The Early Stage
Early stage Alzheimer’s disease first affects memory, language, and reasoning. This stage of the disease is often quite insidious since there are still enough functioning neurons in the brain to compensate for the cellular losses that are beginning to take place. The disease is characterized by a decrease in many of the neurotransmitters that help regulate mood (serotonin), our sense of being grounded and connected to reality (dopamine), and the transmission of messages associated with memory formation and retention (acetylcholine). The Early Stage is typically marked by one of the following symptoms: short term memory loss, changes in mood, changes in personality, loss of initiative, depression, isolation, inability to learn new things, disorientation, difficulty with word finding, confusion, problems with abstract thinking, confabulation, poor judgment, altered sense of time, or visual spatial disturbances.
Most individuals are still capable of living alone with minimal supervision and are able to functionally manage their activities of daily living (ADLs). It is not uncommon for someone to consider the changes associated with early stage Alzheimer’s disease to be normal age-related problems. However, most individuals do not seek a medical diagnosis until they are well into the early stage of the disease unless prompted by a family member or if there have been mood changes and concerns about depression.
Usually a primary care physician (PCP) or a neurologist makes the initial diagnosis based on findings from memory testing, a mini-mental status exam, the results from neuro-imaging, and any behavioral information reported by the patient or family. If the patient is diagnosed with DAT (Dementia of the Alzheimer Type), the doctor will typically prescribe a cholinesterase inhibitor such as Aricept, Exelon, or Razadyne in the hope of improving the “memory signal” damaged by the decrease of the production of the neurotransmitter acetylcholine. If the individual is also experiencing changes in mood, an antidepressant might also be prescribed to help compensate for the decreased production of serotonin.
Some of the side effects of cholinesterase inhibitors are nausea, vomiting, and diarrhea. These may resolve in a few weeks, which is why the medication dosage is slowly increased to a therapeutic dosage. If the symptoms do not resolve, or if no significant improvement is seen in 6-12 months of drug therapy, the doctor may switch to a different cholinesterase inhibitor or discontinue the medication. Each person responds differently to drug therapy. If one cholinesterase drug fails to elicit a response, another may prove effective. Individuals are usually asked to follow up yearly on any testing and neuro-imaging for the sake of comparison to monitor the disease progression.