What are the beginning stages of alzheimers

What happens in the early stage of dementia?

Dementia affects everyone differently and early symptoms are often relatively mild and not always easy to notice.

Many people at the early stage of dementia stay largely independent and only need a bit of assistance with daily living. It is important to focus on what the person can do and not to take over and do things for them. Instead, try doing things with them, for example helping the person develop a routine, reminder lists and prompts, and use technology.

For more information for people living with dementia, see the 'Keeping active and involved' page.

The early stage of dementia is when many people choose to make plans for the future, while they still have the ability (‘mental capacity’) to do so. This includes making a Lasting power of attorney (LPA), and advance decisions and advance statements to ensure their wishes and preferences are made clear.

What are the early-stage symptoms of dementia?

As a very rough guide, the early stage of dementia lasts on average about two years.

In the early stage of dementia, the following common symptoms start to affect the person’s daily life:

Memory problems

These are the most well-known early symptoms. For example, a person may not recall recent events or may keep losing items (such as keys and glasses) around the house. Memory loss is often the first and main symptom in early Alzheimer’s disease. It is also seen, although less often, in early vascular dementia and dementia with Lewy bodies (DLB). Memory loss is not common in early frontotemporal dementia (FTD).

Difficulties in thinking things through and planning

A person may get confused more easily and find it harder to plan, make complex decisions (for example, about finances) or solve problems.

Language and communication

A person may struggle to find the right word in a conversation, or they might not follow what is being said. Speech can also be affected when someone with vascular dementia has had a stroke. Specific types of FTD cause particular early problems with language.

Poor orientation

A person may no longer recognise where they are and so get lost, even in a place that is familiar to them.

Visual-perceptual difficulties

This can cause problems judging distances, for example when using stairs. They are more common in early-stage Alzheimer’s disease and DLB than in vascular dementia or FTD. Visual-perceptual difficulties are different from the visual hallucinations (often of animals or people) that are a feature of early-stage DLB.

Changes in mood or emotion

The person may be more anxious, frightened or sad, and so at risk of depression. It is also common to become more irritable – perhaps in frustration at lost abilities – or easily upset. A person can often be more withdrawn, lack self-confidence and lose interest in hobbies or people.

Changes in behaviour are not common in early-stage dementia, other than in FTD. A person with behavioural variant FTD may lose their inhibitions and behave in socially inappropriate ways. They may also act impulsively and lose empathy for others.

Significant physical changes at this stage tend to be limited to DLB, where problems with movement are similar to Parkinson’s disease. If someone with vascular or mixed dementia has a stroke, this can lead to weak limbs on one side.

Everybody forgets things from time to time. But if you or other people are noticing that memory problems are getting worse, or affecting everyday life, it could be a sign of dementia.

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Page last reviewed: 24 February 2021

Overview

Alzheimer's disease is a progressive neurologic disorder that causes the brain to shrink (atrophy) and brain cells to die. Alzheimer's disease is the most common cause of dementia — a continuous decline in thinking, behavioral and social skills that affects a person's ability to function independently.

Approximately 5.8 million people in the United States age 65 and older live with Alzheimer's disease. Of those, 80% are 75 years old and older. Out of the approximately 50 million people worldwide with dementia, between 60% and 70% are estimated to have Alzheimer's disease.

The early signs of the disease include forgetting recent events or conversations. As the disease progresses, a person with Alzheimer's disease will develop severe memory impairment and lose the ability to carry out everyday tasks.

Medications may temporarily improve or slow progression of symptoms. These treatments can sometimes help people with Alzheimer's disease maximize function and maintain independence for a time. Different programs and services can help support people with Alzheimer's disease and their caregivers.

There is no treatment that cures Alzheimer's disease or alters the disease process in the brain. In advanced stages of the disease, complications from severe loss of brain function — such as dehydration, malnutrition or infection — result in death.

Symptoms

Memory loss is the key symptom of Alzheimer's disease. Early signs include difficulty remembering recent events or conversations. As the disease progresses, memory impairments worsen and other symptoms develop.

At first, a person with Alzheimer's disease may be aware of having difficulty remembering things and organizing thoughts. A family member or friend may be more likely to notice how the symptoms worsen.

Brain changes associated with Alzheimer's disease lead to growing trouble with:

Memory

Everyone has occasional memory lapses, but the memory loss associated with Alzheimer's disease persists and worsens, affecting the ability to function at work or at home.

People with Alzheimer's may:

Repeat statements and questions over and over
Forget conversations, appointments or events, and not remember them later
Routinely misplace possessions, often putting them in illogical locations
Get lost in familiar places
Eventually forget the names of family members and everyday objects
Have trouble finding the right words to identify objects, express thoughts or take part in conversations

Thinking and reasoning

Alzheimer's disease causes difficulty concentrating and thinking, especially about abstract concepts such as numbers.

