Alzheimer's disease

2. Symptoms

The symptoms of Alzheimer's disease are generally mild to start with, but they get worse over time and start to interfere with daily life.

There are some common symptoms of Alzheimer's disease, but it is important to remember that everyone is unique. Two people with Alzheimer's are unlikely to experience the condition in exactly the same way.

For most people with Alzheimer's, the earliest symptoms are memory lapses. In particular, they may have difficulty recalling recent events and learning new information. These symptoms occur because the early damage in Alzheimer's is usually to a part of the brain called the hippocampus, which has a central role in day-to-day memory. Memory for life events that happened a long time ago is often unaffected in the early stages of the disease.

Memory loss due to Alzheimer's disease increasingly interferes with daily life as the condition progresses. The person may:

  • lose items (eg keys, glasses) around the house
  • struggle to find the right word in a conversation or forget someone's name
  • forget about recent conversations or events
  • get lost in a familiar place or on a familiar journey
  • forget appointments or anniversaries.

Although memory difficulties are usually the earliest symptoms of Alzheimer's, someone with the disease will also have – or go on to develop – problems with other aspects of thinking, reasoning, perception or communication. They might have difficulties with:

  • language – struggling to follow a conversation or repeating themselves
  • visuospatial problems judging distance or seeing objects in three dimensions; navigating stairs or parking the car become much harder
  • concentrating, planning or organising – difficulties making decisions, solving problems or carrying out a sequence of tasks (eg cooking a meal)
  • orientation – becoming confused or losing track of the day or date.

A person in the earlier stages of Alzheimer's will often have changes in their mood. They may become anxious, irritable or depressed. Many people become withdrawn and lose interest in activities and hobbies.

Later stages

As Alzheimer's progresses, problems with memory loss, communication, reasoning and orientation become more severe. The person will need more day-to-day support from those who care for them.

Some people start to believe things that are untrue (delusions) or – less often – see or hear things which are not really there (hallucinations).

Many people with Alzheimer's also develop behaviours that seem unusual or out of character. These include agitation (eg restlessness or pacing), calling out, repeating the same question, disturbed sleep patterns or reacting aggressively. Such behaviours can be distressing or challenging for the person and their carer. They may require separate treatment and management to memory problems.

In the later stages of Alzheimer's disease someone may become much less aware of what is happening around them. They may have difficulties eating or walking without help, and become increasingly frail. Eventually, the person will need help with all their daily activities.

How quickly Alzheimer's disease progresses, and the life expectancy of someone with it, vary greatly. On average, people with Alzheimer's disease live for eight to ten years after the first symptoms. However, this varies a lot, depending particularly on how old the person was when they first developed Alzheimer's.

Mixed dementia

An estimated 10 per cent of people with dementia have more than one type at the same time. This is called mixed dementia. The most common combination is Alzheimer's disease with vascular dementia (caused by problems with the blood supply to the brain). The symptoms of this kind of mixed dementia are a mixture of the symptoms of Alzheimer's disease and vascular dementia.

Atypical Alzheimer's disease

In some people with Alzheimer's disease the earliest symptoms are not memory loss. This is called atypical Alzheimer's disease. The underlying damage (plaques and tangles) is the same, but the first part of the brain to be affected is not the hippocampus.

Atypical Alzheimer's disease is uncommon in those diagnosed when they are over 65. It accounts for around five per cent of all Alzheimer's in this age group. It is, however, more common in people diagnosed when they are under 65 early-onset Alzheimer’s disease. In this age group it represents up to one-third of cases.

The atypical forms of Alzheimer's disease are as follows:

  • Posterior cortical atrophy (PCA) occurs when there is damage to areas at the back and upper-rear of the brain. These are areas that process visual information and deal with spatial awareness. This means the early symptoms of PCA are often problems identifying objects or reading, even if the eyes are healthy. Someone may also struggle to judge distances when going down stairs, or seem uncoordinated (for example when dressing).
  • Logopenic aphasia involves damage to the areas in the left side of the brain that produce language. The person's speech becomes laboured with long pauses.
  • Frontal variant Alzheimer's disease involves damage to the lobes at the front of the brain. The symptoms are problems with planning and decision-making. The person may also behave in socially inappropriate ways or seem not to care about the feelings of others.