Recognising Alzheimer’s disease – how AD affects patients

Written by: Professor Peter Garrard
Published: | Updated: 11/03/2019
Edited by: Cal Murphy

The causes of dementia are many, and they vary depending on the age of the patient. The most common by far is Alzheimer’s disease (AD). Alzheimer’s is an insidious condition in which symptoms creep up on patients, often unnoticed by family members at first, but with serious effects becoming evident as the disease progresses. Expert neurologist Professor Peter Garrard is here to talk about the signs that can identify Alzheimer’s disease.

What is Alzheimer’s disease?

Alzheimer’s can have devastating effects on a person’s thinking skills, but can also affect the lives of their loved ones. It can cause problems with higher functions such as memory, language, and social behaviour. The preservation of limb function means that patients can become prone to wandering disoriented and getting lost in the later stages of the disease. It may take over a decade for AD to exert its full effects, by which time severe problems are evident in multiple cognitive domains.


Diagnosing Alzheimer’s disease

Although direct examination of the structure of brain tissue is technically the only way to make a definitive diagnosis, in practice the symptoms are usually sufficient to make an accurate diagnosis of Alzheimer’s disease, which is often supported by diagnostic investigations.


Signs and symptoms of AD

Signs of Alzheimer’s to look out for include:

  • Memory impairment – there are four different ‘types’ of memory: episodic, semantic, procedural, and working. Episodic memory is usually the most affected by Alzheimer’s. Episodic memory enables us to learn new information and recall recent events. Alzheimer’s patients progressively lose the ability to learn, retain and process new information, while preserving earlier learned memories relatively well. Episodic memory loss is not the same as “short-term memory loss”, which refers to working memory, i.e. concentration and the ability to retain information for a few seconds (e.g. remembering the digits of a phone number for long enough to write them down).
  • Language – patients with Alzheimer’s may have difficulty finding the right word in conversation. Although this problem gets more pronounced as the disease advances, it is very often seen and experienced in the early stages as well and is a useful clinical marker of disease. Language difficulty may be the only symptom of AD and remain so for a number of years.
  • Apraxia – advanced motor skills may become impaired and may (rarely) be an isolated problem.
  • Agnosia – difficulty or inability to recognise objects, places, or faces.
  • Frontal executive function – the ability to organise, plan, and sequence becomes impaired.
  • Personality – in AD, personality and social behaviour usually remain fairly normal until late in the disease, while in other forms of dementia these aspects may deteriorate earlier.
  • Anosognosia the patient will often display a lack of insight into their condition and many are reluctant to go to their doctor until pressured by a family member.
  • Visuospatial difficulties – difficulty with orientation and navigation can be caused by parietal lobe involvement. It is often subtle in the early stages but there is a parietal presentation of the disease (posterior cortical atrophy – or PCA) in which these difficulties are prominent but memory relatively well preserved.

There are also several non-cognitive features that can develop later in the progression of Alzheimer’s disease. These include:

  • Myoclonus
  • Seizures
  • Reversal of the sleep-wake cycle
  • Incontinence
  • Swallowing may become impaired – this can lead to aspiration pneumonia, which can prove fatal.

Learn more about spotting the signs of early onset dementia here.

If you notice any of these symptoms in a friend or relative, encourage them to see their doctor or a specialist. If they have Alzheimer’s, there is a wealth of care and support available, and the sooner Alzheimer’s is diagnosed, the more can be done to slow its progress and ensure the best possible care for the patient.

By Professor Peter Garrard

Professor Peter Garrard is an expert consultant neurologist and active clinician scientist in London, with a focus on linguistic profiles of disorders of the nervous system. He has more than 25 years of clinical experience, including 15 years as an accredited specialist in neurology. His specialist interests include neurological disorders, cognitive disorders, progressive language disorders, frontotemporal dementia, and early-onset dementia.

In 1990, Professor Garrard received his primary medical qualification from the University of Bristol and subsequently undertook his higher medical training in Edinburgh for surgery and Yeovil for medicine. Once in London, he completed his general medical training before taking on specialist training in neurology in 2000. During this time, Professor Garrard completed his PhD at Cambridge University on language abnormalities in Alzheimer's and other dementias as a Medical Research Council clinical training fellow.

Professor Garrard has completed extensive neuroscience research, and currently holds the position of Professor of Neurology at St George's University of London, where his primary research interest is in the early language changes associated with neurodegenerative dementians, such as Alzheimer's. He is deputy director of the Molecular and Clinical Sciences Research Institute at St George's, and also leads an active dementia research laboratory. Additionally, Professor Garrard has continuously taken on educational roles in his field since becoming a member of the General Medical Council.

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