When Does Forgetfulness Become Cause for Concern?

It’s not uncommon to forget things from time to time, especially as we age. If you’re like most, you’ve forgotten someone’s birthday at one point or to pick up something at the store. Or maybe you’ve struggled to recall the name of a certain movie or song.  

Forgetting things on occasion isn’t a reason for concern. But if forgetfulness starts to occur on a regular basis, it could indicate something more serious: Alzheimer’s disease.  

What is Alzheimer’s Disease? 

Named after Alois Alzheimer, a German psychiatrist and neuropathologist, Alzheimer’s disease falls under an umbrella of what is more commonly referred to as dementia. In fact, it is the most common form, accounting for 60% to 70% of all dementias.   

“Dementia isn’t a disease. It’s an umbrella term for a group of symptoms,” says Mike Garrigan, Dementia Specialist and Life Enrichment Supervisor at ThedaCare-owned The Heritage and Peabody Manor. “There are over 200 types of dementia, with Alzheimer’s being the most common.”

All dementias affect the brain, but in different ways. The hallmark symptom of Alzheimer’s disease is memory loss, specifically memory loss that disrupts daily life. Everybody has a little bit of memory loss or natural difficulty in recalling certain things as they get older. When it affects your activities of daily living, you should pay attention to it, Garrigan says.

How Alzheimer’s Disease Progresses

Before someone even starts exhibiting symptoms of Alzheimer’s, changes are already taking place in the brain. This pre-clinical stage can last for years before moving into the three main stages of progression. Even then, the speed at which each affected person moves through the various stages may differ. By understanding common signs and symptoms associated with each stage, loved ones, caregivers, and medical providers can help offer the appropriate level of care and support. 

Early (Mild) Stage

Symptoms at this stage are often dismissed as normal forgetfulness that happens as people age. For those with Alzheimer’s disease, however, the forgetfulness can impair the ability to carry out normal, everyday tasks. People with early-stage Alzheimer’s can still live independently, and even hold down a job. However, they may struggle with the following tasks: 

• Remembering names or recent events 
• Managing money 
• Remembering where they put a valuable object, or even where they last put their keys 
• Making plans and staying organized 

The affected person may be aware of this forgetfulness and make excuses for why it’s happening. However, family, co-workers, and friends may begin to take notice of the changes in behavior.  

“When we lose something, we can go back and think about where we’ve been or what we’ve done by retracing our steps,” Garrigan says. “When you have Alzheimer’s disease you struggle to go back and retrace your steps. It’s a debilitating kind of memory loss. You may have no clue what you just did for the last hour or so, or why you walked into a certain room in the house, for example. Some may even read something and then be unable to recall what they just read. A person in those early stages might also be at work and suddenly wonder where they are or what they’re doing there.” 

Middle (Moderate) Stage

This is typically the longest stage of Alzheimer’s, often lasting many years. An individual’s symptoms may include: 

• Trouble remembering their own name and details about their own life, such as their address and phone number 
• Trouble with speaking, reading, writing, and working with numbers, as well as learning new things 
• Struggles with remembering events 
• Difficulty planning complicated events like a dinner or party 
• Exhibiting a decrease in judgment, leading to making poor decisions 

“All of these things tend to lead to social isolation because the person may try to hide it out of embarrassment and withdraw,” Garrigan says. “This ends up changing their mood or personality.” 

As the moderate stage progresses, the individual may: 

• Recognize familiar people but forget their names, including the names of their spouse, significant other, children, or pets 
• Lose track of time and place, where they may not know if it’s day or night and whether they should be making breakfast or dinner 
• Experience changes to their circadian rhythm, such as getting up at midnight, getting dressed and ready to start their day, but then feeling exhausted and ready for bed by noon 
• Need help choosing the right clothing and getting dressed 
• Need assistance with daily activities, such as brushing their teeth or combing their hair 
• Become moody or withdrawn 
• Feel restless, agitated, anxious, or tearful, especially in the late afternoon or at night 
• Become suspicious of other people and their motives, even loved ones 
• Have hallucinations, paranoia, or delusions   

“A person in this stage may start to wander. They’ll walk out the door with the intent to go somewhere, forget where they are or where they were going, and how to get back home,” Garrigan says. “That’s why we have Silver Alerts so often in our state. The middle stage is considered the most dangerous time because they still have that combination of lucidity and increasing signs and symptoms of Alzheimer’s.” 

Late (Severe) Stage

At this stage, a person may: 

• Lose many physical abilities, including walking, sitting, and eating 
• Become incontinent 
• Be able to say some words or phrases, but not have a conversation 
• Need supervision and help with all activities, 24/7 
• Be unaware of their surroundings and recent experiences or events 
• Be more likely to get infections, especially pneumonia and urinary tract infections, because they can’t communicate to someone that they’re not feeling well  

“At this stage, the caregiver must be more intuitive and anticipate needs because the affected person is not communicating needs to them,” Garrigan says. “Hospice or palliative care is also appropriate at this stage.” 

Act Early 

If you suspect that you — or a loved one — may be in the early stages of Alzheimer’s, see a doctor as soon as possible.  

“While it’s incurable, people can take steps to slow the disease down,” Garrigan says. “By receiving the diagnosis, you’ll have the opportunity to start moving ahead with plans for the future, while you or your loved one are still cognitively intact.” 

He also recommends that people visit alz.org.  

“They have more information than you could ever need,” Garrigan says. “It’s important to get educated so you can better understand the illness and advocate for yourself or on your loved one’s behalf.” 

For example, keeping the brain active during the progression of Alzheimer’s is helpful.  

“Alzheimer’s disease destroys connections in the brain, but new connections around it can sometimes develop if you’re doing something you’re not as familiar with,” Garrigan says. “Try doing a different kind of puzzle, learn a new language, learn to play an instrument — something that you’ve not done before.”  

Local Resources  

Fox Valley Memory Project is a collaborative nonprofit organization that operates and supports programs and services that improve quality of life for those experiencing dementia. It also offers services for family members, care partners, and friends.  

One such program is Memory Cafés. Memory Cafés consist of facilitated activities, informal conversation, and light refreshments. They invite the person with memory loss and their loved ones to interact with one another in ways they did before the memory loss occurred. Because every participant is going through a similar experience, there is a feeling of belonging and acceptance. There is no cost to participate. 

View a listing of local Memory Cafés and other available resources on the organization’s website.