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If you're new to this blog and want some context for it, read this post from the day I announced my Alzheimer's disease and this post about the day I announced I had lost it. For more info, visit my website with my autobiography and all blog entries in chronological order for easier reading to catch up. There's also a sermon on the spiritual lessons I've learned through this journey through my damaged mind.

Friday, May 24, 2013

Normal Aging or Alzheimer's?

Washington DC

A number of people have commented here written me directly, asking how to tell the difference between the symptoms of Alzheimer’s and normal aging.  As I wrote in my previous post, “Do I Really Have Alzheimer’s,” it’s not that easy.  There are no foolproof answers.

The Alzheimer’s Association does have a helpful web page laying out ten early signs of Alzheimer’s and how they differ from normal aging.  If you’re wondering whether you have the disease, reading them can be a little frustrating because early in the disease the distinctions are matters of degree and not easy to be sure about.  Nevertheless, they can give us some comfort about normal changes in aging or help us decide when we need to get ourselves checked out.  The following are taken largely from that page but somewhat edited; occasionally I include my own reflections.

Memory Loss

Changes in memory are the most common initial symptoms in Alzheimer’s, but normal aging changes memory, too.  A normal person might forget names or appointments but will usually remember them later on, perhaps with a little prompting.

In early Alzheimer’s, however, memory loss begins to disrupt daily life.  We forget recently learned information and important dates or events.  We may have to ask for the same information and over again and/or rely on notes or electronic devices to remember.

Challenges in Planning or Solving Problems

In normal aging we might make occasional errors when, say, balancing a checkbook or figuring out a tip.  But in mild cognitive impairment, there may be trouble following a familiar recipe or keeping track of monthly bills.  You may have difficulty concentrating or take much longer to do things than you did before.

Difficulty completing familiar tasks at home, at work or at leisure

In normal aging we might need occasional help in using the settings on a microwave or recording a TV show, but in early Alzheimer’s you may find it hard to complete daily tasks, drive to a familiar location, successfully manage a budget at work or remember the rules of a favorite game.

Confusion with time or place

Any older person may get confused about, say, the day of the week or the date, but we can usually figure it out later.  But with Alzheimer’s you may lose track not only of dates but also of seasons or the passage of time in general.  You may sometimes forget where you are or how you got there.

Trouble understanding visual images and spatial relationships

There are some vision problems that are just signs of normal aging, like those related to cataracts or the need for reading glasses.  But for some people, vision problems are a sign of Alzheimer's.  A person may have difficulty reading, judging distance or determining color or contrast, which may cause problems with driving.

New problems with words in speaking and writing

As we age, most of us have occasional trouble finding the right word, but it’s worse in early Alzheimer’s.  You may have trouble following or joining in a conversation; you might find yourself stopping in the middle of a conversation and having no idea how to continue.  You might have to repeat yourself or struggle with vocabulary; you might have problems finding the right word or call things by the wrong name (eg, calling a "watch" a "hand-clock"). 

Misplacing things and losing the ability to retrace steps

Normally, in getting older we may misplace things from time to time, but we can usually retrace our steps to find them.  In Alzheimer’s, however, you may put things in unusual places or lose things and be unable to retrace your steps to find them again, sometimes even suspecting others of taking them (because you can’t believe you just lost it).  Losing things becomes a regular habit. 

Decreased or poor judgment

Anyone makes a bad decision once in a while, and it may happen a little more frequently as we age.  But in Alzheimer’s you may experience regular changes in judgment or decision-making, for example, poor judgment when dealing with money like giving large amounts to telemarketers.  We may pay less attention to grooming or keeping ourselves clean.

Withdrawal from work or social activities

As we get older, anyone can feel weary of work, family, or social obligations.  But people with Alzheimer's may start to remove themselves from hobbies, social activities, work projects or sports.  You may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby.  You may also avoid being social because of other changes you’ve experienced. 

Changes in mood and personality

As we age many of us get more rigid, developing very specific ways of doing things and becoming irritable when a routine is disrupted.  But in Alzheimer’s, the mood and personality changes can be more pronounced.  You can become confused, suspicious, depressed, fearful or anxious.  You may be easily upset at home, at work, with friends or in places where you’re out of your comfort zone. 

Unfortunately, none of these is precise; the borders between normal and abnormal are blurry.  Something that might be normal for one person may be a sign of Alzheimer’s for another.  Furthermore, there’s no set number of symptoms that indicates disease.  If we find ourselves in between, it’s hard.  Personally, I wanted to know, but I still found myself waiting even after some changes that should have prompted me.  If you’re seriously wondering whether or not you have Alzheimer’s, my own advice is to see your physician and get a referral to a neurologist.  The worse that can happen is reassurance you’re normal.


  1. Another thought, there are many older people that suddenly get very confused or combative and we find out they have a UTI. Give them the proper medication and they go back to normal for them. Someone already having cognitive difficulties and getting a UTI, can suddenly be very difficult and combative. So when we would have a sudden change in someone's behavior, the first thing we would check is their urine.

