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As a primary care and geriatric medicine provider based in Baltimore, Maryland, Dr. Ernestine Wright often sees firsthand how Alzheimer’s disease progresses in her patients. The early stages can mimic normal aging—like forgetting a name or where you put your keys—so knowing the difference between occasional forgetfulness and a sign of a deeper issue is the key to unlocking access to early intervention.
Normal aging vs. early signs of Alzheimer’s disease
Occasionally forgetting a name or appointment is not typically cause for concern, explains Beth Battaglino, RN-C, CEO of HealthyWomen, an organization dedicated to women’s health in midlife. For example, if you forget the name of an old TV show but remember it a few minutes later, that is not consistent with the early stages of Alzheimer’s disease. However, persistent changes that interfere with your daily functioning, such as repeatedly asking the same question or getting lost in a familiar place, are reasons to start a conversation with your doctor, she says.
Battaglino explains that ruling out other medical reasons for cognitive issues, as well as addressing conditions that can increase dementia risk like high blood pressure, diabetes, high cholesterol, and atrial fibrillation, is a good place to start.
“I want you to talk to your health care professional because some of these memory and concentration problems can be addressed,” Battaglino says. “You may be diagnosed with sleep apnea, depression, or anxiety that could have an effect on your brain health. You may have a thyroid disorder or a vitamin B12 deficiency, or maybe you’re on a new medication and the side effects could affect your memory."
But if it is Alzheimer’s disease that’s responsible for the memory and cognition changes, evidence shows that it’s best to receive a diagnosis as early as possible.
HealthyWomen’s This is Alz initiative is designed to share the stories of people who received early Alzheimer’s diagnoses. This is Alz encourages people to understand their risk, particularly if they have a strong family history of dementia, and recognize signs and symptoms of the disease.
“What it also represents is how these people, even though they're confirmed that they have earlier stage Alzheimer's, they are able to live their best life,” Battaglino says.
Why it’s important to detect Alzheimer’s disease early
An earlier diagnosis means earlier access to treatments that can slow the progression of the disease. It also gives you more options for enrolling in clinical trials, Dr. Wright explains.
In Alzheimer’s disease, abnormal proteins called amyloid plaques build up between brain cells and can interfere with cognition. Researchers believe these plaques contribute to damage and death of brain cells over time, and new therapies are designed to target and remove amyloid plaques in hopes of slowing disease progression.
“With earlier detection you have better access to medications that are going to be more helpful,” Dr. Wright says. “Most importantly, you avoid an irreversible crisis because you can put plans in place to make life more manageable.”
She recommends that people diagnosed with early-stage Alzheimer’s disease make legal and financial plans for the future, including designating a medical power of attorney, while the individual still has the ability to make informed decisions. “One anticipates that with progression of the disease, you might get to a point where legally you're not deemed medically competent to make such decisions, and that can have dire consequences on both the individual with Alzheimer's disease as well as their caregivers and their immediate families,” she says.
Tests that can help diagnose Alzheimer’s disease
Cognitive tests, including neuropsychological testing, can help measure memory and problem-solving skills that deteriorate in people with Alzheimer’s disease, explains Tim Brearly, Psy.D., FANA, associate professor of neurology and of neuroscience and experimental therapeutics at Penn State College of Medicine and researcher in The Open Measures Network Initiative for Alzheimer’s Disease and Related Dementia Research Prevention led by Penn State.
Even for people without symptoms, a baseline cognitive test can be a valuable tool to help flag deterioration as soon as possible, he says.
“Maybe three, four, or five years ago we would be slightly less motivated to evaluate somebody early and get a cognitive baseline, but now there’s a lot more value to it because there are interventions that are more effective in the earlier stages,” Dr. Brearly explains.
Anti-amyloid monoclonal antibodies are the first therapies designed to target the underlying disease and remove amyloid plaques rather than just manage symptoms like older medication options. Dr. Brearly adds that while new medications can slow the progression of the disease, there isn’t clear evidence yet that they can fully stabilize disease progression.
