Early on, as the nerve cells first begin to deteriorate, AD may present no signs or symptoms at all. Even the person who has Alzheimer’s may not notice anything different at first. But as the destruction worsens, and the person moves into this early stage, changes in behavior may become more apparent. Not every person in the early phases of Alzheimer’s will experience these symptoms, but they may include:
Virtually everyone in the early stages of AD will experience a loss of memory, especially of recent events. That’s because the destruction of the disease is believed to strike first in the hippocampus, where our short-term memories are stored and converted into long-term memories.
Everyone has lapses in memory. When they occur in someone older, it’s easy to dismiss them as a consequence of advancing age. As a result of these memory problems, it may become more difficult to pay attention, to learn something, and to recall a specific name, phone number, or fact. But given some extra time, most older people eventually retrieve the lost memory.
In people who have Alzheimer’s, these short-term memories disappear completely. Appointments go neglected. Events of recent weeks, days, even hours, slip away. Important tasks like paying bills are forgotten. Gradually, these lapses start to interfere with daily functioning, like missing an important doctor’s visit or having the phone disconnected because of a forgotten bill. Often, these practical problems become the first indication that something is seriously wrong.
At the same time, the person with early AD can usually still recall things that occurred long ago, which are known as remote memories. Names of a childhood friend or the layout of a grandparent’s house may remain vivid because the early stage of AD has not affected the temporal and parietal lobes, where long-term memories are stored.
Every day, without a second thought, we go about performing tasks that require us to think logically. In the person with early AD, that thought process, which is sometimes called abstract thinking, becomes increasingly difficult. Without it, it becomes hard to do things that involve multiple steps and that require sound reasoning and judgment. Activities like balancing a checkbook, following a recipe, or reading a manual become very difficult. It may be hard to determine what needs to be done with the numbers, and difficult to comprehend the information that’s being read.
Judgment refers to the ability to do things according to the information you have. Good judgment also requires sound memory, logic, and the ability to reason. For people with early Alzheimer’s, those skills are diminished, and they may make choices and decisions that are faulty, even dangerous. People with Alzheimer’s may dress in shorts on a winter day, buy expensive objects they can’t afford, or donate large amounts of money to unscrupulous telemarketers.
We all occasionally struggle to find just the right word to express a thought. But for the person with early AD, finding the right word or phrase may become almost impossible. The ability to say what he or she means becomes diminished as does the person’s vocabulary. Instead, the person with early AD may substitute correct words with others that sound like it. She may also stop talking as much in order to avoid the embarrassment of making mistakes, or she may ask the same questions repeatedly.
Difficulty with communication is called aphasia. Losing the ability to speak and write is called expressive aphasia, while the inability to understand spoken or written words is called receptive aphasia. Often, the person with early AD may cover up these shortcomings by smiling, nodding, and agreeing, making this symptom initially difficult to spot. But over time, family and friends may notice the person’s withdrawal and suspect something is wrong.
Confusion About Time and Space
It’s normal to occasionally forget what day it is, but a person in the early stage of AD may become frequently confused about what day it is and where they are. She may get lost on her own street and forget how to get back home. She may not remember the day of the week or the month of the year. This type of confusion on a regular basis is often seen in early AD.
Difficulties gauging location may be linked to a condition called agnosia, in which a person has trouble using the information he gets from his senses. Often, the sense affected by Alzheimer’s is sight. The person with early AD whose visual information is distorted may lose depth perception, misjudge the appearance of objects, and become disoriented while driving.
Loss of Smell
Many people in the early stages of AD lose their ability to smell. In fact, one study found that elderly people with mild to minimal cognitive impairment who could not identify certain smells were more likely to develop Alzheimer’s. More specifically, these people had difficulty detecting die smells of strawberry, smoke, soap, menthol, clove, pineapple, natural gas, lilac, lemon, and leather.
Inability to Concentrate
Our knack for following a conversation or comprehending a newspaper article relies on the ability to concentrate. In people with early AD, concentration skills wane. Reading a passage and making sense of it becomes increasingly difficult, and tracking a conversation may become impossible. Even doing something familiar may become difficult, because a person with AD loses the ability to stay focused.
Loss of Initiative
Most people are energized by doing things they enjoy, whether it’s gardening, spending time with loved ones, or taking a walk. A person with Alzheimer’s may lose her get-up-and-go energy and become very passive. She may spend hours sitting in front of the television, sleep more than usual, and express a lack of interest in activities.
Extreme Mood Changes
It’s normal to feel sad or moody on occasion, but in a person with early Alzheimer’s, the mood shifts can be sudden and dramatic, often for no apparent reason.
Change in Personality
The extrovert who becomes a recluse. The proper gentleman who becomes brazenly outspoken. The energetic go-getter who stops seeing friends. Such dramatic shifts in personality are often a part of early Alzheimer’s, as inhibitions give way to a loss of control. Some of these behaviors may become antisocial, offensive, and embarrassing.
In some cases, subde personality characteristics that a person kept under control prior to the illness go haywire. When that happens, a suspicious person may become blatandy paranoid, or an obsessive person may become a hoarder.
Other Signs of Early AD
AD can affect a person’s behavior, cognitive function, and personality in many ways. Below is a list of some other changes you might see in a person with early AD:
• Misplacing things in odd places. The person with early Alzheimer’s may put things in strange places like a wallet in the freezer.
• Repeating the same phrase or story, over and over again, with no awareness of the repetition.
• Resistance to making even simple decisions.
• Taking longer to do routine chores and becoming upset if something unexpected occurs.
• May forget to eat, eat only one kind of food, or eat all the time.
• May neglect hygiene and wear the same clothes day after day, while insisting they’re clean.
• May become obsessive about checking, searching, or hoarding things of no value.