    Working in a special unit, occasionally one of the aides or nurses would forget someone's name or a date to remember, and they would sometimes get an "OMG I'm forgetting something" look. So our standard answer always was, "You are not getting Old Timers when you lost your keys, you are getting Old Timers when you forget what keys are."

    A friend of mine took care of his Mom with dementia. She was high functioning and just seemed quiet and shy. One day someone lost their phone (or keys, whatever it was). And she tried to help. So she looked through the house and came running out, "I think I found it." She had an electric razor in her hand. So we had to try to explain that "no, this wasn't the phone". So she went back to looking.

    I think the memory difficulties add up over time. Nothing happens in a day or a week. But over a long period of time.

  2. If not mistaken Alzheimer himself admitted "his" disease is another form of normal brain aging and therefore inevitable. Sincerely dislike the 'pharmaceutical industry taking advantage of (and therefore money) from folks who believe it's not normal to grow up. First do no harm,indeed.

    1. It is true, apparently, that 50% of people over 85 have Alzheimer's, so, in that sense, I suppose, it's "normal." But the other 50% don't have any of the brain pathology of Alzheimer's on autopsy. The incidence of diabetes reaches over 50% in some Native American groups, but that doesn't mean it's "normal" or inevitable.

  3. Hi David, thanks for a great post which I'm sure will be very helpful for grappling with this difficult issue. It is still quite rare to hear openly and directly from people 'from within Alzheimer's disease' and so you provide a great service to many I'm sure. We'll be sharing with our communities in Australia to provide insight and encouragement. Peter, HammondCare.

  4. Anonymous5/27/2013

    "The worst that can happen is reassurance that you are normal."

    That is a sad, but true statement for so many if us. We live in a society that has been programmed and conditioned to label ourselves and each other. Labels bring some sort of perceived understanding or respect. Is this real?

    Who are you? What do you do? We label our illnesses and weaknesses for many reasons. Sometimes, labels actually bring us comfort. Sometimes it seems we wear our labels as personal badges of "specialness."

    "MY forgetfulness is 'really' forgetfulness. You can't possibly understand my haven't had MY disease."

    I've read comments where respondents are labeling others as narcissistic because they point out "yes, I am forgetful too" (probably in their attempt to provide comfort or to relate to another). That angers some of us because we think, "No, I am different. I am special." If I attach a label to my human condition, somehow I retain control and gain respect. Right? Wrong!

    These labels have enabled our medical system to design itself in such a way that, psychologically, we NEED to visit the doctor - despite whether there is a "cure" or treatment, we lean on the medical system for "reassurance," at a great expense to ourselves. We spend thousands of dollars "watchfully waiting." What are we waiting for? Somehow that makes us feel better? Really? Do we feel better?

    Of course there are illnesses that can be helped by conventional medicine. I'm not suggesting we ignore seeking medical help. I'm simply wondering what would happen if we ditched the labels and practiced real human compassion rather than the serial labeling of ourselves and others?

    Surely, overcoming the fear and loss of control that a decline in cognitive function (or ability to care for one's self) is a reason for concern. Perhaps seeking (and actually accepting) reassurance and compassion from others could be a useful medicine and should be considered as a source of healing.

    Can we trust that human compassion will be there? I'm not talking about under-handed compassion you know the kind? The kind of "compassion" where pharma-funded non-profits, friends and family would be happy to "walk or run" on your behalf to raise money for "a cure" to your pain and sorrows, but when you are dying on the street they might be noticeably missing.

    When will we understand that health and well-being do not come in the form of a pill or medical treatment. Health and well-being come from learning to seize the day. Learning to embrace the goodness and struggles that life brings - with grace and compassion, for ourselves and each other.

    What if today you released your anxiety and fear? What if instead of surfing for labels and obsessing over your own pain you decided to embrace life and what lies before you NOW? What if you reached out to someone else who might be in pain? What if you decided today will be the day that you make someone else's life better and forget about your own struggles?

    Blogging and discussion geared toward helping and understanding each other are useful, but beware of the trap of self-indulgence. It's one that's difficult to wiggle out of.

    Compassion may not be the cure to Alzheimer's disease, but I don't see the harm in considering it could help.

    What makes the human race so unique is we are all special, but none of us are special.


    1. I have certainly recognized in myself this not-so-well-hidden desire to remain "special" as a person with Alzheimer's and it is certainly part of the reason I get irritated with those who confuse their normal aging with "my" Alzheimer's. Especially since I've become a "professional Alzheimer's patient," the temptation is great and I need to be aware of it at every step.
      At the same time the label of Alzheimer's can give us some comfort. I remember when after twenty years of suffering the terrible feelings of isolation and the symptoms of neuroticism, I finally discovered the label of "depression." It brought enormous relief, a way of understanding what I had previously considered a character defect. If I lost my label of Alzheimer's at this point, I would find myself lost: Where do these symptoms come from, then? True, if I could truly live in the present, I wouldn't need the label, but I am only part way there and grateful that I have some incomplete way of understanding.
      And you're certainly right that the only real healing that anyone can offer me or I anyone is the compassion of one human being for another.
      Thanks for writing, a.b.

  5. Nice posting.....i like it:-)
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