Cognitive Issues in Alzheimer’s

Reviewed by: HU Medical Review Board | Last reviewed: May 2023

Problems with cognition (thinking) are one of the most well-known symptoms of Alzheimer’s disease. Trouble remembering things and people can be one of the first symptoms caregivers notice in their loved ones. Mild cognitive difficulties are common with aging. But cognitive difficulties that affect the ability to perform daily tasks are not.1,2

Problems with cognition are common across all stages of Alzheimer’s. Symptoms can vary from person to person. For example, one person may experience issues with language. Another may have more difficulty not getting lost.2

Knowing the different types of cognitive issues in Alzheimer’s can help you notice them in your loved one. And there are steps available to potentially help slow cognitive decline.3

Memory issues and confusion

Issues with memory can look different person to person. Even the same person will show different memory problems depending on the stage of Alzheimer’s they are in.

In earlier stages, people with Alzheimer’s typically have trouble remembering new and recent information (short-term memory). They may remember a familiar path to work, but not the name of someone they just met, for example. As Alzheimer’s progresses, longer-term memories may become affected. For example, the person with Alzheimer's may forget their phone number or home address.1,2

Someone with Alzheimer’s may also become confused, especially in new or overwhelming environments. They may not know where they are or what day it is. This may cause them to wander and become lost. This is most likely in the middle stage of Alzheimer’s.1

Language issues and communication difficulties

Problems with language and communication can stem from issues with memory. Forgetting someone's name or identity can cause uncertainty in communication. But there are also language and communication problems that are separate from memory.1

Someone in the later stages of Alzheimer’s may have a hard time communicating. They may not be able to start a conversation or connect with you as much. But people who have difficulty communicating can still benefit from things like listening to relaxing music or watching a movie. These things can provide reassurance even if there is no verbal communication.1

Poor decision-making or planning

People with Alzheimer’s may struggle with planning, organization, and decision-making. These skills are also called “executive functioning.” As with many Alzheimer’s symptoms, executive functioning may get worse as the disease progresses. The person with Alzheimer's may:1,4

  • Have difficulty thinking logically
  • Struggle to organize tasks
  • Act impulsively
  • Take financial risks they cannot afford

Planning and decision-making skills can worsen as time goes on. That is why the early stage is a good time to make long-term plans. Early in Alzheimer’s, someone can still have input into their legal, financial, and end-of-life plans. They can determine what type of care and treatment they would want at all different disease stages.1

Hallucinations or delusions

Hallucinations are incorrect ways of experiencing the world around you. Hallucinations involve the senses such as vision or hearing. Hallucinations may be ordinary visions of people, situations, or objects, or they may be frightening. Hallucinations usually happen when people are in the later Alzheimer’s stages.5

Someone with Alzheimer’s may act suspicious or have delusions. Delusions are similar to hallucinations but do not involve the senses. A delusion is a firmly held belief not based in reality. For example, you might believe people are trying to harm you. If you notice signs of hallucinations or delusions, talk to your doctor about the best path forward.1

When to talk to a doctor

Talk to a doctor if you start to notice the symptoms of cognitive decline in yourself or someone you are close to. Even in early stages, doctors are able to identify symptoms of Alzheimer’s with diagnostic tools. And early diagnosis is critical for long-term:1

The US Food and Drug Administration (FDA) has approved the drug lecanemab to slow cognitive decline in Alzheimer’s. Other treatments include cholinesterase inhibitors and memantine. There are also coping strategies available for the person with Alzheimer's and caregivers. These strategies can help keep everyone safe, happy, and comfortable during all stages of life. Talk to your doctor about the best care for you.3,6

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