Neurologists Reveal The Overlooked Signs Of Alzheimer’s They Wish Everyone Knew

When it comes to Alzheimer’s disease, major memory loss is the symptom that tends to come to mind. In reality, the disorder can manifest in many other ways.

“Most people expect Alzheimer’s to begin with forgetting names or misplacing keys,” Dr. Majid Fotuhi, a neurologist and adjunct professor in the department of neuroscience at Johns Hopkins University, told HuffPost. “Often the earliest changes are more subtle.”

These smaller signs often go overlooked or are attributed to other causes.

“Early changes can be gradual and easy to explain away as stress, fatigue, aging or being overwhelmed,” said neurologist Dr. Shaheen Lakhan. “People also fear what an evaluation might mean for their independence.”

We expect changes in how we think and behave as we get older, so it’s easy to brush things off bit by bit over time.

“People find ways to compensate, and family members may start helping with certain tasks without even realizing it,” said Davide Cappon, director of neuropsychology at Tufts Medical Center. “Sometimes it’s only when you look back that you notice how much things have changed.”

And the person experiencing the changes may not even see them.

“In some people, the disease affects awareness of their own difficulties,” Lakhan said. “This is called anosognosia. A person may sincerely believe nothing has changed. Treating that as stubbornness can turn a neurological symptom into a family argument.”

None of the signs below necessarily mean someone has Alzheimer’s, and each has other possible causes. But experts say they’re worth paying attention to.

“A previously careful person starts missing payments, paying the same bill repeatedly or making financial decisions that are out of character,” Lakhan said. “A new pattern of difficulty, especially alongside other changes, deserves attention.”

They may become more susceptible to scams, start making odd purchases, or even give money away in a way that is out of character.

“Someone who’s always been very organized may suddenly struggle to plan things or keep track of everyday responsibilities,” Cappon said.

They may have previously multitasked easily, but now it’s difficult.

“Planning becomes harder, with more mistakes coordinating plans and more errors with numbers ― missed bills, incorrect tip calculations,” said Dr. Yasmin Mohiuddin, a neurologist with Orlando Health.

Complex tasks also feel more challenging or even downright impossible.

“A person who has always paid the bills, managed investments or cooked holiday meals starts making mistakes or quietly hands these jobs to someone else,” Fotuhi said. “Families often see this as getting older or losing interest.”

“People’s social lives start to shrink,” Lakhan said. “Someone stops organizing gatherings, avoids a favorite game or withdraws from conversations they once enjoyed. Following several speakers or remembering the rules may have become harder.”

Withdrawing from friends and social situations may stem from their difficulties finding words or keeping up with conversations.

“Someone may become less motivated, withdraw socially, or lose interest in things they used to enjoy,” Cappon said. “The tricky part is that these changes can easily be mistaken for depression, stress or simply getting older. And of course, they don’t necessarily mean someone has Alzheimer‘s.”

“Personality and mood changes ― apathy, withdrawal from friends and hobbies, new irritability or anxiety ― can show up before obvious memory problems,” Fotuhi said. “These are frequently mistaken for depression or stress.”

Dr. Michael Stanley, a neurologist at Tufts Medical Center, said mood changes are an increasingly recognized early clue.

“There is increasing evidence to support changes in mood and behavior, rather than in what we traditionally think of as ‘cognitive’ symptoms as being early precursors,” he said. “Older persons with newfound depression, anxiety, and apathy without an obvious and clear environmental or social trigger are prime candidates for consideration of getting themselves checked out by a PCP for cognitive impairment as well.”

Examining mood matters for many reasons.

“The relationship between mood and memory is anatomic, as well as physiologic,” Stanley said. “So if you directly address your mood, you can often see improvements or stabilization in attention, concentration and memory functions.”

“One overlooked clue is that ordinary life starts requiring extraordinary effort,” Lakhan said. “People start having difficulty with familiar technology. Someone who previously managed their online banking, sent messages or used the same remote comfortably begins needing repeated help.”

Familiar digital routines can offer useful hints about someone’s everyday brain function.

“Trouble learning a newly redesigned app is common,” Lakhan said. “A persistent loss of previously comfortable skills is more concerning. A phone can offer a clue, but it cannot make the diagnosis.”

“Repeating the same story or question is another one,” Fotuhi said. “They ask what time dinner is three times in an hour, with no memory of having asked. This is different from occasional forgetfulness because the whole conversation is gone, not just a detail.”

