On the left, an elderly woman sits in a chair with a blanket over her, looking serenely out a window showing a calm daylight scene. On the right, in the same room the window now shows rain and the woman is standing with the blanket in her hand, looking agitated.

Balancing the Good and Bad Days: Changes in Alzheimer's Symptoms

Last updated: September 2023

Alzheimer's disease is known as a progressive disease, but that doesn't mean there aren't changes on a daily basis that might seem to fluctuate. We have noticed the phenomenon of "good days and bad" in our family's experience with my grandma's symptoms.

Though they haven't been documented nearly enough in those web pages that nearly all of us read early on after a family member's diagnosis! In fact, it seems to be under-considered even in the research about Alzheimer's disease, per some investigators themselves!1

Fluctuating cognition

Cognitive and symptomatic fluctuations are in no way unrecognized when it comes Alzheimer's disease. However, this has been considerably more investigated in other forms of dementia, namely Lewy body dementia, of which "[f]luctuating cognition (FC) is a core feature of dementia with Lewy bodies."2

I found one study article aptly titled, "Good days and bad days in dementia". The authors "aimed to characterize symptom fluctuation in patients with Alzheimer's disease and mixed dementia."1 The authors found in reviewing medical charts of 52 women with mild dementia, typically Alzheimer's disease, aged 39 to 91 living in the community. "Good days" and "bad days" were used as measures of reporting symptoms or symptom fluctuations.

The study notes stated, "Good days were typically associated with improved global cognition, function, interest, and initiation. Bad days were associated with frequent verbal repetition, poor memory, increased agitation, and other disruptive behaviors."1

Changes in Alzheimer's symptoms

Does that sound familiar to you? Because it does to me!

Of course, being a qualitative review, this doesn't help us understand what causes these good and bad days. However, it notes that understanding the causes of these fluctuations may help improve the quality of life for patients and caregivers.1

What causes these changes?

Well, that is the golden question, isn't it? After all, if we know what the cause is, we might be able to help keep things a bit more stable or predictable. My initial hunch was, just like all of us, various different aspects promote good days or bad days. After all, if you slept well, the sun was shining, and you got to do something you enjoyed, you're probably more likely to have a good day, with or without Alzheimer's disease.

An international study confirmed my suspicions. Alzheimer's Research UK Head of Research, Dr. Rosa Sancho, stated that sleep quality and mood can affect cognitive performance whether or not someone has dementia.

That same study also suggests that seasons may also play a role. Older adults who were assessed for memory and cognitive skills in the summer and fall tended to have better scores than those assessed in winter and spring.3

The statement continues to note that researchers found relevant fluctuations in biomarkers of Alzheimer's disease in participants' spinal fluid depending on the season.3

This is by far more than simply observational evidence but still leaves much to be learned about how seasonality and a myriad of other things affect Alzheimer's symptoms. It also gets us a bit closer to understanding how weather, light, and other considerations may play a role in fluctuating Alzheimer's symptoms.

Thoughts on fluctuating Alzheimer's symptoms

It may go without saying, but I think at least some of the fluctuations we see in symptoms of people with Alzheimer's disease may be amplifications of the mood or day-to-day changes we all experience, that may be more challenging with Alzheimer's disease.

For people with milder Alzheimer's disease who are managing independently in the community, it is important to remember that a person's ability to consistently take medications may play into these fluctuations, too, especially those used to manage psychosis or stabilize mood, but also those for physical health conditions—this is certainly one area where support can be provided by both home healthcare or family and friends.

It will be interesting to see future research in this area, especially if it can help people with Alzheimer's disease and their caregivers mitigate mood and cognitive fluctuations and improve quality of life!

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