The early signs of Dementia: 'I thought my nan was grieving, but it was Alzheimer's'

People with early Alzheimer's disease, the most common type of dementia, have difficulty turning when walking, new research suggests.

This unique insight has led Liz Clifton, Calm Coach and Mentor, 43, living in South Wales, to share the early signs of the disease she didn't recognise in her late grandmother, which she put down to old age, normal forgetfulness, and the grief and stress of losing her husband, Liz's grandfather.

In the new small study, University College London (UCL) experts used virtual reality to help examine navigational errors among people with the first signs of the disease, with the hope of developing simple tests for the condition.

They compared 31 healthy younger people with 36 healthy elderly people and 43 patients with mild cognitive impairment. All three groups were asked to complete a task while wearing virtual reality goggles, allowing them to make real movements.

Participants walked along a route guided by numbered cones, consisting of two straight walks connected by a turn. They then had to return to their starting point, guided by just memory. This was performed repeatedly under three different conditions.

The study, published in Current Biology, found that people with early Alzheimer’s consistently overestimated the turns on the route and had a greater variability in their sense of direction.

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Author, Dr Andrea Castegnaro, from the UCL Institute of Cognitive Neuroscience, acknowledged there is already evidence that problems with navigation is an important early sign of Alzheimer’s disease.

"What we added here is that there are specific aspects in the navigation in Alzheimer’s that are particularly disrupted,” the expert told the PA news agency. "In particular, we found out that individuals with early Alzheimer’s consistently overestimated the turns on the given route and showed increased variability in their sense of direction.

"In other words, it seems that when you ask (people with mild cognitive impairment) with Alzheimer’s to turn a certain amount, they think they have turned much more than they actually did.

"More importantly, by including healthy elderly in the study, we also found that these specific aspects are not an extension of healthy ageing (for which we also know navigation ability declines), and they seem rather specific to Alzheimer’s disease."

Dr Castegnaro pointed out that these are early findings the team are working to confirm, but added, "Our findings offer a new avenue for the early diagnosis of Alzheimer’s disease by focusing on specific navigational errors."

'I thought it was due to my grandad's passing, but my grandma was actually showing signs of Dementia'

Early signs of dementia – a syndrome associated with an ongoing decline of brain functioning, of which there are many different causes, and many different types – can be difficult to recognise, often appearing as just signs of old age.

Liz didn't realise that some of her late grandmother's behaviours were early signs of dementia (Alzheimer's, in her case), she shares with Yahoo Life UK. "Initial signs included her forgetting what she was saying and we just put this down to her having a poor memory as she'd always said she had. It could be small things such as going to the kitchen to make a cup of tea only to return with nothing," Liz recalls.

"She would sometimes put the water in the kettle but forget to turn it on and then pour a cold cup of tea.

"There were also occasions when she would wander off and my uncle would get back home and the house would be empty. For the time until she went to live in a care home, he had to stick little notes near the door to remind her not to open it.

"After my grandad passed away in 2005 her talking to herself progressed to another level as did her love of background noise. Throughout my life, they'd always kept a blue budgerigar and its name was always Bertie. Whenever one passed away they got a new one and they'd pretend it was the same bird."

Liz now realises that her grandfather was doing this for her grandmother, as her memory was already affected, with her then going on in later years to forget who Liz and her daughters were at times, or confuse them.

During visits to her care come (before they closed during the pandemic), Liz says her grandmother was still able to sing beautifully and remembered many hymns from her childhood. "Early signs here [she now realises] were her occasionally choosing to sing rather than speak her replies or getting distracted and start singing in the middle of a conversation."

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As well as putting early signs down to forgetfulness, Liz adds, "Initially we thought it was because my grandad passed away which obviously caused her a lot of stress and disruption. However, it didn't seem to get better and instead continued to silently progress.

"The progression was quite slow to start with so it wasn't until she started wandering off that we noticed how far things had really progressed. Until then her change in behaviour was generally considered to be her just naturally ageing."

Liz's grandmother, her beloved nanny, was in her mid-80s when she was diagnosed and passed away a little after her 89th birthday in 2020.

Dementia diagnosis

While it's understandable to mistake symptoms for ageing, the condition is not a natural part and can affect memory, thinking or language, and changes in mood, emotions, perception and behaviour. One in four people with dementia battle with symptoms for more than two years before they are diagnosed, previous Alzheimer’s Society research found.

The charity produced a checklist in collaboration with leading clinicians, including the Royal College of General Practitioners (RCGP), to help people identify its possible symptoms and get diagnosed.

The sheet – which can be printed and taken to the doctor to help both patients and clinicians have an easier diagnosis experience – includes a range of tick-box questions, with options for 'tick if affected by', 'tick if impacting daily life' and 'how long it's been happening'.

Signs one-five include forgetting things more frequently, losing track of date and time, not finding the right words, becoming withdrawn and less social, and finding it hard to complete familiar tasks.

Signs six-10 include putting things in unusual places, difficulty understanding what you see, trouble making informed careful decisions, regularly getting distracted and losing focus, and changes in mood and behaviour.

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"Asking the same question over and over again is not called getting old, it's called getting ill," says Kate Lee, CEO of Alzheimer’s Society.

"If you're worried for yourself or someone you love, take the first step – come to Alzheimer's Society for support."

Lee acknowledges getting a diagnosis can be daunting. "I know I was terrified when my mum got diagnosed. But it is worth it – over 9 in 10 people with dementia told us they benefited from getting a diagnosis – it gave them crucial access to treatment, care and support, and precious time to plan for the future," she says.

"With the pandemic causing diagnosis rates to plunge, it’s more important than ever to seek help. You don’t have to face dementia alone, we’re here to support everyone affected."

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While it can be normal for memory to be affected by stress, tiredness, certain illnesses and medicines, if you're becoming increasingly forgetful (particularly if you're over the age of 65) it's a good idea to talk to a GP about the early signs of dementia, the NHS advises.

Alzheimer’s Society urges anyone worried about themselves or someone they love to take the first step and contact the charity for support. Support and more information about a diagnosis is just a phone call or a click away. Visit alzheimers.org.uk/memoryloss or call 0333 150 3456.

See the checklist for possible dementia symptoms in full.

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