Understanding Fluctuating Alzheimer's Symptoms

Alzheimer's disease is known as a progressive condition, but that doesn't mean it looks the same every day. Symptoms can shift in ways that seem to go up and down over time. Many families — including mine, through my grandma's experience — have noticed this pattern of "good days and bad days" firsthand.

Surprisingly, these daily variations haven't been well covered on most of the websites many of us turn to right after a loved one's diagnosis. In fact, some researchers themselves have pointed out that this area hasn't received enough attention in Alzheimer's research either.¹

What do cognitive fluctuations look like in Alzheimer's?

Cognitive changes and symptom fluctuations are not unknown in Alzheimer's disease. However, this topic has been studied more closely in other forms of dementia — particularly Lewy body dementia, where shifting cognition is considered a defining feature.²

I came across one study with the fitting title "Good days and bad days in dementia." The researchers aimed to describe how symptoms fluctuate in people with Alzheimer's disease and mixed dementia.¹ They reviewed medical charts of 52 women with mild dementia — most with Alzheimer's disease — ranging in age from 39 to 91, all living in the community.

"Good days" and "bad days" were used to track and report changes in Alzheimer's symptoms.
The study found that good days were typically marked by better overall thinking, daily functioning, interest in activities, and motivation. Bad days, on the other hand, tended to involve more repeated questions, poor memory, increased agitation, and other difficult behaviors.¹

How do these daily variations affect caregivers?

Does that sound familiar? It certainly does to me.

Of course, because this was a qualitative review, it doesn't tell us what actually causes these good and bad days. Still, the researchers noted that understanding the reasons behind these daily variations could help improve the quality of life for both patients and caregivers.¹

What causes these changes in cognitive function?

That's the big question, isn't it? If we could identify the cause, we might be able to help make things a bit more stable and predictable. My first instinct was that many of the same factors affecting anyone's mood on a given day — getting enough sleep, enjoying good weather, doing something meaningful — likely apply to people with Alzheimer's disease too.

An international study backed up that idea. Dr. Rosa Sancho, Head of Research at Alzheimer's Research UK, noted that sleep quality and mood can affect how well someone thinks, regardless of whether they have dementia.

The same study also found that seasons may play a role. Older adults who were tested on memory and thinking skills in summer and fall tended to score better than those tested in winter and spring.³

Researchers also found seasonal shifts in Alzheimer's disease biomarkers in participants' spinal fluid.³

This goes well beyond simple observation, but there is still much to learn. It does bring us closer to understanding how weather, light, and many other factors may contribute to daily variations in Alzheimer's symptoms.

How can we help reduce cognitive changes day to day?

It may go without saying, but I believe that at least some of the symptom shifts we see in people with Alzheimer's disease are intensified versions of the mood and day-to-day changes we all experience. These changes can simply be harder to manage with Alzheimer's disease.

For people with milder Alzheimer's disease who are still living on their own, it's worth remembering that keeping up with medications can also affect these fluctuations. This is especially true for medications that manage mood or psychosis — but physical health medications matter too. This is one area where home healthcare, family, or friends can offer meaningful support.

It will be interesting to watch how research in this area develops. Better understanding of what drives cognitive changes and daily variations in Alzheimer's symptoms could one day help people living with the disease — and those who care for them — enjoy a better quality of life.