The other key piece of the puzzle is biomarker testing, which looks for measurable biological signs of Alzheimer’s disease in the body, even before symptoms develop or become severe. There are three main types: blood tests, cerebrospinal fluid tests (which require a lumbar puncture to extract the fluid that surrounds the brain and spinal cord), and imaging tests like a PET scan.
Research shows that minimally invasive blood tests can detect biological signs of Alzheimer’s disease, including amyloid plaque buildup, more accurately than a standard clinical evaluation.
In one study that included more than 1,200 patients, primary care physicians made an accurate diagnosis for Alzheimer’s disease 61% of the time when they used a clinical evaluation, cognitive test, and CT scan to make their diagnosis. The accuracy rate jumped to 91% when the physicians used a blood test to diagnose Alzheimer’s.
Biomarker testing is becoming increasingly important because Alzheimer’s disease can begin affecting the brain years before symptoms become obvious in daily life or a cognitive test result shows impairment. Detecting these biological changes earlier gives patients advance access to treatment options that can slow disease progression and more time to make informed decisions for their future.
Why is Alzheimer’s disease more prevalent in women?
The answer is likely due to a variety of factors, according to Dr. Wright. First, your likelihood of developing Alzheimer’s disease increases with age, and generally, women live longer than men.
But there are several biological and social factors that can also contribute to the discrepancy, she explains.
For example, researchers found a link between declining estrogen levels during menopause and measurable changes in brain structure and metabolism, including patterns linked to increased Alzheimer’s risk. Also, the strongest known genetic risk factor for Alzheimer’s disease (the APOE-ε4 allele) is shown to have a greater effect in women than in men.
Battaglino and Dr. Wright agree that chronic stress, particularly caregiver burden, can amplify women’s risk for developing Alzheimer’s disease. Stress itself, along with sleep deprivation, can take a toll on brain health, but it can also be a reason why women don’t have their Alzheimer’s disease symptoms recognized earlier, Battaglino explains.
“Many of the early cognitive symptoms overlap with experiences women commonly have during midlife, including menopause, chronic stress, and caregiving fatigue, because we're taking care of everyone but ourselves,” she says. “Because of that, women may be dismissing symptoms themselves, or they may be told that they are simply stressed out or getting older.”
How lifestyle habits can help reduce the risk of Alzheimer’s disease
While there is no guaranteed way to prevent Alzheimer’s disease, research increasingly shows that certain lifestyle choices can help protect brain health and reduce your risk of cognitive decline. There are several things you can do to protect your brain health on a daily basis, Dr. Brearly explains.
Exercise regularly
Physical activity has a protective effect against cognitive decline. Dr. Brearly recommends aiming for 150 to 220 minutes of moderate exercise each week, ideally. “Find something that’s fun, something you can enjoy, and something you can do that much,” he says.
Maintain a healthy diet
Limiting alcohol, red meat, and simple carbohydrates in favor of focusing on lean meats and complex carbohydrates (key components with the Mediterranean diet) is associated with reduced dementia risk and better overall health. Also important, Dr. Brearly notes, is getting enough omega-3 fatty acids from sources like fish, walnuts, or chia seeds. Paying special attention to your omega-3 intake is helpful because your body does not produce it on its own, he explains.
Get your hearing and vision checked
Research shows that people with hearing or visual impairments may be at higher risk for cognitive decline due to reduced cognitive stimulation and social isolation.
Keep an active social life
“Engage with people around you,” Dr. Brearly says. “It makes your brain stay active. It has to adapt to different social situations and be challenged in new ways.” These challenges, he explains, help maintain strength in the networks in your brain responsible for cognition and memory.
Cognitive stimulation, which includes challenging your brain through activities like puzzles or learning a new language, can also help your brain stay active, he says.
