Everyone occasionally finds it challenging to come up with a name, but how can you determine if it’s one of the signs of Alzheimer’s? Raj C. Shah, MD, from the Rush Memory Clinic at Rush University Medical Center in Chicago, explains that a single symptom alone doesn’t necessarily mean someone has Alzheimer’s or dementia. Dementia is a long-term decline in cognitive abilities, primarily affecting memory, with Alzheimer’s responsible for 50 to 80 percent of dementia cases.
Clingy or Childlike Behavior
Experts describe the behavior of Alzheimer’s patients who become entirely dependent on a specific individual and persistently follow them as “shadowing.”
Gwyther explains, “It’s usually a response to feeling frightened in a confusing world. The patient constantly needs to see the person they trust most. If that person is out of sight, they may lose track of how long they’ve been gone or where to locate them, leading them to follow them around the house, even into the bathroom.”
Trouble Sleeping
Symptoms such as restlessness, anxiety, agitation, disorientation, and confusion often worsen as the day progresses and can persist through the night, leading to sleep difficulties and wandering.
This phenomenon, known as “sundowning,” can be caused by factors like fatigue, shifts in the biological clock, difficulty distinguishing dreams from reality, and a reduced need for sleep with age.
Verbal and Physical Aggression
As dementia progresses, it’s not uncommon for individuals to display physical or verbal aggression.
These aggressive behaviors may appear sudden, but they usually have underlying causes that might not be immediately obvious to family members or caregivers, such as physical discomfort, difficulty communicating, or frustration with a situation.
Delusions and Paranoia
Some individuals may progress from having seemingly irrational suspicions, like thinking someone stole their glasses, to holding firm false beliefs or delusions, such as believing someone is trying to harm them.
They may also start experiencing hallucinations, where they see, hear, smell, or taste things that aren’t present.
Inappropriate Behavior
In the mid to late stages of Alzheimer’s, individuals may start losing control over their impulses and behave in inappropriate or uncharacteristic ways.
Gwyther notes, “They might say things like ‘Gosh, you got fat,’ that they would never have said before.“
Additionally, people with AD may forget their marital status and make inappropriate advances, undress in unsuitable settings, or engage in shoplifting, not realizing they need to pay for items in stores.
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Forgetting Meals
People with dementia may forget to eat and drink, partly because many Alzheimer’s patients have reduced appetite and interest in food.
Conversely, some may forget they’ve already eaten, leading them to consume multiple meals a day. It’s also common for individuals with AD to suddenly develop new food preferences or dislike previously favored foods.
Disregard for Grooming and Hygiene
As Alzheimer’s advances, individuals may forget to perform personal hygiene tasks such as brushing their teeth, bathing regularly, changing clothes, or using the toilet.
They might not recall the reasons for these routines or how to carry them out, including tasks like combing their hair, clipping their nails, shaving, or using grooming tools.
Difficulty Dressing
Dressing can be challenging for dementia patients, who might feel overwhelmed by clothing choices or forget how to dress, tie shoelaces, or buckle a belt.
They may repeatedly wear the same outfit, forgetting they wore it the previous day. Additionally, in the mid-to-late stages of AD, motor skill decline can make buttoning and unbuttoning clothes more difficult.
Loss of Initiative and Motivation
In the early or mid-stage of Alzheimer’s, apathy, loss of interest in activities, and social withdrawal might indicate depression, which affects about 40 percent of those with AD. Identifying depression can be challenging due to cognitive impairment, making it hard for individuals to express their feelings.
If a family member sleeps excessively or watches TV all day while avoiding other activities, they might be experiencing depression. It’s important to discuss these concerns with their doctor.
Loss of Motor Skills and Sense of Touch
Dementia can impair fine motor skills, making tasks like buttoning clothes or using utensils challenging. However, motor issues such as weakness or trembling hands, as well as sensory symptoms like numbness or loss of sensation, might indicate a different condition, such as Parkinson’s disease. It’s crucial to consult a doctor to discuss your parent’s or relative’s specific symptoms for an accurate diagnosis.
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Withdrawal
Alzheimer’s can be a lonely and isolating condition, leading individuals to lose interest in activities and withdraw from family and friends. They may abandon hobbies, social activities, work, or sports they once enjoyed, possibly due to forgetting how to engage in their favorite pastimes, like knitting or playing the piano.
Seemingly Purposeless Activity
If your relative starts regularly engaging in repetitive actions like opening and closing a drawer, packing and unpacking clothes, pacing, or repeatedly asking questions, it could be a sign of Alzheimer’s.
While these behaviors might seem pointless or strange from the outside, experts suggest they often serve a purpose for the person, such as fulfilling a need to feel productive or occupied according to Katie Couric.
