Early Stage Symptom: Poor Decision-Making

Reviewed by: HU Medical Review Board | Last reviewed: June 2019 | Last updated: January 2023

In the early stages of Alzheimer’s, a person may experience a variety of symptoms that seem like normal aging at first – but as the symptoms increase in severity or frequency, it may become clear that this is more than just “normal aging.”

Lapses in judgment

One of these symptoms is poor or decreased judgment and trouble with decision-making. This symptom can sometimes even precede any memory loss, so it might not be apparent that it’s a sign of Alzheimer’s disease. A person with Alzheimer’s disease might start giving money away or be conned by an email scam, or they might decide it’s not necessary to bathe or change clothes daily because they can’t decide what to wear.

As the disease progresses, these lapses in judgment and difficulties with decision-making get more pronounced. While many older individuals might make a bad decision once in a while, in those with Alzheimer’s disease, the poor judgment and difficulties with decision-making are more consistent and more severe as time goes on.

When to check-in with the doctor

Depending on how severe the symptoms are, someone might see their doctor at the urging of others or even be brought to the doctor by concerned friends or family.

Once an individual is at the doctor, a thorough medical exam should be done to rule out any other ailments that might be impairing judgment and decision-making. Other medical conditions that can impact cognition and judgment include stroke, brain tumor, adverse medication interactions or side effects, and pain.

Get a baseline cognitive evaluation with tests that evaluate executive functioning, in addition to a medical workup, to get a full picture as to what’s happening and where the person is at with cognition and functioning.1 Once an accurate diagnosis is made and the level of impairment is assessed, plans can be made to assist an individual in whatever way helps the most.

What does poor decision-making look like?

Impaired judgment and poor decision-making can take a variety of forms, including1,2:

  • Impaired problem-solving (a term often used interchangeably with judgment)
  • Wearing inappropriate clothes for the season
  • Lack of personal hygiene
  • Trouble with finances (ie, giving money to scammers, making rash investments or withdrawals, gambling, not balancing accounts)

Have safeguards in place so that financial, mental, and physical well-being are ensured if appropriate decisions cannot be made.

How is this treated?

There are medications used to help treat the cognitive symptoms of Alzheimer’s disease, especially those related to thinking, memory, language, and judgment. These medications do not slow down the progression of Alzheimer’s, nor are they a cure. However, they can minimize the symptoms and impairment for a time and provide people with Alzheimer's with more time to be independent, leading to a better quality of life.

Medications for early to moderate Alzheimer’s disease are the cholinesterase inhibitors, which work on a brain chemical called acetylcholine. These drugs include the brand name medications Aricept (this can be used in all stages of Alzheimer’s), Exelon, and Razadyne. 3 In moderate to severe Alzheimer’s, the drugs Namenda and Namzaric are options.3 Interested patients should talk with their doctor about medication options, especially if they’re taking other medications as well.

In addition to medication, there are things patients can do to help reduce any risk of harm to themselves. If they’re not confident with their finances, get a trusted financial advisor for the long-term, and a trusted family member for the day-to-day financial tasks. Especially as the disease progresses and medications are no longer effective, security and safety is paramount.

Tell us about your experience in the comments below, or share your story with the community.

By providing your email address, you are agreeing to our privacy policy.