so they can get the help they need. So let me now take you through my 10 warning signs of Alzheimer's. Number one on my list is poor short-term memory. Now people often think that this is normal with aging, but actually it's not. And it's especially worrisome if they keep forgetting what happened recently, or if they keep asking repeated questions, because they can't remember what they were recently told. Now you should know that it is extremely common for short-term memory to be affected in early Alzheimer's, but for long-term memory to be preserved for much longer. So for instance, we often see that older adults with early Alzheimer's are still able to remember their childhood or remember information that they've known for a long time, but they will definitely have trouble remembering new things. Number two, on my list is repeating the same stories or questions in particular. When I hear that somebody is repeating the same stories over and over again, that is a total warning sign for me. Now, let me tell you a true story. Many years ago, I was doing a few weeks of attending on the internal medicine service of the hospital. That's when you're the senior doctor supervising junior doctors. And we had an older gentleman in his early nineties who had been hospitalized for heart failure a few days before I came on the service. And when the residents told me about him, they said he was so delightful and how it was so funny that whenever they'd see him, he'd repeat the same story of how he was looking forward to getting home, to eat some beans and greens. Now, when I heard this, I said, Hm. And does he seem to be cognitively okay? And they assured me that he was fine. He just liked to talk about beans and greens. But when we went to see him together, I asked him a few more questions about things that had happened recently and about his medications. And it turned out he couldn't remember any of those things. And it did turn out eventually that he had early dementia and actually the internal medicine residents had missed it because they were focused on his heart. And also because he was being very friendly and charming in conversation. Now, why might a person be repeating the same story when they have early Alzheimer's? I think it's often related to a few things. So one is that they may not remember that they just told you the same story a few moments ago, or recently. Another thing that I think drives this for some people is that even though they are having trouble with memory or thinking, they still often feel driven to be socially appropriate and respectable. And so they want to make the listener happy by making conversation, or in other cases, I think some people at some level are trying to cover up their memory problems because in a certain way, they realize that if they keep saying something, they might be asked fewer questions and that feel's safer to them. Okay, let's move on now to warning sign number three, for me, that's difficulty with instrumental activities of daily living or IADL's. So, as I explained, in a previous episode, IADL's are the life skills we often learn as teenagers, and they include things like managing finances, grocery shopping, and cooking, home maintenance, and so forth. And in early Alzheimer's, it's very common to see people struggle to do IADL's and to otherwise struggle with things they used to do pretty easily, especially those activities that require a few steps, like planning and cooking a meal, or making reservations for a vacation, or getting the bills paid on time or getting the yard cleaned up and so forth. Furthermore, when this happens in early Alzheimer's, the person often has some trouble explaining why they couldn't do it, or they may even deny that they had any trouble at all. So in general, I think we see this difficulty with IADL's and with skills they used to be able to do because as people develop Alzheimer's they often develop difficulty with executive function and with problem solving, let's move on to warning sign, number four, that would be being unaware of or denying difficulties or mistakes. Not only do many people with early Alzheimer's have trouble doing things they used to do, but many of them will also either deny that they're having trouble or otherwise seem unaware of their difficulties. In geriatrics. We often refer to this as lack of insight. There's also a fancy medical term for this called anosognosia, which is related to the Greek words for without knowledge of disease. Anosognosia means being unaware of a neurological problem or psychiatric condition. And it's associated with mental illness, dementia, and certain forms of stroke damage. It is extremely common in early Alzheimer's. So I consider it a warning sign. Now, sometimes it can be hard to tell if a person is truly unaware of their problems versus denying them because they are embarrassed or afraid or worried that their independence is going to be taken away. But in general, we know that Alzheimer's often affects insight and people often have trouble remembering or perceiving the difficulties they are having. So if this is happening to your parent or someone you care about, it is very frustrating if they keep the nine things, but you need to remember that they aren't being stubborn or purposefully trying to deceive you. It's probably just lack of insight due to their brain changes. Now for number five, number five on my list of warning signs is accusing others, such as accusing others of taking things, stealing things, hiding things, or misplacing things. So for instance, the older person might start accusing others of having taken their wallet or purse or their glasses. This is another one that is a warning sign for me. And it sometimes comes up before the person is otherwise showing signs of memory loss that are obvious to the family. Why might this be happening? Well, in many cases, it's the older person who has misplaced their belongings due to memory problems or confusion, but they either can't remember that or can't really accept that. So they conclude that someone else has taken the item. Now for number six, my six warning sign is developing delusions, which are also called false beliefs. This is a little less common than the other signs. I've mentioned so far in terms of a very early warning sign. But occasionally I encounter someone in which one of their earliest symptoms is that they start