5 early signs of Alzheimer's you may not expect

Memory slips aren’t the only clue to this common form of dementia. Spotting other, lesser-known factors may be a key to early diagnosis — and potentially be a way to slow down the disease. 

Elizabeth Millard
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When you hit a certain age, any sign of memory loss can make the calmest person jump to the worst case scenario: Alzheimer’s disease.

Our fear can be a bit extreme — there are plenty of normal age-related memory issues — but it’s certainly understandable. After all, this progressive form of dementia is so closely associated with taking away precious memory powers. 

It’s true that memory loss is the best-known symptom of Alzheimer’s. But it’s not the only clue that your brain may be experiencing changes that fall outside the getting-older norms, says Scott Kaiser, M.D., director of geriatric cognitive health for the Pacific Neuroscience Institute at Providence Saint John’s Health Center.

“Alzheimer’s is a progressive condition,” says Dr. Kaiser, which is why it’s so important to know about other early symptoms. “Although there’s no cure yet, it can be slowed down, and the earlier it’s caught, the better your chances [are] of reducing the disease’s progression.”

Here are five lesser-known signs of the early stages of Alzheimer’s that warrant a closer look. But don’t make an automatic assumption: Experiencing them doesn’t necessarily indicate that you’re developing Alzheimer’s, Dr. Kaiser emphasizes. Rather, these are things that you should share with your doctor, so you can decide your next steps together.

Surprising Early Sign #1: Personality Shifts

Frazzled nerves. Newfound fears. Minor annoyances setting you off. Unless you’ve always been on edge, these kinds of uncharacteristic personality changes are often one of the first signs of the early stages of Alzheimer’s.

Usually, the disease first affects the hippocampus, the part of the brain associated with long-term memory — but also with handling emotions and stress, says Dr. Kaiser. If you used to pride yourself on being fairly easy-going, but are noticing that lately you’re becoming irritable, angry or fearful, don’t brush this behavior aside. 

In its later stages, Alzheimer’s begins to affect another part of the brain, the amygdala, which deals with regulating emotions. This may cause more anxiety, sadness and paranoia. “If a person feels frustrated by other symptoms,” adds Dr. Kaiser, “this mood shift can be even more pronounced.”

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Surprising Sign #2: Two Left Feet

The hippocampus also plays a key role in how you navigate and orient your body — literally, it means how smoothly you move through a room. You use visual cues, but also a sense of how your body is maneuvering through spaces. 

With early Alzheimer’s, this sense may go awry. The result may be that you bump into objects more often, misjudge the height of a step or suddenly drop things. You may also start to walk slower: When proteins known as beta-amyloid build up in the brain (a marker of Alzheimer’s), walking speed tends to slow down, according to a 2016 study in the journal Neurology.

“Many people might chalk this up to being a little clumsy or just getting older,” Dr. Kaiser says. But if it’s happening often, it could be a prompt to see your doctor.

Surprising Sign #3: Confusion

Because the hippocampus allows you to form new memories, even a minor loss in that function can be disorienting, says Dr. Kaiser. You might lose track of time or the seasons. Organizational tasks, like writing down your appointments or following a recipe, may become more challenging, too. 

You may also forget the function of specific objects or misplace items more frequently. Starting projects and then abandoning them mid-stream is another clue of memory troubles, according to the Mayo Clinic. 

Lots of people want to label these signs as “senior moments,” he adds, but they’re not a normal part of aging.

Surprising Sign #4: Language Issues

Alzheimer’s affects each person differently. Some may be able to communicate well into the later stages of the disease, while others could have language challenges from the start. 

Yes, a first sign is forgetting words and names, or taking a longer time to recall them, says Dr. Kaiser. But there can be issues related to pronunciation or inaccurate word choice as well. 

Surprising Sign #5: Can’t Spot Sarcasm

Early stages of the disease have a way of messing with your ability to read vocal and facial cues, according to a University of California at San Francisco study. That means you may lose your internal lie detector or your ability to know when someone’s being sarcastic or telling a joke. Dr. Kaiser says this may be related to changes in parts of the brain that are responsible for both communication and memory.

On the surface, the ability to identify what the study calls “ironic speech” may not sound like a big deal. But Dr. Kaiser points out that being able to follow a conversation and other social cues matter in terms of quality of life. Just think about a time when you may have misinterpreted a sarcastic comment as an earnest statement. Now imagine that happening in every discussion you have. 

What to Do if You Recognize These Signs 

If any of the above hits close to home, your first step is to take a deep breath. Again, even if you have several of these symptoms, it doesn’t automatically mean you have Alzheimer’s, says Jasmeer Chhatwal, M.D., Ph.D., a neurologist at Massachusetts General Hospital and an assistant professor of neurology at Harvard Medical School. 

That said, it’s wise to talk to your doctor and ask if you’re a good candidate for a cognitive screening. “If your symptoms are minor, a screening will at least give you a baseline that you can compare with later screens if those symptoms should worsen,” says Dr. Chhatwal. “If nothing else, this can be a wake-up call to look at your lifestyle habits and see if anything needs improvement.”

A number of lifestyle behaviors have been shown to have a positive impact on the prevention and progression of Alzheimer’s, he notes. These include:

  • Regular exercise
  • Quality sleep
  • Good eating habits (including following the MIND diet
  • Meaningful social interactions 
  • A sense of purpose

“Even modest improvements in habits like exercise can be substantial for your brain health and preventing Alzheimer’s or slowing its progression,” says Dr. Chhatwal. “Don’t think that just because you have symptoms, there’s nothing you can do.”

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