MANIPAL HOSPITALS, DWARKA
Dr (Lt Gen) CS Narayanan, VSM***
In the early stages, patients with Alzheimer’s disease (AD) may appear completely normal on physical examination and mental status testing. Specific regions of the brain are affected decades before any signs or symptoms appear. They may also have remarkably preserved social graces and the ability to participate in routine conversations
Early Signs of AD that may be noticed by family and friends include:
Patients may not remember where they have kept items of daily use, like car keys. They may also keep things in unusual places and accuse others of hiding them. They may miss important appointments and forget the dates of significant life events.
- Confusion about time and place:
They may develop a tendency to get lost in places which they were earlier familiar with. This is particularly distressing when driving. They may struggle to find their way back home after going out for a walk. There may be a tendency to wander aimlessly, a phenomenon called sun-downing, which is more pronounced in the late evenings
- Taking longer to accomplish normal daily tasks:
Family members may notice that the patient takes much longer than usual in daily activities like self-care, grooming and dressing.
- Trouble handling money and paying bills:
Patients may not remember to collect balance of cash after making a payment. They may present inappropriately high bill denominations for small purchases.
- Repetitive statements or movements:
People living with Alzheimer’s may have trouble joining or following a conversation. They may repeat themselves frequently andstruggle finding the right word for familiar objects.They may compulsively perform some repetitive activity like checking whether the house door is locked.
- Shortened attention span:
Patients are easily distracted and may find it difficult to participate in meetings at work or watch a full length movie.
- Difficulty organizing thoughts and thinking logically:
This along with compromised judgment may often lead to bad decisions both in the personal and work situations. They have increasing difficulty in planning and executing activities.
- Inability to learn new things or to cope with new or unexpected situations:
The ability to adapt to unfamiliar situations declines and patients may become distressed and agitated under these circumstances.
- Withdrawal from work or social activities
Individuals who were previously socially active and outgoing may become withdrawn and avoid the company of friends and relatives.
- Change of mood and personality changes
Individuals living with Alzheimer’s may experience mood and personality changes. They can become suspicious, depressed, fearful or anxious. They may be easily upset at home, with friends or when out of theircomfort zone.
It is important to consult with a neurologist if an individual manifests these symptoms so that an early diagnosis of Alzheimer’s disease is made. Formal testing of mental functions may unmask disorders of memory and other domains of cognition that may not be apparent to a casual observer. Medications used to treat early stages of Alzheimer’s disease work by increasing the levels of neuro-transmitters such as acetyl-choline that are responsible for storage of memory in the brain.
Activities like puzzle-solving and learning a new language may delay the progression of the disease by increasing brain reserve.
It is also important to rule out certain conditions which mimic dementia but warrant urgent treatment like clots in the brain, brain tumours and certain endocrine disorders like hypothyroidism.