Author: jgbrand27

For many people, even mention of the word “Alzheimer’s” sends shivers down spines. This is particularly true for those with a family history of the condition and who have observed firsthand its unfortunate effects in their loved ones. My office has seen many people who burst into tears even when simply describing thinking problems that they’ve noticed in themselves. However, while I certainly feel empathetic, their fears are unjustified in many if not most of these instances.

In my last post, I highlighted some signs that I have found concerning for the presence of Alzheimer’s disease, based on my years of working closely with that condition. Today, I’d like to turn to signs that seem to make people anxious about potential Alzheimer’s, but are actually quite common. Here are my top five, based on the reports of many patients I have seen who turn out not to have Alzheimer’s disease:

1. Trouble remembering the reason for entering a room. You have undoubtedly done this before. This is a very common problem and it doesn’t mean that there are significant memory problems present. Yes, maybe the person can’t “remember” why they went into the kitchen, but the problem probably lies more in the attentional or executive domains rather than in memory. In other words, the real issue is most likely distractibility, rather than actually retaining information. This is not a clear sign of Alzheimer’s disease.
2. Word-finding difficulty. Trouble retrieving words in conversation can be associated with Alzheimer’s disease, but it is far from specific to the condition. The most common problem that I hear about in my office – whether from people with dementia or people who are completely cognitively healthy – is word-finding difficulty. It can be frightening and embarrassing, and in rare instances when it is severe enough it can signal dementia, but in the vast majority of cases, it is relatively benign.
3. Forgetting people’s names. The only thing more embarrassing to people than word-finding difficulty seems to be a related issue: forgetting people’s names. It’s not surprising either; I’m embarrassed when I can’t remember someone’s name. But it happens. And it doesn’t mean that I’m developing Alzheimer’s disease. Names are hard! They’re abstract and often meaningless associations that our brains are expected to pull out of storage unexpectedly at a moments notice. I want to tell people to give their brains a break and allow for some lapses in that ability.
4. Forgetting to do something you were asked to do. Yes, this happens to everyone, and yes, it can be a sign of memory problems. But it is very often simply a sign of not paying attention, especially when it is your significant other doing the talking. Sometimes people ask for attention right at the moment you’re doing something else and you don’t fully absorb what they’re saying. It’s not necessarily a reason to fear dementia.
5. Missing a turn while driving. People with Alzheimer’s disease sometimes get lost while they’re driving, even in familiar places. It can be one of the first signs for some people that there is something not right with their thinking abilities. But missing a turn while driving or getting lost in unfamiliar places is hardly a sign of Alzheimer’s disease. This is particularly true if the driver is able to reorient themselves relatively quickly. The problem, again, most likely lies in attention rather than memory.

Of course, if you are concerned about a decline in thinking abilities, whether in yourself or in a loved one, please do not hesitate to seek help from a doctor. My point in this post is only to highlight common problems that should not cause a panicked response.

Please feel free to reply to this post and to let me know your thoughts! 

With this blog, I’m hoping to help people understand their thinking abilities better, using a perspective I’ve developed over years practicing as a board-certified clinical neuropsychologist. My field allows for a unique view of human behavior, whether “normal” or “abnormal,” and an in-depth understanding of the underpinnings of that behavior. This is my outlet for relaying my thoughts to the public and to connect with those who are interested in brain-behavior relationships, whatever the reason may be. I do want to hear your thoughts, questions, and opinions as well!

What does a clinical neuropsychologist do? Well, in part, we administer and interpret paper-and-pencil tests of cognitive (i.e. thinking abilities) and emotional functioning. In addition to those tests, we conduct in-depth interviews with our patients in order to find out as much as we can about them, their background, and the history of their presenting concerns.

In my work, I see a lot of people who probably have Alzheimer’s disease. I also see a lot of people who are worried that they have Alzheimer’s disease, but they’re actually cognitively healthy. Using a neuropsychological evaluation, in combination with neuroimaging and a neurological exam, doctors can be pretty sure about who does have it and who doesn’t.

For my first post, I thought I would write about some behaviors that seem to be associated with probable Alzheimer’s disease. You can read all about the formal diagnostic criteria for Alzheimer’s all over the internet, but these are my own anecdotal impressions and should be taken as such. Interestingly, this is all information that is gathered in the clinical interview alone, prior to the actual tests being administered. I could also write for hours on which actual test results suggest the presence of Alzheimer’s, but below are behaviors that even a layperson can identify, which I do think is helpful for those wondering about the cognitive condition of their loved ones, or even of themselves.

1. Reports of repetitiveness. This is one that should be clear to anyone in close contact with individuals with Alzheimer’s disease. People with very poor memories tend to repeat themselves within a short timeframe, whether they are asking the same question or making the same statement over and over. Certainly, people who are cognitively healthy may do the same on occasion, but in Alzheimer’s, this becomes a pattern that is not easy to ignore. When there is little recognition by the individual that they are repeating themselves, that should especially be a source of concern.
2. Trouble reporting on daily activities. This is one that I started to notice pretty early on in my work with patients with Alzheimer’s disease. When asked about their daily activities, it is very often difficult for them to remember what those might be. If a friend or family member is in the room with them when asked, they often turn to that person to ask, “What do I do during the day?” Sometimes, the patient will talk about things that they used to do, but don’t do anymore, without then turning to current activities.
3. Lack of emotional connection to their condition. People with Alzheimer’s disease often do not realize that they have it, which is an example of a common cognitive deficit called anosognosia, or lack of awareness of one’s condition. Many times, those with Alzheimer’s do recognize that they have memory problems, but they don’t completely grasp what that means for their lives. They have anosodiaphoria, which is a lack of an emotional connection to their memory symptoms. Due to this phenomenon, they often seem relatively unfazed when performing poorly on memory tests and seem relatively uninterested in receiving feedback on their performance at the end of the evaluation.
4. Diminished reading time. I find that a common theme in patients with Alzheimer’s is that they have seemed to lose their interest in reading books, or reading in general. Of course, this is most striking to family and friends when the patient used to be an avid reader. Often, the patient is aware that they do not read much anymore, but they have trouble expressing why that might be. Reading involves a lot of different cognitive skills, and their impairments are probably making reading more difficult and less enjoyable for them.
5. Social withdrawal. Similar to reading, social interaction becomes more difficult when a person’s cognitive abilities decline. Reports that an individual has been self-isolating and less active in conversation are often associated with Alzheimer’s disease. This may be due to impairment in a number of different cognitive abilities, including memory (e.g., it can be hard to converse without remembering basic facts about the other person’s life), executive functioning (e.g., tracking what someone is saying requires efficient processing of information), and language (e.g., word-finding problems, comprehension problems). Of course, sometimes social withdrawal is a product of other issues, such as depression or familial discord. The ability to discern between causes of social withdrawal is an excellent example of the power of a neuropsychological evaluation.

This is only a short list of the many signs and symptoms associated with Alzheimer’s disease. They’re the ones that come most easily to my mind. Showing one or more of these signs is certainly not an indication that Alzheimer’s disease is present, but it could signal a need for a neuropsychological evaluation.

In my next post, I’ll take a look at the other side of the coin and write about the top five behaviors that make people very anxious because they think it means they are developing Alzheimer’s, but in actuality they are very nonspecific and usually benign.

Again, I want to hear from you! Whether you have a family member with Alzheimer’s or work with Alzheimer’s patients, or none of the above, what do you think of this list? Do you agree or disagree? What more would you want to hear about?