Multitasking is especially difficult, and it may be challenging to manage finances, balance checkbooks and pay bills on time. Eventually, a person with Alzheimer's may be unable to recognize and deal with numbers.

Making judgments and decisions

Alzheimer's causes a decline in the ability to make reasonable decisions and judgments in everyday situations. For example, a person may make poor or uncharacteristic choices in social interactions or wear clothes that are inappropriate for the weather. It may be more difficult to respond effectively to everyday problems, such as food burning on the stove or unexpected driving situations.

Planning and performing familiar tasks

Once-routine activities that require sequential steps, such as planning and cooking a meal or playing a favorite game, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's often forget how to perform basic tasks such as dressing and bathing.

Changes in personality and behavior

Brain changes that occur in Alzheimer's disease can affect moods and behaviors. Problems may include the following:

Depression
Apathy
Social withdrawal
Mood swings
Distrust in others
Irritability and aggressiveness
Changes in sleeping habits
Wandering
Loss of inhibitions
Delusions, such as believing something has been stolen

Preserved skills

Many important skills are preserved for longer periods even while symptoms worsen. Preserved skills may include reading or listening to books, telling stories and reminiscing, singing, listening to music, dancing, drawing, or doing crafts.

These skills may be preserved longer because they are controlled by parts of the brain affected later in the course of the disease.

When to see a doctor

A number of conditions, including treatable conditions, can result in memory loss or other dementia symptoms. If you are concerned about your memory or other thinking skills, talk to your doctor for a thorough assessment and diagnosis.

If you are concerned about thinking skills you observe in a family member or friend, talk about your concerns and ask about going together to a doctor's appointment.

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Causes

The exact causes of Alzheimer's disease aren't fully understood. But at a basic level, brain proteins fail to function normally, which disrupts the work of brain cells (neurons) and triggers a series of toxic events. Neurons are damaged, lose connections to each other and eventually die.

Scientists believe that for most people, Alzheimer's disease is caused by a combination of genetic, lifestyle and environmental factors that affect the brain over time.

Less than 1% of the time, Alzheimer's is caused by specific genetic changes that virtually guarantee a person will develop the disease. These rare occurrences usually result in disease onset in middle age.

The damage most often starts in the region of the brain that controls memory, but the process begins years before the first symptoms. The loss of neurons spreads in a somewhat predictable pattern to other regions of the brains. By the late stage of the disease, the brain has shrunk significantly.

Researchers trying to understand the cause of Alzheimer's disease are focused on the role of two proteins:

Plaques. Beta-amyloid is a fragment of a larger protein. When these fragments cluster together, they appear to have a toxic effect on neurons and to disrupt cell-to-cell communication. These clusters form larger deposits called amyloid plaques, which also include other cellular debris.
Tangles. Tau proteins play a part in a neuron's internal support and transport system to carry nutrients and other essential materials. In Alzheimer's disease, tau proteins change shape and organize themselves into structures called neurofibrillary tangles. The tangles disrupt the transport system and are toxic to cells.

Risk factors

Age

Increasing age is the greatest known risk factor for Alzheimer's disease. Alzheimer's is not a part of normal aging, but as you grow older the likelihood of developing Alzheimer's disease increases.

One study, for example, found that annually there were four new diagnoses per 1,000 people ages 65 to 74, 32 new diagnoses per 1,000 people ages 75 to 84, and 76 new diagnoses per 1,000 people age 85 and older.

Family history and genetics

Your risk of developing Alzheimer's is somewhat higher if a first-degree relative — your parent or sibling — has the disease. Most genetic mechanisms of Alzheimer's among families remain largely unexplained, and the genetic factors are likely complex.

One better understood genetic factor is a form of the apolipoprotein E gene (APOE). A variation of the gene, APOE e4, increases the risk of Alzheimer's disease. Approximately 25% to 30% of the population carries an APOE e4 allele, but not everyone with this variation of the gene develops the disease.

Scientists have identified rare changes (mutations) in three genes that virtually guarantee a person who inherits one of them will develop Alzheimer's. But these mutations account for less than 1% of people with Alzheimer's disease.

Down syndrome

Many people with Down syndrome develop Alzheimer's disease. This is likely related to having three copies of chromosome 21 — and subsequently three copies of the gene for the protein that leads to the creation of beta-amyloid. Signs and symptoms of Alzheimer's tend to appear 10 to 20 years earlier in people with Down syndrome than they do for the general population.