Lakhan said people may also remember the distant past while losing recent information.

“A person can tell a vivid story from 40 years ago while struggling to remember a conversation from 40 minutes ago,” he said. “Repeated questions, forgotten plans or needing the same explanation again can be dismissed because the person still seems articulate and knowledgeable. Preserved old memories do not rule out a problem learning and retaining new information.”

Majid Fotuhi also pointed to potential indicators like “taking a wrong turn on a route they have driven for 20 years or feeling briefly disoriented in a familiar store.”

Declining vision can be a factor, but this also may point to a serious cognitive cause like Alzheimer’s.

“People develop new problems navigating or judging space,” Lakhan said. “Getting lost on a familiar route or increasingly misjudging distances while driving can be overlooked as an eyesight problem.”

Research also suggests that a fading sense of smell may be an early clue. A recent study found that in Alzheimer’s, the brain’s immune cells may mistakenly attack the nerve fibers that carry smell signals. That could explain why smell loss can show up years before a diagnosis.

“If you start noticing some decrease in your smelling ability, please get to a doctor,” Dr. Dale Bredesen, a neurologist at Apollo Health who focuses on Alzheimer’s, previously told HuffPost. “Don’t assume that it’s a benign condition.”

He suggested that people over 35 with a family history of cognitive conditions could ask their neurologist about smell testing. But he stressed that passing a smell test doesn’t mean someone is in the clear.

Sometimes the sign is the workaround itself. People may take steps to hide or compensate for changes, whether or not they’re fully aware they’re doing it.

“People are remarkably good at compensating,” Fotuhi said. “They rely on sticky notes, let a spouse answer questions or laugh off a lapse with ‘I’ve always been bad with names.’”

The brain’s large reserve can make this possible.

“People with a strong education, an active social life, and a demanding career can compensate for years, which makes the early changes harder to spot,” Fotuhi added.

Loved ones may also end up compensating.

“People often attribute these symptoms to age, stress, or poor sleep, until a more critical problem or error occurs,” Mohiuddin said. “Social skills and general knowledge are preserved early, so short interactions can seem entirely normal. Family members compensate gradually without realizing it, as a spouse takes over driving, paying bills and cooking.“

But that gradual shift toward reliance is worth noticing.

“That help is valuable,” Lakhan said. “The growing need for it is also useful information for the doctor.”

“First, I wouldn’t panic, but I also wouldn’t ignore it,” Cappon said. “A good starting point is to talk with your primary care provider and share a few specific examples of what’s changed.”

Preparation can make your evaluation with a medical professional even more helpful.

“Bring a family member to the visit who knows the person well and sees them regularly,” Mohiuddin advised. “Have specific examples with approximate dates.”

In addition to examples and a timeline, prepare a list of medications and over-the-counter products you take.

“Ask for a thorough evaluation rather than reassurance or a quick label,” Fotuhi said. “A good workup includes a cognitive assessment, blood tests (including thyroid function, vitamin B12 and blood sugar), a review of all medications, and screening for sleep problems, depression, and hearing loss.”

Brain imaging and blood tests for Alzheimer’s-related proteins can also help doctors get a clearer picture of what’s happening.

“They should evaluate for modifiable risk factors like sleep, substances, medications, toxins, electrolytes, hormones, vitamins, even certain infections,” Stanley said. “They should also do a screening neurological test. And they should refer to an occupational therapist or a speech/language therapist to help a person find rehabilitative strategies to make their cognition work better for them.”

Depending on the findings, your primary care doctor may also refer you to a neurologist or psychiatrist.

Not every cognitive problem is Alzheimer’s, Cappon noted.

“Poor sleep, depression, medications and other medical conditions can cause similar difficulties,” he said. “The encouraging thing is that we have better diagnostic tools today, and for certain patients, treatments that can help slow the disease. So getting evaluated early can make a real difference.”

Noticing changes can also prompt you to focus on your overall brain health. Stanley recommended asking yourself whether you’re exercising regularly and prioritizing sleep.

“Are you eating a heart-healthy diet?” he said. “Are you engaging in something social and intellectual like music, games, crafts, dance or hobbies two to three times a week? Are you trying to learn something new?”

Consider how often you’re consuming alcohol, tobacco, cannabis or other substances as well, he added.

“These lifestyle factors that engage you physically, emotionally, and intellectually are keys to slowing down cognitive decline and helping to improve outcomes for anyone at any stage of life, but especially when you detect symptoms in yourself.”