If You’ve Met One Person With Alzheimer’s Disease

The second chapter of my teaching memoir carries this title “If You’ve Met One Person With Alzheimer’s, You’ve Met One Person With Alzheimer’s.” I discussed this phrase and how it affected me in a blog post on 3/23/2020: HERE

The chapter details the events that led to my husband’s, Harvey’s, diagnosis of Alzheimer’s disease. If you are not familiar with the story, you can read my essay that was published in JAMA Neurology HERE. In it, I discuss a family trip to Costa Rica when I first noticed a problem with his cognition. I think that because he was out of his routine, Harvey was unable to cope with a new location and a changing schedule on vacation. Several issues were manifested.

The most common presenting sign of Alzheimer’s disease is a problem with short term memory,  and, in fact, Harvey had been telling me that he didn’t think his memory was as good as it had been. In Costa Rica, he had trouble remembering our guide’s instructions and would ask me to repeat them throughout the day.

A person might first exhibit subtle changes in behavior such as socially withdrawing, increased anxiety, agitation, depression, or a loss of spontaneity and initiative. I didn’t note any of these in Harvey, but he did. He worried that he was becoming too distant and content to just watch from the side lines. It’s really interesting that he noticed that about himself.

Another early cognitive deficit might be visual-spatial issues. It’s not a vision issue, but rather, the way that the brain interprets information from the eyes can be disturbed. This can lead to some loss of depth perception, an inability to recognize how far away an object is. One of our activities on the Costa Rica trip was zip-lining. Harvey had some difficulty with landing on the platforms and seemed uncomfortable with the activity. That was odd.

Misplacing objects might be a very early sign. Occasionally misplacing your keys is normal, but forgetting that you misplaced something is not. On the family vacation, Harvey was constantly rummaging through his luggage to find one object or another.

If a person had previously been good at mental calculations in the past, but now seems to lack that ability, it could be an early sign of cognitive problems. When I asked him to calculate our daughters’ birth years while in Costa Rica, Harvey couldn’t do it.

Another early warning sign is difficulty with time, getting confused about the time of day, day of the week or even time of year. This also presented itself on our trip as Harvey could not keep up with the schedule our guide gave us, forgetting which day it was.

Problems with navigation may show up early. Studies have shown that people with even very early Alzheimer’s disease cannot learn a new environment as well as someone with normal cognition can. This occurred in Costa Rica when Harvey became lost in one of the resorts.

There are other non-memory aspects of cognition that Harvey did not exhibit, but might be a presenting feature in some patients. These include increasing trouble with word-finding, difficulty with familiar tasks, money issues such as neglected bills, or poor judgement.

It’s really stunning to me how many cognitive deficits were apparent on this seven day vacation. All together, the picture it painted was enough to get me started with finding a diagnosis. I wonder if we had not taken that vacation, how long it might have taken me to see the problem.