to report something bizarre to their family or doctors. It's often something that seems far-fetched or impossible to most of us, but they can become quite convinced that this is true. So when people believe something that most people around them agree is not true. We call this a delusion. Some of the early delusions I've encountered or heard about from families include that people are entering the house, especially at night that their medications are being replaced by poison, that their spouse is having an affair, that people are out to get them or harm them or that a deceased person has come to visit. Delusions often have a paranoid flavor, meaning they involve suspicion and fear of harm from others, but that's not always the case. Now it is common for people with Alzheimer's to have delusions later, once they've developed other obvious symptoms of the disease, but every now and then I hear about someone who hasn't yet been diagnosed with Alzheimer's, but who is telling a story that sounds bizarre, unlikely to be delusional. So when that happens, especially if it's an older person, I pay attention because I know that delusions can be a warning sign of Alzheimer's that said there are other conditions that can cause delusions. So of course the next step should be further evaluation. Moving on to number seven. Number seven on my list is developing hallucinations. A hallucination is when a person perceives something that others don't. So a visual hallucination means seeing something that others don't and an auditory hallucination means hearing something that others don't hallucinations are sometimes an early warning sign of Alzheimer's or another dementia. Visual hallucinations are actually especially associated with Lewy body disease, which is another common cause of dementia in older adults, in Lewy body disease. It's fairly common for the person to report seeing children or animals. Next warning sign number eight is getting lost while driving or walking, getting lost in familiar surroundings is another concerning symptom that sometimes pops up early. It can be related to memory problems, but it can also be related to difficulties with spatial memory or with recognizing familiar landmarks, moving on to number nine. Number nine on my list of warning signs is trouble with speech and language, especially with naming things and finding words. And that's because Alzheimer's does often affect the part of the brain that manages language. So one early warning sign is to start having trouble naming things or finding the right word for things. Now, anyone can have trouble remembering a word every now and then we've all had those. What is it called again, moments. And they do generally become more common as we age. But if people can't name an object that's shown to them, or if they use a descriptor instead of the name of an object, such as saying the thing you sit on, instead of saying chair, that would be concerning, it would also be concerning. If they're using a word that's not quite right, such as book to refer to a newspaper now, trouble producing or understanding language is called aphasia, but aphasia by the way is not a diagnosis. It's really a symptom that is caused by some kind of underlying problem affecting the parts of the brain that manage language. So when they announced that the actor Bruce Willis had aphasia in March of 2022, right away, I thought, well, due to what and what other symptoms is he having? And actually it turns out that coworkers had been noticing some cognitive difficulties for a few years. Now, this doesn't mean that he has Alzheimer's disease, but it is likely that he has some kind of ongoing brain condition that is affecting his language and other brain functions. Moving onto warning sign number 10, for me, that's uncharacteristic behaviors and or changes in personality. So for instance, this is when things start to happen that leave others who know the person saying that's so weird, this is so unlike them, sometimes it's uncharacteristic spending or risk-taking or actions that reflect impaired judgment. Other times it might be a change in social appropriateness or in how the person engages socially. So it might be someone starting to blurt out inappropriate things, or it might be someone who used to be very social, becoming withdrawn and much quieter. And so there you have them 10 warning signs that often cause me to sit up and pay attention and wonder if someone might be manifesting early Alzheimer's disease. Now there are of course, many other signs and symptoms people can have early on. I actually have a list of 21 in my book when your aging parent needs help. And I cover those in another video. So if you'd like to learn more about what to look out for, be sure to check out that video. I also want to note that although I've been referring mostly to Alzheimer's disease in this video, it would be reasonable to say that these are common early warning signs of dementia in general, because most dementia in older adults is caused at least in part by Alzheimer's disease. If you'd like to learn more about the difference between the terms Alzheimer's disease, dementia, and also mild cognitive impairment, be sure to check out one of my earlier videos in which I covered that topic. Otherwise, if you've noticed one or more of these signs in your aging parents or in someone else you care about, I don't want you to panic, but I do want you to pay attention and keep thinking about how you can support your parents in getting more of the health and care they need. One important next step, if you've noticed any worrisome signs, is to help your parent get an adequate medical evaluation so that your parent and your family can find out what is causing the memory loss or other symptoms you're noticing. But that of course can be tricky because often older adults with warning signs of early Alzheimer's are lacking insight. That was warning sign number four on my list, and they can't see that they're having a problem that requires evaluation, or they may not want to go to the doctor or tell the doctor for their own reasons. If you're in this situation, then I do have a free online workshop that can help you with this. And I'll post a link below, or you can stay tuned and I'll be covering next steps and how to get around common challenges in upcoming episodes. Thank you. Take care and hope to see you again soon.
