Normal Aging or Alzheimer's?

Washington DC

A number of people have commented here written me directly, asking how to tell the difference between the symptoms of Alzheimer’s and normal aging.  As I wrote in my previous post, “Do I Really Have Alzheimer’s,” it’s not that easy.  There are no foolproof answers.

The Alzheimer’s Association does have a helpful web page laying out ten early signs of Alzheimer’s and how they differ from normal aging.  If you’re wondering whether you have the disease, reading them can be a little frustrating because early in the disease the distinctions are matters of degree and not easy to be sure about.  Nevertheless, they can give us some comfort about normal changes in aging or help us decide when we need to get ourselves checked out.  The following are taken largely from that page but somewhat edited; occasionally I include my own reflections.

Memory Loss

Changes in memory are the most common initial symptoms in Alzheimer’s, but normal aging changes memory, too.  A normal person might forget names or appointments but will usually remember them later on, perhaps with a little prompting.

In early Alzheimer’s, however, memory loss begins to disrupt daily life.  We forget recently learned information and important dates or events.  We may have to ask for the same information and over again and/or rely on notes or electronic devices to remember.

Challenges in Planning or Solving Problems

In normal aging we might make occasional errors when, say, balancing a checkbook or figuring out a tip.  But in mild cognitive impairment, there may be trouble following a familiar recipe or keeping track of monthly bills.  You may have difficulty concentrating or take much longer to do things than you did before.

Difficulty completing familiar tasks at home, at work or at leisure

In normal aging we might need occasional help in using the settings on a microwave or recording a TV show, but in early Alzheimer’s you may find it hard to complete daily tasks, drive to a familiar location, successfully manage a budget at work or remember the rules of a favorite game.

Confusion with time or place

Any older person may get confused about, say, the day of the week or the date, but we can usually figure it out later.  But with Alzheimer’s you may lose track not only of dates but also of seasons or the passage of time in general.  You may sometimes forget where you are or how you got there.

Trouble understanding visual images and spatial relationships

There are some vision problems that are just signs of normal aging, like those related to cataracts or the need for reading glasses.  But for some people, vision problems are a sign of Alzheimer's.  A person may have difficulty reading, judging distance or determining color or contrast, which may cause problems with driving.

New problems with words in speaking and writing

As we age, most of us have occasional trouble finding the right word, but it’s worse in early Alzheimer’s.  You may have trouble following or joining in a conversation; you might find yourself stopping in the middle of a conversation and having no idea how to continue.  You might have to repeat yourself or struggle with vocabulary; you might have problems finding the right word or call things by the wrong name (eg, calling a "watch" a "hand-clock"). 

Misplacing things and losing the ability to retrace steps

Normally, in getting older we may misplace things from time to time, but we can usually retrace our steps to find them.  In Alzheimer’s, however, you may put things in unusual places or lose things and be unable to retrace your steps to find them again, sometimes even suspecting others of taking them (because you can’t believe you just lost it).  Losing things becomes a regular habit. 

Decreased or poor judgment

Anyone makes a bad decision once in a while, and it may happen a little more frequently as we age.  But in Alzheimer’s you may experience regular changes in judgment or decision-making, for example, poor judgment when dealing with money like giving large amounts to telemarketers.  We may pay less attention to grooming or keeping ourselves clean.

Withdrawal from work or social activities

As we get older, anyone can feel weary of work, family, or social obligations.  But people with Alzheimer's may start to remove themselves from hobbies, social activities, work projects or sports.  You may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby.  You may also avoid being social because of other changes you’ve experienced. 

Changes in mood and personality

As we age many of us get more rigid, developing very specific ways of doing things and becoming irritable when a routine is disrupted.  But in Alzheimer’s, the mood and personality changes can be more pronounced.  You can become confused, suspicious, depressed, fearful or anxious.  You may be easily upset at home, at work, with friends or in places where you’re out of your comfort zone. 

Unfortunately, none of these is precise; the borders between normal and abnormal are blurry.  Something that might be normal for one person may be a sign of Alzheimer’s for another.  Furthermore, there’s no set number of symptoms that indicates disease.  If we find ourselves in between, it’s hard.  Personally, I wanted to know, but I still found myself waiting even after some changes that should have prompted me.  If you’re seriously wondering whether or not you have Alzheimer’s, my own advice is to see your physician and get a referral to a neurologist.  The worse that can happen is reassurance you’re normal.