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On this World Alzheimer's Day, we take a fresh look at the question of how to know whether forgetfulness is a sign of early Alzheimer's.

In the household where I live, we're all pushing or past sixty years old. Those of us who don't dye our hair have manes of gray. If we don't get to bed before midnight, we're cranky the next morning. And we have our senior moments.

Drawers get left open. Toilets don't get flushed. Sunglasses and socks mysteriously disappear and reappear. We forget whose turn it is to deal when we play cards. We remember words in French but can't think of them in English and vice versa.

But we can rattle off facts about laboratory testing of coccidioidomycosis (and we can still spell coccidioidomycosis) and describe the surgical procedure for craniotomies. We actually understand the equations on the dry erase boards in the background when we watch Big Bang Theory. We can swap out fan belts on cars and at least one of us can sew a dress without a pattern and bake souffles. I'm not saying whether that's me.

I confess it took me about a minute to remember the term "dry erase boards," thinking to myself, "Darn, what is that word?" as I was writing this article. But I am not in the early stages of Alzheimer's. Here's how I know.

What Are the Symptoms of Early-Stage Alzheimer's?

The hallmark symptom of Alzheimer's disease is progressive memory impairment.

First you forget where you left your keys, but then you forget what keys are used for. First you forget your child's name, but then you forget your child has grown up.

Many other conditions, however, also cause memory loss. There is no brain scan or laboratory test that diagnosis "early Alzheimer's." Doctors generally agree that there is "mild cognitive impairment," also known as early-stage Alzheimer's, or pre-Alzheimer's when:

  • Either the individual or people who know the individual well notice changes in "with-itness" or general mental functioning.
  • There are mild problems in performing daily tasks, such as paying bills, preparing meals, or maintaining personal appearance. The process may not be as efficient as it used to be, but the individual retains independence.
  • Over a period of months or years, there is progressive deterioration of language skills, memory skills, and reasoning, whether measured on standardized tests or assessed by others who know the person well.

Genetic Testing Not Especially Helpful in Diagnosis

There are genetic tests, for the apolipoprotein E gene, that can measure the future risk of Alzheimer's but not absolutely whether someone will develop the disease. In its early stages, Alzheimer's disease presents vague and subjective symptoms. It's important to make sure that symptoms are caused by another, treatable condition.

Continue reading after recommendations

  • Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, Gamst A, Holtzman DM, Jagust WJ, Petersen RC, Snyder PJ, Carrillo MC, Thies B, Phelps CH. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011 May. 7(3):270-9. doi: 10.1016/j.jalz.2011.03.008. Epub 2011 Apr 21. PMID: 21514249.
  • Hsiung GY, Donald A, Grand J, Black SE, Bouchard RW, Gauthier SG, Loy-English I, Hogan DB, Kertesz A, Rockwood K, Feldman HH. Outcomes of cognitively impaired not demented at 2 years in the Canadian Cohort Study of Cognitive Impairment and Related Dementias. Dement Geriatr Cogn Disord. 2006. 22(5-6):413-20. Epub 2006 Sep 11.
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