Neurologists Identify the Early Alzheimer’s Clues People Often Miss

Specialists say these everyday symptoms are frequently missed or mistaken for something else.

When people think about Alzheimer’s disease, severe memory loss is usually the first symptom that comes to mind. But the condition can show up 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.”

Those smaller warning signs are often overlooked or blamed on something else.

“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.”

Because some changes are expected with age, it is easy to dismiss them little by little over time.

“People find ways to compensate, and family members may start helping with certain tasks without even realising 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.”

The person experiencing the symptoms may not notice them either.

“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 automatically mean someone has Alzheimer’s, and each can have other causes. Still, experts say they are worth paying attention to.

Changes in judgment and money management

“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 also become more vulnerable to scams, begin making strange purchases, or give money away in ways that do not fit their usual behavior.

Trouble with planning and complex tasks

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

Tasks that once felt manageable may become much harder.

“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 responsibilities can also start to feel overwhelming or 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.”

Pulling away from social life

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

Withdrawing from friends and social settings may happen because it becomes harder to find words or keep up with conversation.

“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.”

Changes in mood and behaviour

“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 now being recognised more often as an early clue.

“There is increasing evidence to support changes in mood and behaviour, 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.”

Looking at mood is important for several 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 stabilisation in attention, concentration and memory functions.”

Difficulty with familiar technology

“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.”

Routine digital habits can reveal a lot about day-to-day 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 questions and remembering the past better than the present

“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 some people may remember the distant past clearly 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.”

Getting lost in familiar places

Majid Fotuhi also cited signs such as “taking a wrong turn on a route they have driven for 20 years or feeling briefly disoriented in a familiar store”.

Although vision changes can play a role, this can also point to a serious cognitive issue such as 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.”

Changes in sense of smell

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 fibres that carry smell signals. That could explain why smell loss can appear years before 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.

Quietly covering for lapses

Sometimes the sign is the workaround itself. People may take steps to hide or compensate for changes, whether or not they fully realise they are 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 reserve can make that 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 begin compensating without noticing it.

“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 realising it, as a spouse takes over driving, paying bills and cooking.”

That slow increase in dependence is something to watch.

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

What to do if you notice these signs

“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.”

Preparing ahead of time can make a medical visit more useful.

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

Along with examples and a general timeline, make a list of medications and over-the-counter products you use.

“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 understand what is happening more clearly.

“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 results, a primary care doctor may also refer the person to a neurologist or psychiatrist.

Not every thinking problem is caused by 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 be a cue to focus on overall brain health. Stanley suggested asking whether you are exercising regularly and making sleep a priority.

“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?”

He also advised thinking about alcohol, tobacco, cannabis or other substances.

“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.”