Alzheimer’s disease 101 – Recognizing warning signs and understanding risks

More than 7 million Americans age 65 and older are living with Alzheimer’s disease. Although there is currently no cure, there are treatments that can slow disease progression in some people. A Baylor College of Medicine expert says recognizing the warning signs and early detection can help individuals and families better understand their options and help support a better quality of life.

Dr. Roy Lin, assistant professor of neurology at Baylor, says one of the most important things people can do is recognize changes in their cognitive abilities, particularly a consistent pattern of decline from their usual level of functioning.

“People often associate Alzheimer’s disease exclusively with memory loss, but that’s not always how it begins,” Lin said. “Changes in work performance, language, visual-spatial abilities and other cognitive functions also can be warning signs. What matters is noticing a consistent pattern of change from a person’s usual abilities and original day-to-day functioning.”

Early warning signs

For late-onset Alzheimer’s disease, which usually develops after age 65, short-term memory problems are the first noticeable symptoms. Family members or close friends may notice changes before a person recognizes the problem themselves.

“Some signs might be repeatedly asking the same questions, forgetting upcoming appointments or recent conversations, forgetting the details of a movie or becoming lost or disoriented, even on familiar routes,” Lin said. “They might take longer to travel between familiar places or have difficulty navigating familiar places.”

Early onset Alzheimer’s disease refers to Alzheimer’s that begins before age 60 to 65, sometimes appearing in people as young as their 40s. In some people, symptoms initially affect thinking skills other than memory, an atypical presentation of the disease. They may have difficulty finding words, speaking fluently, completing familiar work tasks, or making decisions that once came easily. Less commonly, early symptoms may affect visual and spatial abilities, making it difficult to read, judge distances, or maneuver while parking. This pattern is called posterior cortical atrophy (PCA), a syndrome most often caused by Alzheimer’s disease.

“Some people think they have a vision problem, yet an eye exam may be normal. Any consistent decline in cognitive function deserves attention, even if memory isn’t the primary issue,” Lin said.

He adds that it is important to talk to your doctor if you have concerns, and you do not need to wait until you have memory issues.

Family history and when to see a doctor

Having a family history of Alzheimer’s does not automatically mean someone will develop the disease.

There are genetic factors, such as the APOE gene. Depending on how many copies a person has, the risk increases. However, developing the disease is still not guaranteed.

Early onset Alzheimer’s can sometimes be associated with rare inherited genetic mutation. However, not all early onset cases show genetic mutations.

“Genetic testing doesn’t always provide a clear answer. It is important to discuss this with your doctor, perhaps a genetic counselor, before considering genetic testing,” Lin said. “An evaluation to establish a baseline is helpful, and anyone can have this done. A baseline provides a reference point that physicians can use to compare cognitive performance over time.”

A primary care physician is a good place to start, and there are several screening options they can provide. However, a neurologist is better equipped to provide a more detailed interpretation and evaluation of cognitive function.

Some tests a neurologist can conduct include basic blood work and neuropsychological testing. These tests can last up to four hours and review multiple areas of cognition. This testing also can help determine normal age-related changes from Alzheimer’s disease or other conditions.

Treatment

There are two newly FDA-approved medications available since 2023. Both are administered through infusion and are intended for patients in the early stages of the disease, including those with mild cognitive impairment.

These treatments can slow disease progression in some patients, but curative therapies have not been identified yet. Lin says that is why joining clinical trials for therapy development is an important consideration for many patients to look for assessment in an academic center like Baylor Medicine.