If you've been struggling with memory problems, the chances are you've wondered if you are at risk of developing Alzheimer's disease or another form of dementia. Memory loss is one of the most commonly known dementia symptoms, but it's not the only indication or even the first symptom you're likely to notice.
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While memory loss and forgetting the faces and names of our loved ones are probably the most talked about early symptoms, there are other signs of cognitive decline beforehand. Spotting these early signs of Alzheimer's can lead to better care and even slow the disease's progress.
Although there is no single test to diagnose dementia or cure for Alzheimer's disease, understanding the risk factors and recognizing these early symptoms can help identify the right time to seek medical advice.
Understanding the warning signs of dementia
Occasionally forgetting where you left your keys or even where you parked your car doesn't mean you should worry about the early stages of Alzheimer's. Although age increases the risk for the onset of dementia, it's not a foregone conclusion you will suffer from it as you age. We all forget important things at times.
Stress, lack of sleep and anxiety can all bring about cloudy mental moments. However, memory problems are typically one of the first warning signs, and it's natural for this to cause worry about your health. Although the stages of the disease progress slowly, noticing the persistence of worrying symptoms means it's time to speak with your healthcare provider. The indicative symptoms may include:
- Misplacing items and memory problems
- Difficulty finding the right word or remembering the names of people, places and objects
- Repeating the same questions
- An unwillingness to try new things or change plans
- Poor judgement and difficulty making decisions
- Withdrawal from family and friends
- Confusion, disorientation and mood swings
If your GP sees a correlation between the symptoms described and other aspects of your health, they may refer you to a specialist for further testing.
Research from the National Institute on Aging in the US shows that after age 65, the risk of Alzheimer's doubles every five years. While the most significant known risk factor is increasing age, getting older doesn't mean you'll develop Alzheimer's. Other risk factors include genetics, family history, environment and lifestyle factors such as smoking, drinking and obesity.
About a third of younger people with dementia have Alzheimer's. Familial Alzheimer's Disease (FAD) usually develops before age 65 - most commonly in people in their 40s or 50s. Along with the genetics we're born with, disabilities like Down's Syndrome can make it more likely someone will develop Alzheimer's.
Alzheimer's signs and symptoms as the disease progresses
Alzheimer's disease is caused by the dying off of brain cells and the subsequent shrinking of the brain. Recent research found older people with high blood pressure are more likely to have biomarkers for Alzheimer's disease in their spinal fluid. This may be linked to the fact that high blood pressure can damage the smaller blood vessels in the brain, decreasing the oxygen available to brain cells.
Research by John Hopkins also found using potassium-sparing diuretics reduced the risk of Alzheimer’s by nearly 75%, and medication to lower blood pressure could reduce the risk of Alzheimer's by around 33%.
Typically, the disease progresses in three clear stages:
- Early-stage Alzheimer's. Progressing slowly over several years, this disease may present mostly as memory loss. Forgotten conversations, repetitive questions and trouble finding the right words are common indications of the early stages of this disease. Throughout these early signs and symptoms of Alzheimer's, people can continue taking care of themselves and often do.
- Middle-stage Alzheimer's As the disease develops, it can become much more difficult for family members and caregivers to manage. This stage can begin years after the first symptoms were noticed and diagnosed. Memory problems worsen, and increasing confusion and disorientation can be punctuated with hallucinations. Other symptoms can develop in the later stages, including paranoia, believing things that are untrue, problems with speech and frequent mood swings.
- Late-stage Alzheimer's symptoms The final stages of this disease can be very distressing to see and experience. Hallucination and delusion symptoms become increasingly severe. Difficulty eating, moving and going to the toilet are also typical in the final stages of the disease. Around 11.25% of deaths in the UK are due to dementia - higher than respiratory or cardiovascular diseases and lung cancer.
