Alzheimer’s disease: Symptoms and outlook

Most people’s memory and other cognitive abilities gradually get worse as they get older. No longer being able to react as quickly and flexibly to new situations is a natural part of aging. It often becomes harder to recognize and solve problems in new areas. But it is still possible to access the knowledge that has been gained over the years, and stay oriented, independent, and able to make sound judgments.

This is different in people who have Alzheimer’s disease. Their memory gradually fades away. At first, short-term memory is affected more. This means that they forget about events that have just happened, but can still remember experiences from long ago. But long-term memory also fades with time. The ability to concentrate is affected too, making it more and more difficult to maintain orientation in time and space.

It becomes harder to link things that were learned in the past to new situations or impressions. There comes a point when it is no longer possible to understand contexts or assess information, formulate an opinion and then decide what to do. An example: A person who has late-stage Alzheimer’s can see that it's raining outside, and can express this fact in words. But they will not be able to draw conclusions for their own actions. They may then go out to do their shopping in a t-shirt instead of putting on a raincoat or taking an umbrella.

Activities that are made up of several steps (like shopping or cooking) become more and more difficult as someone’s memory, comprehension and planning skills start to fade. In early-stage Alzheimer’s, completing more complex business matters can be a problem. For instance, doing taxes may become an insurmountable challenge. Forgetfulness might not only mean forgetting things like what you wanted to buy or why you left the house, but can also make you more likely to get lost and have problems finding your way home again.

We all have to search for the right word or feel tongue-tied now and then. But forgetting individual words more and more frequently is a different matter. As dementia progresses, it becomes more difficult to remember the right words, and people use words or phrases that do not match the context instead. This makes it difficult for others to understand them. And people with dementia also forget the meaning of words and are then often no longer able to follow conversations. This makes it increasingly harder to communicate verbally.

Many people with Alzheimer’s go through noticeable changes in their behavior. Later on their personality may also change considerably. They can become unusually fearful, distrustful or passive, or may become aggressive as well. These changes can happen suddenly, and might cause fits of rage – or they may develop gradually, as with listlessness. Unusual behavior like this may be directly caused by the disease. But fear, passivity or aggression can sometimes be perfectly normal reactions to the circumstances of living with the disease: After all, a person who has Alzheimer’s keeps finding themselves in situations that are confusing and in which they behave “wrongly.”

Plus there is the shame and frustration of forgetting more and more, being wrong a lot of the time, and gradually losing your independence. Many people who have Alzheimer’s feel that others are being patronizing, and are worried about being seen only as a sick and needy person. A considerable number of people with Alzheimer’s have depression and trouble sleeping, too. But they might also experience unusually euphoric phases.

Alzheimer’s is a chronic disease that progresses over the course of many years. It typically begins after the age of 65. Alzheimer’s that starts at a younger age usually progresses faster than if it develops later on.

Alzheimer’s disease has three stages, each of which has its own characteristic symptoms. But the changes that happen, and how fast they happen, can vary from person to person. Some symptoms may appear earlier, and others may not occur at all.

In the early stages of the disease, people have problems with their memory and concentration. Sometimes, the forgetfulness is mild and doesn't affect daily life (much). But it can also be a little worse already, making it harder for them to manage on their own in everyday life. There is no clear cut-off point between the normal problems associated with aging and early dementia. Specialists distinguish between mild cognitive impairment (MCI) and mild Alzheimer's dementia.

People with mild cognitive impairment have slight memory and thinking problems. These are particularly noticeable when performing complicated everyday tasks. For example, they might have trouble remembering a short shopping list or knowing what day of the week it is when asked. But these difficulties don't cause any big problems in everyday life. They can live independently. The symptoms of mild cognitive impairment are very similar to normal forgetfulness in old age. Doctors can only tell the difference by doing thorough testing and asking specific questions.

In mild Alzheimer's dementia, the memory and thinking problems have a bigger impact on daily life: People become increasingly forgetful, have problems concentrating and find it difficult to cope with more complex everyday tasks. For example, they almost always need help with business and financial matters or official appointments. Driving and taking medication regularly can also become a problem. But they can mostly still live independently.

Behavior and mood can already change in early-stage Alzheimer’s. The limitations resulting from the disease can cause fear, stress, anger, or even feelings of shame: It can be embarrassing to forget things and lose your orientation. And it takes a lot of strength to find strategies to deal with these problems.

A person’s inner drive and interest in hobbies or other activities may fade. Some people feel down or irritable, or they may have intense mood swings. These mood swings – making people suddenly burst into tears for no apparent reason, for example – are often puzzling as well as draining for other family members.

People with middle-stage (moderate) Alzheimer’s usually have to give up living independently. They can still eat, drink and wash themselves, and perhaps do simple tasks around the home or garden, but may have to be reminded and asked to do so. Cooking, shopping, keeping their home clean, and going out on a walk are only possible with the help of others.

They are more likely to get lost, not find their way back home, leave the stove on and endanger themselves or others. Patterns of behavior such as frantic pacing, seemingly meaningless rummaging through drawers and fiddling with clothing become more frequent. Fits of rage, distrust and aggressive behavior are also consequences of problems associated with Alzheimer’s that affect the person’s perception and limit their abilities.

People’s daily sleep-wake cycle is often affected. It becomes more difficult for them to express things in words and understand what other people say. They also confuse the past with the present. For instance, they may falsely believe that their parents are still alive and are expecting them to come back home.

In late-stage (severe) Alzheimer’s, people need constant help from others. Speech and language problems may start making conversation barely possible. They now even need help to accomplish simple everyday activities, and to eat and drink.

People who have late-stage Alzheimer’s are often restless, hallucinate or confuse the past with the present. They no longer recognize people who they used to know very well. The control of bodily functions and the ability to coordinate movement may also be lost.

On average, people with Alzheimer’s die about six years after being diagnosed.