Don’t Recognize Family and Friends
As Alzheimer’s disease advances, your loved one may struggle to recognize you or other family members and friends, which can be deeply distressing.
Gwyther explains, “Recognition tends to fluctuate over time. Generally, individuals forget recent information or new acquaintances first, with memories of friends and family fading later. It can be puzzling why someone might remember one child’s name but not another.
Trouble with Visual or Spatial Relationships
Vision issues in dementia often differ from typical age-related problems like cataracts. As Alzheimer’s progresses, individuals may struggle with reading, judging distances, and distinguishing colors or contrasts.
In terms of perception, they might look in a mirror and mistake their reflection for another person. Dementia can also affect visual and spatial skills, making it difficult to differentiate food from the plate it’s on.
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Repetitive Speech or Actions
Frequent repetition of words, statements, questions, or activities is a common feature of dementia and Alzheimer’s disease. This repetitive behavior can be triggered by anxiety, boredom, or fear, or may serve to provide comfort, security, or a sense of familiarity.
Wandering
Unfortunately, around 60% of people with dementia tend to wander and become lost, often repeatedly.
Sometimes, individuals might leave the house at night to address a physical need, like finding a bathroom or food, or they might attempt to “go home” because they don’t realize they are already at home, or they might believe it’s 20 years earlier and they need to return to a former job.
Difficulty Communicating
As dementia advances, language and communication skills deteriorate. Individuals may interrupt conversations and struggle to continue, have trouble finding the right words, use incorrect names, or create new words. They might also rely more on gestures, revert to a native language, or speak less frequently.
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Confusion with Time or Place
Disorientation with time and place is common in Alzheimer’s, such as forgetting where you live, getting lost, or losing track of dates and seasons. Gwyther notes, “The key issue with AD is the perception of time; five minutes might feel like five hours, so someone might think their spouse has been gone for weeks when it’s only been minutes or believe they haven’t seen a grandchild in years when it was just yesterday.”
Misplacing Things
Misplacing items like car keys in the freezer or a remote in a sock drawer can be a strong sign of dementia. Unlike typical forgetfulness, individuals with Alzheimer’s frequently leave items in unusual spots and struggle to retrace their steps. They may also become suspicious, accusing others of hiding or stealing their belongings.
Trouble Planning or Problem-Solving
As dementia advances, your loved ones may struggle with concentration, causing basic tasks to take longer. They may find it hard to plan and execute activities such as using a grocery list, following recipes, or managing monthly bills. This difficulty is much more severe than occasional mistakes like errors in checkbook balancing or forgetting an item on a grocery list.
Difficulty with Familiar Tasks
A person with dementia often takes longer to complete and may struggle to finish familiar tasks they once did easily. For example, a skilled cook might have trouble preparing their signature dish or even remembering how to boil water. Everyday activities like finding a familiar place, playing a favorite game, or managing a budget can also become challenging.
Money Trouble
As Alzheimer’s disease progresses, abstract thinking becomes challenging, making numbers and money especially problematic. While occasional missed payments aren’t typically concerning, significant trouble with handling money, paying bills, managing a budget, or understanding numbers could indicate dementia.
Impaired Judgement
As Alzheimer’s progresses, individuals may start making decisions that seem silly, irresponsible, or inappropriate compared to their previous behavior, such as dressing inappropriately for the weather or misjudging safety.
Gwyther notes, “The earliest signs of impaired judgment often involve money. Normally cautious individuals may begin spending unusually, like giving money to untrustworthy telemarketers or refusing to pay bills due to misplaced distrust in their utility company.”
Agitation and Mood Swings
Individuals with Alzheimer’s often appear anxious or agitated, exhibiting behaviors like pacing, getting upset in specific places, or fixating on details.
This agitation typically stems from fear, confusion, fatigue, and the stress of trying to understand a confusing world, according to Gwyther. Moving to a nursing home or similar changes can increase anxiety.
Memory Loss
Significant memory loss and confusion are not a normal part of aging, though stress, anxiety, or depression can sometimes mimic dementia, especially in older adults.
Lisa P. Gwyther, co-author of The Alzheimer’s Action Plan: A Family Guide, explains, While everyone forgets details occasionally, a person with Alzheimer’s might forget what just happened or what was just said, leading to repetitive behavior.
Getting Diagnosed
Even with an Alzheimer’s diagnosis, life doesn’t have to come to a halt; individuals with AD can continue to lead fulfilling and productive lives for many years. However, obtaining an accurate diagnosis is crucial.
“Most diagnoses are made in the moderate stage, by which time symptoms have been present for years,” says Dr. Shah. “Waiting until symptoms are so pronounced that a diagnosis is straightforward doesn’t benefit the person or their family.
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