SMB medicine: Alzheimer's Disease WARNING SIGNS And SYMPTOMS

What are the Signs and symptoms of Alzheimer’s disease symptoms?

Memory impairment

Memory impairment is the most common initial symptom of Alzheimer disease dementia.
The pattern of memory impairment in Alzheimer disease is distinctive.
Declarative episodic memory which is memory of events occurring at a particular time and place is usually profoundly affected in Alzheimer disease. This type of memory depends heavily on the hippocampus and other medial temporal lobe structures.
Within episodic memory, there is a distinction between immediate recall (eg, mental rehearsal of objects name), memory for recent events (which comes into play once material that has departed from consciousness must be recalled), and memory of more distant events (remote memory). Memory for recent events, served by the hippocampus and related structures in the medial temporal lobe, is prominently impaired in early.
Memory is usually tested by asking patients to learn and recall a series of words or objects immediately and then at a delay of 5 to 10 minutes. Impaired ability to recall objects with selective hints or recognize items as previously studied on a recognition memory test represents a more severe deficit and one that may be particularly specific.

Executive function and judgment/problem solving
Reduced insight into deficits (anosognosia) is a common but variable feature of of Alzheimer’s disease.
Loss of insight increases over time along with overall disease severity. Such loss of insight may be associated with behavioural disturbances. Those with relatively preserved insight are more likely to be depressed; those with more impaired insight are likely to be agitated, be disinhibited, and exhibit psychotic features. Lack of insight also may impact safety, as patients may attempt to take on tasks that they no longer have the capacity to perform effectively (eg, driving).

Visuospatial impairments are often present relatively early, while deficits in language often manifest later in the disease course. These deficits develop and progress insidiously. Less commonly, language deficits, visuospatial abnormalities, or even executive functions may be impaired as the most prominent initial symptom.

Behavioral and psychologic symptoms
Neuropsychiatric symptoms are common, particularly in the middle and late course of disease. These can begin with relatively subtle symptoms including apathy, social disengagement, and irritability.
More problematic in patient management is the emergence of behavioral disturbances, including agitation, aggression, wandering, and psychosis (hallucinations, delusions, misidentification syndromes).

Apraxia Dyspraxia, or difficulty performing learned motor tasks, usually occurs later in the disease after deficits in memory and language are apparent. Before it is clinically manifest, dyspraxia can be elicited by asking the patient to perform ideomotor tasks. Clinical dyspraxia leads to progressive difficulty first with complex, multistep motor activities, then with dressing, using utensils to eat, and other self-care tasks, and is a significant contributor to dependency in mid- to late stages.
Olfactory dysfunction Changes in olfactory function are common in patients with Alzheimer’s disease.

Sleep disturbances Sleep disturbances are common. Patients with Alzheimer’s disease spend more time in bed awake and have more fragmented sleep compared with older adults without Alzheimer’s disease. Such changes may occur very early in the disease process, including in patients who are cognitively normal.

Seizures Seizures occur usually in the later stages of disease. Younger patients, including those with autosomal-dominant forms of Alzheimer’s disease, may be at higher risk for seizures, which may occur early in the course of disease.
The predominant seizure type is focal nonmotor with impaired awareness, with symptoms often suggestive of medial temporal lobe onset.

Motor signs In the early stages, patients with Alzheimer’s disease generally have a normal neurologic examination except for the cognitive examination. When they occur they are typically late-stage findings. If these are clinically apparent in early to middle stages, alternative diagnoses should be considered.