Alzheimer’s Disease: When Memory, Identity and Relationships Begin to Change

Alzheimer’s Disease: Understanding the Symptoms, Risks and Impact

When I think about dementia and all its forms, I am struck by what a devastating disease it can be. The most common form of dementia is Alzheimer’s disease, accounting for an estimated 60–70% of dementia cases. It affects not only the individual living with the disease but also the family members, friends, and caregivers who walk alongside them.

Over the years, I have witnessed the heartbreaking and debilitating effects of Alzheimer’s disease. The losses can be enormous. There is the loss experienced by the person with Alzheimer’s, but there are also the losses experienced by those who love and care for them. These can be examples of ambiguous loss—grieving someone who is still physically present but whose abilities, personality, memories, or relationship with us may be changing.

At the same time, anticipatory grief can begin to emerge. We may find ourselves grieving what we know we are gradually losing while also trying to adjust to what is happening today. The questions of Why is this happening? How did we get here? What happens next? can feel overwhelming.

Alzheimer’s can rob us of memories—those precious moments neatly tucked away in our minds. Tasks that once came naturally and required little thought can suddenly become difficult or impossible. And, perhaps most painfully, a person may eventually lose the ability to recognize the people they love most.

There may also be significant changes in personality or behaviour. Someone who was once gentle and even-tempered may become irritable or angry. A person who was always socially aware may lose some of their inhibitions or say things they would never have said before. These changes can be confusing and painful for everyone involved.

In this first blog about Alzheimer’s disease, I want to look at some of the risk factors and common symptoms. In a future blog, I will explore diagnosis, treatment, prevention, and preserved skills in greater detail.

What Is Alzheimer’s Disease?

Alzheimer’s disease falls under the broader umbrella of dementia, a term used to describe a decline in cognitive abilities that is significant enough to interfere with everyday life.

Alzheimer’s causes changes in the brain that can affect memory, thinking, learning, language, problem-solving, and behaviour. Although memory loss is often the symptom we notice first, Alzheimer’s can affect many different areas of a person's life.

It is important to remember that dementia is not simply a normal part of aging. While some changes in memory and processing speed can occur as we get older, Alzheimer’s disease involves a more significant decline that interferes with daily functioning.

Early-Onset and Late-Onset Alzheimer’s

There are two general categories of Alzheimer’s disease: early-onset and late-onset Alzheimer’s.

Early-onset Alzheimer’s occurs before the age of 65 and is much less common. It can affect people as early as their 30s, although this is rare. Most people diagnosed with Alzheimer’s are over the age of 65.

As our population ages, we are likely to see more people living with Alzheimer’s disease. This is not necessarily because Alzheimer’s itself is becoming more common, but because the number of people living into older age is increasing.

For many people, receiving an Alzheimer’s diagnosis during what they expected to be their “golden years” can be incredibly difficult. Instead of looking forward to retirement, travel, grandchildren, or simply enjoying life at a slower pace, they may suddenly find themselves facing an uncertain future.

What Causes Alzheimer’s Disease?

One of the questions I hear most often is, “Why them?”

We know that Alzheimer’s disease is associated with changes and damage to nerve cells in the brain. Over time, these changes can affect how the brain functions and can lead to brain shrinkage and inflammation. Importantly, these changes may begin many years before noticeable symptoms appear.

Researchers have learned a great deal about the biological and biochemical changes associated with Alzheimer’s, but there is still much we do not know.

There appear to be several factors involved, including genetics, lifestyle, environmental influences, cardiovascular health, and aging. However, there is no single explanation for why one person develops Alzheimer’s while another does not.

Factors That May Increase the Risk

There are several factors that may be associated with an increased risk of Alzheimer’s disease and other forms of dementia.

Family history and genetics: Having a close family member with Alzheimer’s may increase your risk, although it certainly does not mean that you will develop the disease.

Heart health: Conditions such as high blood pressure, heart disease, and other cardiovascular concerns can also be associated with cognitive decline.

Social connection: Staying socially connected and engaged appears to be important for overall brain health. Social isolation and loneliness can have a significant impact on older adults.

Depression and mental health: Depression and other mental health concerns can sometimes affect memory and thinking and may be associated with an increased risk of cognitive decline.

Brain injury: Certain types of traumatic brain injury may also increase the risk of developing dementia.

Alcohol use: While it is not accurate to say that alcohol directly causes Alzheimer’s in every individual, heavier alcohol consumption is associated with cognitive decline and an increased risk of dementia.

Smoking: Smoking is another factor associated with cognitive decline. Quitting smoking can help reduce a number of health risks, including risks related to brain and cardiovascular health.

Recognizing the Symptoms of Alzheimer’s Disease

One of the most recognizable symptoms of Alzheimer’s disease is memory loss. But this is more than occasionally misplacing your keys or forgetting someone's name.

As we discussed in my earlier blog about normal aging and memory, occasional forgetfulness can be a normal part of getting older. With Alzheimer’s, however, memory problems become more persistent and begin to interfere with everyday life.

You may notice:

• Repeating the same questions or stories
• Forgetting conversations or recent events
• Becoming lost or confused in familiar places
• Having increasing difficulty finding words
• Changes in language and communication
• Difficulty paying bills or managing finances
• Struggling with tasks that were once completed easily
• Increasing difficulty solving everyday problems
• Making decisions that seem unusual or out of character
• Difficulty knowing what is appropriate to wear for the weather or a particular situation

Sometimes these changes are subtle at first. Family members may notice them before the individual does.

Changes in Personality and Behaviour

Perhaps some of the most difficult changes to witness are changes in personality, mood, and behaviour.

Someone who has rarely experienced depression may suddenly appear withdrawn or lose interest in activities they once enjoyed. They may struggle to continue hobbies that were once an important part of their life.

You may also notice:

• Mood swings
• Irritability or anger
• Increased suspicion or mistrust
• Becoming unusually cautious or guarded
• Loss of social inhibitions
• Changes in motivation
• Anxiety or fearfulness
• Behaviour that seems out of character

For family members and caregivers, these changes can be particularly difficult to understand. You may find yourself wondering, “Why are they acting this way? They have never been like this before.”

It is important to remember that these behaviours may be part of the disease process. The person you love has not necessarily chosen to behave differently, even though the changes can still be incredibly difficult to experience.

The Emotional Impact of Alzheimer’s

Alzheimer’s disease is not only about memory loss. It is about loss, change, uncertainty, and adjustment.

For the person living with Alzheimer’s, there may be an increasing awareness that things are changing. For family members and caregivers, there may be grief for the relationship they once had, even while their loved one is still physically present.

This is where the concept of ambiguous loss can be particularly helpful. You may be grieving the gradual loss of abilities, memories, independence, or aspects of the person you once knew. At the same time, you are still loving, caring for, and spending time with that person.

Anticipatory grief can walk alongside this experience as you begin to think about what may be lost in the future.

There are no easy answers to these losses. And there is no “right” way to feel.

Continuing the Conversation About Alzheimer’s

Alzheimer’s disease can bring tremendous uncertainty for individuals, families, and caregivers. Understanding the symptoms and recognizing when changes may be more than normal aging is an important first step.

In my next blog on Alzheimer’s disease, I will look more closely at diagnosis, treatment, prevention, and preserved skills. I will also explore some of the ways we can continue to connect with and support someone living with Alzheimer’s, even as their abilities change.

If you are caring for someone with Alzheimer’s or another form of dementia, remember that your experience matters too. Caregiving can bring exhaustion, frustration, sadness, love, guilt, and grief—all at the same time. You do not have to navigate those emotions alone.