Before memory loss or any common dementia warning signs appear
Changes in the brain that lead to the early signs of Alzheimer's occur up to a decade before the first signs and symptoms become apparent. Long before someone notices symptoms that get worse, the brain cells experience an abnormal build-up of proteins. These form amyloid plaques and tau tangles that cause neurons to lose connection with each other. Then they stop functioning. Eventually, they die, and the brain begins to shrink.
These proteins are one leading cause of Alzheimer's disease.
Alzheimer's damage begins in the hippocampus and entorhinal cortex. The hippocampus is part of the brain that controls memory. It's essential for the forming of both short and long-term memories, while the entorhinal cortex works as a gatekeeper and is a significant hub for spatial navigation. As Alzheimer's disease progresses, more brain cells die, and other parts of the brain also begin to shrink. This is how Alzheimer's causes memory loss and difficulty with movement as the disease reaches its final stages.
In these earlier stages, disease onset is so mild that it's hardly noticeable. Signs of the disease can easily be passed off as over-tiredness or the results of stress. Modern brain scans may show areas of the brain with less activity or brain tissue. As such, early diagnosis, before people become symptomatic, may become possible in the coming years. However, there is currently no cure for Alzheimer's or way of completely halting the progression of the disease.
Medications for Alzheimer's disease
Many different medications are available to treat Alzheimer's and help people with dementia manage the challenging behaviour that accompanies the later stages of the disease. A specialist or a GP must prescribe these medications.
In the early stages of Alzheimer's, GPs may prescribe Donepezil, Galantamine or Rivastigmine. Each of these drugs increases levels of acetylcholine, which helps nerve cells to communicate with each other. While neither is better or worse than the other, some people will have fewer side effects with one than another.
Memantine is used as the later stages of Alzheimer's symptoms develop. It works to block excessive amounts of glutamate in the brain. This can improve thinking and memory while slowing the decline of cognitive ability. Side effects tend to be temporary and may include dizziness, constipation and headaches.
Aducanumab is an antibody therapy that targets the amyloid-beta protein behind the build-up of plaques and tangles in brain cells. This is currently unavailable in the UK due to a refusal from the European Medicines Agency (EMA) because there is insufficient evidence that the drug was safe, effective and had a clear benefit for people living with dementia and Alzheimer's disease that outweighed the risks.
The main known side effects noted included swelling in the brain and micro-bleeds following high-dose treatment. As a result, the UK's National Institute for Healthcare and Excellence (NICE) suspended its appraisal and approval of this treatment based on the EMA's findings.
In addition to medications specifically for treating Alzheimer's disease, other medicines may be prescribed, particularly in the later stages, to help manage challenging behaviours and psychological symptoms.
Preventing mental decline and symptoms of Alzheimer's disease
Knowing your family history can provide important information about your own likelihood of developing this condition in later life. However, it's not a foregone conclusion you will develop dementia if other family members have. Taking good care of your health as you age can prevent dementia and many other diseases from developing. Many of the lifestyle choices for preventing Alzheimer's disease will also reduce your risk of cardiovascular disease, diabetes and osteoporosis.
Obesity, high blood pressure and lack of exercise are thought to have the most significant impact on the development of symptoms and causes for many types of dementia. Managing your weight and maintaining a healthy diet as you age will help prevent Alzheimer's and many other lifestyle-related diseases.
Ensuring you exercise and remain active as you age protects your mental and physical health. Exercising daily can improve sleep, lower blood pressure, and improve energy. It also makes it easier to maintain a healthy weight. Our physical and mental health are intimately related; taking care of one naturally supports the other.
Early detection is vital when it comes to managing the progression of Alzheimer's disease, so it is essential for over 50s to be aware of the warning signs. By understanding what types of changes could indicate a potential problem, you'll be better equipped to take action if faced with this challenging situation. If you suspect that someone you know may have early-onset Alzheimer's disease or another form of dementia, it is best to make an appointment with a doctor as soon as possible. Further tests and an accurate diagnosis can then be made, and an effective treatment plan developed.