Sex

There appears to be little difference in risk between men and women, but, overall, there are more women with the disease because they generally live longer than men.

Mild cognitive impairment

Mild cognitive impairment (MCI) is a decline in memory or other thinking skills that is greater than normal for a person's age, but the decline doesn't prevent a person from functioning in social or work environments.

People who have MCI have a significant risk of developing dementia. When the primary MCI deficit is memory, the condition is more likely to progress to dementia due to Alzheimer's disease. A diagnosis of MCI encourages a greater focus on healthy lifestyle changes, developing strategies to make up for memory loss and scheduling regular doctor appointments to monitor symptoms.

Head trauma

People who've had a severe head trauma have a greater risk of Alzheimer's disease. Several large studies found that in people age 50 years or older who had a traumatic brain injury (TBI), the risk of dementia and Alzheimer's disease increased. The risk increases in people with more-severe and multiple TBIs. Some studies indicate that the risk may be greatest within the first six months to two years after the TBI.

Air pollution

Studies in animals have indicated that air pollution particulates can speed degeneration of the nervous system. And human studies have found that air pollution exposure — particularly from traffic exhaust and burning wood — is associated with greater dementia risk.

Excessive alcohol consumption

Drinking large amounts of alcohol has long been known to cause brain changes. Several large studies and reviews found that alcohol use disorders were linked to an increased risk of dementia, particularly early-onset dementia.

Poor sleep patterns

Research has shown that poor sleep patterns, such as difficulty falling asleep or staying asleep, are associated with an increased risk of Alzheimer's disease.

Lifestyle and heart health

Research has shown that the same risk factors associated with heart disease may also increase the risk of Alzheimer's disease. These include:

Lack of exercise
Obesity
Smoking or exposure to secondhand smoke
High blood pressure
High cholesterol
Poorly controlled type 2 diabetes

These factors can all be modified. Therefore, changing lifestyle habits can to some degree alter your risk. For example, regular exercise and a healthy low-fat diet rich in fruits and vegetables are associated with a decreased risk of developing Alzheimer's disease.

Lifelong learning and social engagement

Studies have found an association between lifelong involvement in mentally and socially stimulating activities and a reduced risk of Alzheimer's disease. Low education levels — less than a high school education — appear to be a risk factor for Alzheimer's disease.

Complications

Memory and language loss, impaired judgment and other cognitive changes caused by Alzheimer's can complicate treatment for other health conditions. A person with Alzheimer's disease may not be able to:

Communicate that he or she is experiencing pain
Explain symptoms of another illness
Follow a prescribed treatment plan
Explain medication side effects

As Alzheimer's disease progresses to its last stages, brain changes begin to affect physical functions, such as swallowing, balance, and bowel and bladder control. These effects can increase vulnerability to additional health problems such as:

Inhaling food or liquid into the lungs (aspiration)
Flu, pneumonia and other infections
Falls
Fractures
Bedsores
Malnutrition or dehydration
Constipation or diarrhea
Dental problems such as mouth sores or tooth decay

Prevention

Alzheimer's disease is not a preventable condition. However, a number of lifestyle risk factors for Alzheimer's can be modified. Evidence suggests that changes in diet, exercise and habits — steps to reduce the risk of cardiovascular disease — may also lower your risk of developing Alzheimer's disease and other disorders that cause dementia. Heart-healthy lifestyle choices that may reduce the risk of Alzheimer's include the following:

Exercising regularly
Eating a diet of fresh produce, healthy oils and foods low in saturated fat such as a Mediterranean diet
Following treatment guidelines to manage high blood pressure, diabetes and high cholesterol
Asking your doctor for help to quit smoking if you smoke

Studies have shown that preserved thinking skills later in life and a reduced risk of Alzheimer's disease are associated with participating in social events, reading, dancing, playing board games, creating art, playing an instrument, and other activities that require mental and social engagement.

Feb. 19, 2022

What is one of the first signs of Alzheimer's?

Memory problems are typically one of the first signs of the disease. Decline in non-memory aspects of cognition, such as finding the right word, trouble understanding visual images and spatial relationships, and impaired reasoning or judgment, may also signal the early stages of Alzheimer's.

What does early stage Alzheimer's look like?

Early symptoms: Forgetting important things, particularly newly learned information or important dates. Asking for the same information again and again. Trouble solving basic problems, such as keeping track of bills or following a favorite recipe.

What is the average life expectancy of someone with early onset Alzheimer's?

The life expectancy for an individual diagnosed with early-onset Alzheimer's is unknown due to the rarity of this form of Alzheimer's and the fact that very few research studies have been done to date. The average life expectancy for an individual diagnosed with late-onset Alzheimer's is between 8-12 years.