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Alzheimer's disease is a brain disorder that causes memory loss, confusion, and changes in personality. At first, people with the disease have a small amount of memory loss and confusion. This is called "cognitive decline." Over time, however, symptoms become more severe and progress through four stages of symptoms.

Preclinical stage. Changes in the brain begin years before signs of the disease. This time period is called preclinical Alzheimer’s disease and it can last for years.

1. Mild, early stage. Symptoms at this stage include mild forgetfulness, which may mirror symptoms of aging, but can also include problems with concentration. A person may be aware of memory lapses. Friends, family or neighbors may also notice these difficulties. Though a person may still live independently, he or she may have problems:

• Remembering names
• Recalling recent events
• Remembering where he or she put a valuable object
• Making plans
• Staying organized
• Managing money

2. Moderate, middle stage. This is typically the longest stage, usually lasting many years. At this stage, symptoms include:

• Increased difficulty remembering events
• Problems learning new things
• Difficulty planning complicated events, like a dinner
• Trouble remembering one’s own name, but not details about one’s life, like an address or phone number
• Problems with reading, writing, and working with numbers

As the disease progresses, the person may:

• Recognize people, but forget names, including a spouse or child
• Lose track of time and place
• Need help choosing clothing, getting dressed, and doing daily activities like brushing teeth
• Become moody or withdrawn, or have personality changes like hallucinations, paranoia, or delusions
• Be restless, agitated, anxious, or tearful, especially in the late afternoon or at night
• Have difficulty sleeping
• Wander away from home

3. Severe, late stage. At this stage, a person:

• Loses many of his or her physical abilities, including walking, sitting, eating
• May lose bowel and bladder control
• May be able to say some words or phrases, but not carry on a conversation
• Needs help with activities all of the time
• Is unaware of recent experiences, or of his or her surroundings
• Is more likely to get infections, especially pneumonia

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Diagnosis

The early signs of Alzheimer disease may not be obvious to anyone other than the person with the disease, or the people closest to him or her. Even then, the symptoms may be confused with normal changes that come with age.

To make a diagnosis, healthcare providers use several tests to determine how well the brain is working. A healthcare provider might also take a medical history and order additional tests to check for other possible causes of memory loss or confusion.

Treatment

Treatment varies based on age, overall health, medical history, symptoms, and preferences. Some medicines may slow the progress of the disease, and may work for a few months to a few years. Treatment might also be needed to help with feelings of depression or anxiety. Sleep disorders can also be treated. Caregivers and family members may benefit from therapy and support groups.

Reduce the Risk of Cognitive Decline

Although there is currently no cure for Alzheimer's disease, the Alzheimer's Association has published a list of 10 tips to help reduce the risk of cognitive decline:

1. Participate in cardiovascular exercise, which increases blood flow to the brain.
2. Quit smoking. Cigarettes increase cognitive decline.
3. Wear a helmet to reduce the risk of brain injury.
4. Get adequate sleep to promote good memory and thinking.
5. Socialize in meaningful ways. Studies suggest that social interaction may promote brain health.
6. Take a class. Pursuing education in any phase of life is good for cognitive function.
7. Eat a healthy diet. Health conditions that affect the heart are also shown to affect the brain.
8. Take care of your heart. Studies show that diseases affecting the heart—like obesity, diabetes, and high blood pressure—may affect cognitive health.
9. Tend to your mental health. Some evidence points to a higher incidence in cognitive decline when there is a history of depression or anxiety. Seek professional help if needed.
10. Challenge your mind. Engage in a creative project, learn a new skill or subject, or solve a puzzle. Stretching yourself mentally may have short and long-term benefits for your brain.

If you or someone you know is experiencing the symptoms of Alzheimer’s, call your primary care physician for an Alzheimer’s screening. If you don’t have a primary care doctor, visit our

This article first appeared in the November 2015 edition of the HealthPerks newsletter and was updated in November 2023.