Many believe short-term memory loss is the very first symptom of Alzheimer’s disease, but this is not always the case, and indeed, forgetfulness is rarely the only early symptom of Alzheimer’s.
As we all know, nobody just wakes up one day with “dementia.” Dementia refers to progressive cognitive decline to a level of severity where the individual needs help with their daily activities. By the time a close family member or friend reaches this point, they’ve been experiencing a gradual progression of cognitive decline for many months and usually several years, right under your nose. We, as family and friends, have completely missed the symptoms, not because we don’t care, but because we don’t know what we are looking for, or we are in denial and too afraid to say anything.
This is why the United States recognizes June as Alzheimer’s and Brain Awareness Month, a time to raise awareness, promote the importance of early detection and diagnosis, and encourage brain-healthy habits for us all. I urge you to take this opportunity to assess how you are feeling and identify any concerns you or others close to you may have.
Why? Because the statistics are alarming: The Alzheimer’s Association estimates that 7.4 million Americans 65 and older have clinical Alzheimer’s dementia, making awareness of the disease, its symptoms, and how to better protect your brain.
Today early diagnosis is more important than ever because new medications Leqembi and Kisunla are most effective when given as early as possible. The most critical time to get an accurate diagnosis and seek treatment is when you first detect something is not right with your short-term memory or any other aspect of your “thinking ability.”
A major shift is happening in Alzheimer’s diagnosis and treatment, which means you can now positively influence the progression rate of the disease, but only if you act quickly when symptoms are mild and when an accurate diagnosis of the cause of your concern can be made by using biomarker tests. These tests confirm whether you have the pathology of Alzheimer’s disease in your brain or not. If you or a loved one has a positive biomarker test result, you or they can benefit from the new treatments.
However, these treatments are in great demand and, sadly, most people spend 8–12 months on a waiting list just to see a neurologist for cognitive testing; risking that by the time they are diagnosed, they have already progressed to the stage of disease where they may be no longer eligible for these newest therapies because the disease has advanced to a level where the treatments are no longer effective. This is the gap we must race to close.
Many of us don’t realize that Alzheimer’s is like cancer; if you leave it and wait for a diagnosis, it will continue to advance at an increasingly rapid rate and then will no longer respond to treatment. We would not leave early cancer detection until it is too late to treat. Treating Alzheimer’s today is the same as treating cancer…it is a race against time.
Memory loss is not a part of aging and should never be dismissed as such. If something you can’t quite put your finger on and your brain just “feels off,” this is the exact window where early interventions are available and viable.
What to Look For
Early cognitive symptoms vary depending on the underlying cause. Dementia is just a symptom like “headache,” but you need to know what is causing dementia, just like you need to know what is causing a headache, to get the right treatment.
But there are several symptoms that many patients who have Alzheimer’s disease have in common:
- Subtle changes in behavior and mood, such as mood swings, anxiety, agitation, irritability, and even apathy. An increase in anxiety is frequently a very early symptom. Inexplicably strong reactions to situations that normally do not cause concern, personality changes, becoming withdrawn, or losing interest in hobbies.
- Difficulty with language, forgetting words, or saying incorrect words. Using more vague language when describing something, repeating phrases, or struggling to follow conversations. This can lead to misunderstandings and frustration for all.
- Issues with performing everyday tasks like cooking, dressing, or personal hygiene.
Problems with executive functioning skills: planning, organizing, and remembering sequential steps. Cooking a meal but forgetting to turn the stove off, or when getting dressed, forgetting the next step. This symptom impacts independence and can lead to frustration or embarrassment. This progressive loss of everyday skills is often one of the most noticeable effects on daily life.
- Problems with visual images and spatial awareness. Incorrectly judging the distance between objects, difficulty perceiving depth, and difficulty recognizing spatial relationships. Everyday activities pouring a drink, reading a map, or navigating around furniture, can become challenging. More prone to getting lost or confused in familiar surroundings, which can cause frustration, disorientation, and anxiety.
- Getting lost in familiar places or forgetting how to reach often-visited destinations. This is caused by the impact of the disease on the areas of the brain involved in spatial memory and navigation. Struggling to recognize landmarks or remember common routes, causing disorientation.
- Problems with money management and calculations. Difficulty budgeting, paying bills, and finding even simple math difficult. Misplacing bills, forgetting due dates, or struggling with basic calculations required for financial management can also occur.
- Difficulty making decisions, even with seemingly simple choices. Challenged by choosing what to wear or what to eat. Becoming indecisive, hesitant, or confused by a decision, and even making irrational choices that seem out of character.
All the symptoms above start as very minor alterations, gradually becoming more noticeable over time. But don’t wait until everyone can easily see you are struggling. That will likely be too late to start the new treatments.
Be Your Own Brain Advocate
You are the best person to do this and the person who cares most!
During annual wellness visits, doctors and nursing staff will perform routine tests, such as bloodwork, taking your blood pressure, and checking your eyesight. Patients never need to ask to have these tests done.
However, physicians will typically ask their patients to take a cognitive test only if the patient exhibits signs of cognitive decline during the appointment or if the patient shares that they are experiencing symptoms. Because cognitive problems are not routinely screened for and patients don’t know that they can ask to be tested, it is common for physicians to overlook the early symptoms.
You must ask and advocate for routine cognitive testing, especially if you are noticing symptoms. If you are a high-functioning individual, the common cognitive assessments are often not sufficiently sensitive to detect early and minor cognitive decline, which you may be very cognizant of, and you will likely be right about your own brain. You can only confirm this by doing a biomarker test. Ask your doctor how to do this, or look online for a ptau217 blood test, as an easy way to double-check if your brain is not functioning at full strength or not.
Don’t Lose Hope
Don’t let your loved ones or yourself join the way too many people who ignore their early symptoms and get diagnosed too late to benefit from the new treatment options.
Early diagnosis has been one of the biggest challenges when it comes to Alzheimer’s disease. Doctors have had to rely on expensive brain scans, invasive spinal taps/lumbar punctures, or the appearance of clinical symptoms to make a diagnosis, and by that point, the disease is already advanced.
Alzheimer’s awareness is no longer about recognizing the disease when dementia has developed and accepting the outcome; it is now in the same realm as cancer:
Be vigilant, recognize early symptoms, and act immediately. Get a biomarker diagnosis (ptau217 blood test), and if it is not normal, your doctor can confirm by PET amyloid scan or spinal tap if the amyloid protein in your brain is abnormally elevated, which is the hallmark of Alzheimer’s disease. If confirmed, you can then take control of your own future by seeking treatment with one of the new amyloid-lowering medications, Leqembi or Kisunla, before it’s too late.
This June, we can celebrate a very hopeful future, where more and more diagnostic tests will be available to confirm a diagnosis of Alzheimer’s pathology, when symptoms are very mild and indeed before symptoms even start. We have the first two medications now that treat this disease by slowing the progression of symptoms. But this is just the beginning. Many more treatments will follow, each one likely better than the last.
Don’t miss the window of opportunity for you or your loved ones to slow disease progression and create a whole new paradigm because of lack of information or by failing to act quickly.
The natural course of Alzheimer’s disease, like cancer, is to progress relentlessly, and that rate of progression will increase with time. You have the information and power now to help yourself and your loved ones.
Make the “United States recognizes June as Alzheimer’s and Brain Awareness Month” a reality, not just an academic exercise that doesn’t actually result in one more person getting a biomarker test, a diagnosis, and a revolutionary treatment – it’s up to you to make a difference!