Lori Nisson, LCSW, on Recognizing Early Signs of Alzheimer's Disease

Lori Nisson, LCSW

Credit: Banner Alzheimer's Institute

The early signs of Alzheimer’s disease include short-term memory loss, planning difficulties and social withdrawal, which families often overlook or attribute to normal aging. In an interview with The Educated Patient, Lori Nisson, LCSW, director of family and community services at Banner Alzheimer's Institute, emphasizes the importance of distinguishing between typical age-related memory changes and Alzheimer’s symptoms, noting that when memory loss interferes with daily life, it's time to seek medical advice.

Behavioral changes, like irritability and agitation, are common as the disease progresses and early detection is crucial for treatment options, lifestyle changes and planning for future care. She highlights the significant burden on caregivers and stresses the need for support, education, and self-care to navigate the long-term nature of Alzheimer’s disease.

What are the earliest signs and symptoms of Alzheimer's that families often overlook?

Lori Nisson, LCSW: Often, we talk about dementia, and Alzheimer’s is the most common type, so the terms are used interchangeably. While there are many types of dementia, the first signs we typically see include short-term memory loss. Families might dismiss this, thinking it's just a bad day, but it tends to build into a noticeable pattern. For example, the person may ask the same question repeatedly because they’re struggling to store new information. You may also see difficulties with planning, familiar tasks, orientation, navigation, or even visual-spatial challenges. Subtle signs like losing items or social withdrawal can appear first and gradually progress.

How can families distinguish between normal age-related memory loss and early Alzheimer's symptoms?

LN: That’s a great question. We all experience cognitive changes as we age, but when memory loss starts to interfere with daily life—whether it’s work, hobbies, or family engagements—that’s when it becomes a concern. It’s important to recognize patterns of behavior and consult a healthcare provider for an evaluation.

Can you explain more about behavioral changes that might signal the onset of Alzheimer's?

LN: In the early stages, mood changes like irritability or depression are common, especially if the person is aware of their memory loss and feeling frustrated. As the disease progresses into moderate stages, you’ll often see more noticeable behavioral changes, such as agitation, anger or even belligerence. This usually happens as the person has more difficulty communicating their thoughts and needs, and they may express this frustration through their behavior.

At what point should someone seek medical advice if they notice potential symptoms?

LN: If you or your loved one notices memory changes, reaching out to a trusted primary care provider is a good place to start. Sometimes the person may not be aware of their memory issues due to how Alzheimer’s affects the frontal lobe, which impacts awareness, judgment and insight. As a care partner, it can be helpful to jot down observations and share those with the physician or nurse beforehand to prompt a more thorough evaluation.

How can families approach a loved one if they suspect early signs of Alzheimer's?

LN: Open communication is key, and if the person isn’t ready to talk, it may take multiple conversations. Sometimes it helps to suggest a cognitive evaluation as part of routine health checks. For instance, couples might say, "We’re both getting older, let’s get a cognitive evaluation together," which can make the process feel less daunting.

What role does early detection play in managing Alzheimer's?

LN: Early detection is crucial for several reasons. First, there are brain-healthy lifestyle changes that can delay onset or slow progression. Second, it allows time for putting health directives and other affairs in order. And finally, there are new therapeutics available for mild cognitive impairment, so catching it early provides the opportunity to explore treatment or research options to enhance well-being.

Are there any resources or support systems that are particularly helpful for caregivers?

LN: Absolutely. Alzheimer’s is often called a "family disease" because it impacts both the individual and their loved ones. At Banner Alzheimer’s Institute, we offer many resources for families, and nationally, the Alzheimer’s Association provides support through local chapters and a helpline. Caregiver education is key to understanding the disease, preparing for future changes and managing the journey. Support groups and community resources, such as in-home care or activity programs, can also be incredibly helpful. Caregivers are at higher risk for emotional stress and physical illness, so taking care of themselves is just as important.

Is there anything else you’d like our audience of patients and caregivers to know?

LN: I think it’s important to balance daily management with future planning. People with dementia often need rest periods, as their brain works harder to do simple tasks. Reducing noise and distractions can help with concentration, and maintaining a predictable routine can be beneficial. As a caregiver, don’t neglect your own well-being. Caregivers of people with dementia face much higher rates of stress, and some even develop health issues themselves. Seeking support, whether through education, counseling, or respite care, is essential. Planning ahead for future care needs—such as hands-on care or behavioral management—can make the journey easier for everyone involved.

This transcript was edited for clarity.