With Alzheimer’s disease, recollection of facts and events (called “declarative” memory) tends to become impaired first, particularly with recently acquired memories.

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Many people fear that everyday acts of forgetfulness, such as not remembering where you put your car keys, are early signs of Alzheimer’s disease. Although forgetfulness can be an early warning sign, the memory loss of Alzheimer’s disease is more serious than normal age-related memory difficulties. Misplacing your keys only to find them later is not uncommon. Placing the keys in an odd or inappropriate location, such as inside the sugar bowl, and completely forgetting about it indicates a more serious problem.

With Alzheimer’s disease, forgetfulness is a consistent problem, and the information generally is not recalled later, as it often is with normal aging. Also, Alzheimer’s disease affects more than just memory. Language, behavior, and the ability to handle day-to-day tasks also become compromised.

Memory Loss

For most people, memory loss is the first noticeable early sign of Alzheimer’s disease. Early in the course of the illness, a person with Alzheimer’s disease will tend to forget recent events and new information, while retaining memories of past events. Forgetting recent events may cause the person to ask the same questions repeatedly. This memory loss also causes the person to have difficulty learning new information. Eventually, the person may not remember the names or identities of family members or close friends, and long-term memory will be lost as well.

Memory is not one simple function, but a collection of several memory systems. For example, remembering how to drive a car involves a different memory system from that used to remember your wedding day, or from the one that allows you to do mental calculations.

With Alzheimer’s disease, recollection of facts and events (called “declarative” memory) tends to become impaired first, particularly with recently acquired memories. With this disruption, it’s easy to forget appointments and the content of conversations. A person with Alzheimer’s disease may ask a question, get an answer, and then ask the same question five minutes later. Often, people in the mild stage of Alzheimer’s disease will be confused about recent experiences, although they may have excellent recall of events that occurred 20 years ago. It may be easier to define vocabulary words than to supply recent autobiographical details (such as what the person did yesterday).

Memories of previously acquired skills and procedures, such as playing golf or mowing the lawn (called “procedural” memory), remain intact longer. These well-learned routines hold up for a while, and it may be possible to learn new routines that make use of the procedural memory system.

Alzheimer’s disease damages another system called “working memory.” Working memory allows you to mentally hold onto information while processing it. For example, arithmetic is performed in working memory. A person with Alzheimer’s disease may be able to remember a string of numbers for a short time but be unable to add or subtract them. Working memory also helps us divide our attention. A person with normal memory can participate in a conversation while remembering that he has to turn off the oven in five minutes. A person with Alzheimer’s disease has increasing difficulty dividing his attention, so the oven stays on.

Language Difficulties

Language ability is divided into expression and comprehension. With Alzheimer’s disease, the ability to intelligibly express oneself with language tends to deteriorate faster than the ability to comprehend words and sentences. Most people with early signs of Alzheimer’s disease have trouble finding the right words to express what they want to say. For example, a person might want to refer to his watch but can’t remember the word “watch,” so he says, “the thing you tell time with.” A person with Alzheimer’s may also become confused and refer to her husband as her son or brother, mistaking one word for the other.

Perception of Time and Orientation

Impaired orientation means that the person with Alzheimer’s becomes increasingly confused about time (date, day of the week, month, year, season) and place (residence, neighborhood).

Early on, people may become confused about the date or day of the week. Time relationships may be slightly impaired. For example, people may get ready for an appointment hours ahead of time. Also, while it may be easy enough to navigate familiar places, such as their own neighborhood, unfamiliar locations begin to present a problem.

In the moderate stage, time orientation worsens. A person in this stage may believe that he or she is living in another period of life, and may think that deceased relatives are still alive. Orientation to place also declines. People in this stage will increasingly have trouble finding their way around, even in familiar places. They may not recall where to put items, such as the dishes or towels, and will store them in inappropriate locations. It’s particularly important at this stage for people with Alzheimer’s to be supervised and to have identification in case they become lost.

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