The Often Overlooked First Sign of Alzheimer’s

Early on, Alzheimer's mild cognitive impairment signs can be hard to spot—but they're worth looking out for.

A pensive older man wonders if his forgetfulness and cognitive impairment are signs of early onset Alzheimer’s disease.

Medically reviewed in January 2022

Alzheimer’s disease is a terrifying prospect for many people. It begins slowly, sometimes silently, but it eventually takes a toll. People in the final stages may become unable to recognize friends and family, speak or use the bathroom on their own. 

Alzheimer’s disease is the sixth-leading cause of death in the United States and it appears to be on the rise. Deaths from Alzheimer’s jumped more than 15 percent between 2014 and 2015 and then another 3 percent between 2015 and 2016. 

Alzheimer’s and other forms of dementia—an umbrella term for severe decline in mental ability—can’t be cured. Many researchers believe that the groundwork for Alzheimer’s is laid down years or decades before symptoms begin, perhaps due to deposits of abnormal proteins in the brain. 

The good news is that some treatments may be able to prevent a risk factor called mild cognitive impairment (MCI) from turning into Alzheimer’s, or at least slow it down. 

But in order to get treatment for MCI, you have to know what it is and how to recognize it. 

What is mild cognitive impairment? 

Like dementia, MCI is an umbrella term. It often, though not always, involves a noticeable decline in memory, and it can affect other executive functions such as language or visual-spatial awareness. 

Additionally, “There’s no singular, specific cause,” says Bruce Morgenstern, MD, a neurologist with Sky Ridge Medical Center in Denver. It’s believed that many cases stem from the same sorts of brain changes that occur in early stages of Alzheimer's or other forms of dementia. 

Although people with MCI are more likely to develop Alzheimer’s disease or dementia, it’s not inevitable. In fact, some cases of MCI never worsen and some even improve. 

What MCI may do is shorten your life. A 2011 study published in Annals of Internal Medicine tracked nearly 4,000 people, more than 500 of whom had MCI. The researchers found that these people died an average of three years sooner than those without MCI. 

What is "normal" forgetfulness? 

“As we age, our memories are not as good,” says Dr. Morgenstern. We aren't able to remember things as quickly as we get older, for example. 

“I tell my patients, ‘You probably can’t run the 100-yard dash in eight seconds anymore, either, but that’s normal,’" says Morgenstern. "Your memories are there, it just takes longer to find them.”  

“But MCI,” he adds, “where there is true memory lost, is not normal.” 

Morgenstern describes it as an absence of memory. If you just asked your spouse what to pick up at the grocery store, but can’t quite remember the full answer, that’s normal. If you can’t remember that the conversation happened at all, it could be a sign of Alzheimer's or cognitive impairment. 

Diagnosing MCI 

Spotting MCI and getting diagnosed take several steps. The changes may be significant enough to be detected by the people experiencing them. 

But, Morgenstern notes, “MCI is typically noted by other observers.”  

Morgenstern says there are a few red flags that make him think someone is experiencing more than just the effects of normal aging. These first signs of Alzheimer’s or cognitive impairment may include: 

  • Repeating questions 
  • Getting lost while driving in your own neighborhood 
  • Not knowing the date, month or year 
  • Having difficulty with simple tasks like logging into a computer 

“Those are clues that may suggest a more serious diagnosis,” he says. 

Once a healthcare provider decides the symptoms are concerning, it becomes a matter of finding the cause, and that means ruling out other conditions. Alcoholism, strokes, brain tumors or masses, vitamin B12 and thyroid deficiencies and medication side effects can all mimic or lead to MCI or dementia. 

"The biggest masquerader is depression,” Morgenstern says.  

Keeping your brain sharp 

There is no cure for some causes of MCI or dementia, but other causes are treatable. “Alcoholism, depression, side effects from medication—those are treatable,” says Morgenstern. You can also proactively address some risk factors

Exercise is one of the best things you can do, not just for your body but for your brain. In a small 2014 study, elderly adults with MCI had less inflammation markers and did better on cognitive tests after 16 weeks of physical training. A systematic review and meta-analysis of 11 studies found that people with MCI showed slight improvements in cognitive ability when they exercised. 

The Centers for Disease Control and Prevention recommends 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise. 

Experts believe that cardiovascular health translates into brain health. The Sharecare app (available for iOS and Android) tracks your fitness to help you keep your heart—and, in turn, your brain—in top shape.

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