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Alzheimer’s is a progressive brain disease where a person suffers various memory, learning, communication and thinking problems. Visible symptoms or early warning signs can be subtle and vague, and can be hard to differentiate from what might be construed as normal. Symptoms may come on gradually and be unnoticed for a long time. Family and friends may mistake warning signs for part of the normal aging process and vice versa.

The first warning sign that someone might have undiagnosed Alzheimer’s is usually memory problems, especially remembering things that have happened recently. A person in the pre-diagnosis stage might ask the same question a number of times over a relatively short period or they might tell the same story several times. They may forget familiar words, and might make up words in their place, for example, a pencil might be called a stick or a thing. Names of people they know may be increasingly forgotten. They might not know where they’ve put their glasses or keys. Other memory warning signs include reduced concentration and comprehension, forgetting to keep several appointments, and forgetting things that were recently learned.

Poor memory, especially short-term memory, is common in many people. If someone occasionally forgets a name or an appointment or phone number and then recalls these things later, this is normal behavior and not a sign of Alzheimer’s. A test of whether a person might have the disease is where they forget something and they don’t later remember they’ve forgotten.

Another common warning sign is difficulty performing tasks. A person with undiagnosed Alzheimer’s might start forgetting how to do all the steps involved in cooking a meal, repairing something, paying bills, doing their banking, shopping, or phoning someone. They might have difficulty with day to day activities such as dressing, washing, and eating, for example, they may forget to eat or eat too much or eat a whole meal of the one food. Decisions can become difficult to make, including simple things such as what to have for tea or what to wear. They are less organized, and work colleagues might see a decline in work performance. Warning signs don’t include occasionally forgetting why you’ve gone into a room or putting two spoons of sugar in your coffee and you usually have one.

Poor judgment is another common warning sign. A person might forget to bathe, saying they have bathed already. They may wear the same clothes for several days, saying they’re clean. Sometimes a person may dress in clothes inappropriate to the season or they might put their night clothes on over the top of their day clothes. Erratic driving might become a problem. They might hoards things, or take or steal things owned by others. Giving away a lot of money or spending it inappropriately may occur. Making the odd poor decision or forgetting the umbrella on a rainy day doesn’t mean a person may have Alzheimer’s.

Family members may see mood and behavioral changes in the person they think might have Alzheimer’s. There can be sharp mood swings and the person can be unpleasant for no reason. They may laugh at something not particularly funny, and then cry at something not especially sad or worrying. An occasional bad mood due to some occurrence at work or home doesn’t count. Changes in personality can occur. A person might become suspicion, develop fears, and show confusion. They might think their spouse is having an affair, or a family member has stolen something. They increasingly prefer to rely on their spouse to do tasks previously done by themselves. Strangely, a person in the early stages of Alzheimer’s gets fewer colds.

A person with undiagnosed Alzheimer’s might develop problems with communication and language. They may communicate less with family, friends, and work colleagues. They might have more limited vocabulary, shorter sentences, and stop in the middle of a sentence more often. Speech may be less fluent. They may not be able to find someone listed in a phone book. They may also revert to a first language more often.

Being unable to think of the right word in conversation or writing wouldn’t be a sign. Abstract thinking and complex mental reasoning are sometimes a problem for people who may have Alzheimer’s. For example, a person usually good with numbers might be slower at mental arithmetic or have difficulty counting backwards in threes. But if a person is naturally not numbers oriented and they have difficulty reconciling their bank account balance, this could be quite normal.

Being disoriented with place and time and losing things are further warning signs. People might forget familiar surroundings, becoming lost in places they normally know. They might forget how to get home or the route to a place they frequently visit. They may also have a tendency to wander and get lost. Misplacing things more frequently or putting them in strange places could point to Alzheimer’s, for example, putting the wallet in the fridge or keys in the washing machine. However, simply forgetting where you’ve put your keys and later finding them still in the car or in your bag instead of in the drawer, or temporarily forgetting the day of the week, isn’t a sign of Alzheimer’s.

Signs of a loss of initiative or apathy could occur in a person who may have Alzheimer’s. They may become indifferent about various aspects of life, become more passive, and want to go out less. Instead, they may watch more television or sleep more. They might need reminding to do things and have less enthusiasm for activities they have always enjoyed. But this warning sign needs to be treated with caution just as all the others do. Apathy can relate to other conditions, such as stress or depression. Also, everyone can feel lazy sometimes, and might be tired because of a busy schedule and skip an activity now and then.

Researchers in Sweden examined 47 studies that included investigation into the warning signs of Alzheimer’s between 1985 and 2003, finding that people later diagnosed with the disease had deficiencies in their thinking processes and their short-term memory. The researchers found smaller deficiencies in communication ability, spatial skills, and attentiveness among people in the pre-diagnosed stage of Alzheimer’s. The findings were consistent across the studies and showed that the warning signs could be many and complex.

However, they found that the major deficiencies were similar to the normal aging process and that there was no clear difference between a normal 75-year-old and someone before being diagnosed with Alzheimer’s. Early diagnosis can be difficult for this reason. They also found that early onset was followed by a period of relative stability, and then decline, before diagnosis. Another interesting finding was that the warning signs are more visible in younger people, as they tend to have a greater build-up of brain plaques.

There are many warning signs that a person may have Alzheimer’s, although the presence of symptoms doesn’t necessarily mean a person has the disease. Signs can be visible years before the disease is diagnosed. A difficulty is that a person often doesn’t realize they might have a problem or might be reluctant to accept that warning signs are there. If you know someone you think might be displaying the signs of Alzheimer’s, encourage them to see a doctor.