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Diagnosing Alzheimer’s Disease

Early Symptoms

Finding out you or a family member have been diagnosed with Alzheimer’s can leave you with many emotions. For some people it can be upsetting or may come as a shock. For others, receiving an ‘official’ medical diagnosis can simply confirm what has long been suspected.

Early Symptoms

The below diagram shows the usual route to diagnosis for a patient in the early stages of Alzheimer’s Disease. Typically, a patient or sometimes their family members report memory problems to their GP. The GP will ask a series of questions and may conduct a short test of mental ability. On the basis of this, the doctor will decide whether to refer a patient on to a specialist.

How to get a diagnosis

General Practitioner (GP)
Report memory complaints to a GP. On the basis of an examination, some questions and a brief memory assessment, referral to a specialist may be made.

Specialist
A specialist and their team may perform a thorough set of examinations. This may include in depth memory testing and brain scans.

Diagnosis
Doctors will rule out other possible causes of dementia-like conditions. To make a diagnosis of Alzheimer’s disease, doctors use specific standardised tests and procedures.

Talking to your doctor

Whether you are attending an appointment for yourself or for someone you are supporting, you may find the following tips useful:

  • Before your visit, think about any symptoms that you want to raise during your consultation.
  • Go with someone who will support you and who can write down any important points the professional makes
  • Ask the doctor to write down any medical terms, particularly if English is not your first language
  • Ask what you can expect to happen further on in the future – this can be very useful to help you make plans
  • Request any information they have about contacting local support groups
  • Ask any professional to explain words or phrases that you do not understand
  • Ask for specific dietary, exercise and health advice
  • Ask where you can get further information if needed

Symptoms of Alzheimer’s Disease

Early Symptoms

The earliest symptom of Alzheimer’s disease is usually short term memory loss. People living with Alzheimer’s disease will typically forget what they did recently but may remember events from years ago in great detail. This can make people think that there can’t be anything wrong with their memory if they can recall information from so long ago. However it is this loss of short term memory that usually occurs early and which is so characteristic of the onset of Alzheimer’s disease.

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The Difference Between Early Alzheimer’s Disease and Forgetfulness

We all forget things from time to time and this forgetfulness tends to increase with age. It can be difficult to judge whether this forgetfulness is a part of normal ageing. Typically it is the ‘depth’ of the memory loss that differs in ‘normal forgetfulness’ versus that due to Alzheimer’s disease.

A person with ‘normal forgetfulness’ can usually still remember other facts associated with the thing they have forgotten. For example, they may briefly forget their neighbour’s name but that the person they are talking to is their neighbour. A person with Alzheimer’s disease will often forget not only their neighbour’s name, but also the context in which they know them.

Stages of Alzheimer’s disease

Alzheimer’s disease is a complex condition that can affect people in different ways. There are, however, stages that many people will progress through and these reflect the movement of the disease through the brain. The symptoms that someone is experiencing will therefore often change, depending on the stage of their disease.

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Early (or mild)

In the very early stages, day-to-day memory problems dominate but these can be subtle so it can be hard to tell if they are due to the normal ageing process.

Early warning signs to look out for include:

  • Losing or misplacing things
  • Becoming confused in familiar places
  • Taking longer to carry out everyday tasks
  • Changes in mood
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Moderate

In this stage of Alzheimer’s disease, the problems with memory become more pronounced and other cognitive processes also start to become affected.

People may:

  • Tell the same stories or ask the same question repeatedly
  • Have difficulty recognising family members or friends
  • Have word-finding difficulties or non-fluent speech
  • Show a lack of concern over their appearance
  • Experience changes in mood and personality
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Severe

In this stage, the disease spreads to engulf most parts of the brain and the person has what is termed ‘a global dementia’. All areas of cognition are severely affected but there are also problems with physical functioning.

People at this stage of disease may:

  • Be unable to remember their own name or recognise close family members
  • Suffer from bladder and bowel incontinence
  • Experience visual/auditory hallucinations
  • Develop repetitive or ritualistic behaviours
  • Need help with even the most basic activities of daily living

If you recognise signs of memory loss in a loved one that keeps on getting worse, to the point you are concerned about it, it is strongly recommended that you make an appointment to see a doctor for an assessment. The earlier that Alzheimer’s Disease is diagnosed, the more can be done to manage it.

What is Alzheimer’s Disease?

Accounting for between 50 per cent and 70 per cent of all dementias worldwide, Alzheimer’s disease is the most common form of dementia. It is a physical brain disease characterised by the impairment of brain functions such as impaired memory, language, thinking and behaviour. It is a progressive disease caused by the gradual degeneration of brain cells.

Alzheimer’s disease can broadly be categorised into two areas:

  • Sporadic Alzheimer’s disease: Can affect adults at any age, but occurs most often after age 65. This is the most common form of Alzheimer’s disease and affects people who may or may not have a family history of the disease.
  • Familial Alzheimer’s disease: Much less common form in which the disease is passed directly from one generation to another.
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Causes of Alzheimer's Disease

Although the causes of Alzheimer’s disease are still not yet fully understood, scientists are starting to gain a greater understanding of the risk factors that increase the likelihood of developing the disease. These include age, family history, heart health and lifestyle factors, such as diet or physical activity.

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The greatest risk factor for developing Alzheimer’s disease is advancing age. Studies have shown that the occurrence of Alzheimer’s increases from about the age of 65. In Singapore, one in 10 people aged 60 and above has dementia1.

1 Source: Well-being of the Singapore Elderly (WiSE) study by the Institute of Mental Health

People with a first degree relative, such as a parent or a sibling, who has developed Alzheimer’s disease, have an increased risk of developing the disease. This risk is higher if two or more first degree relatives have been affected.

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Although there are no definitive protective factors for dementia, there is now a growing body of evidence that suggests that there are several lifestyle factors that could reduce the risk of developing dementia.

These include:

  • Maintaining a level of physical activity
  • Adopting a healthy diet
  • Maintaining a socially active lifestyle
  • Staying mentally active
  • Managing your cholestorol levels or blood glucose levels if you have cardiovascular disease or diabetes
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