Beyond Forgetting — The Subtle Signs Of Alzheimer’s You Might Miss
{By Dr Kersi Chavda}
When people think of Alzheimer’s disease, the immediate association is usually memory loss. That image, of a loved one forgetting names, faces, or daily routines, has been etched into the public imagination. But as someone who has spent years working in psychiatry, I can tell you that Alzheimer’s is not just about memory. In fact, long before the classic forgetfulness sets in, there are often subtle, deeply troubling shifts in personality, behaviour, and emotion—changes that families may notice but struggle to understand.
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Early Symptoms Of Alzheimer’s Beyond Memory Loss
Early signs of Alzheimer’s can include difficulties with planning, judgment, and decision-making. A person who was once meticulous with finances may begin to make errors. They might lose their way on familiar roads, or struggle with tasks they have done for years. These are not always recognised as red flags and are often dismissed as normal ageing or stress.
But what is often missed—and what can be even more distressing for those around the patient—are the emotional and behavioural changes. Individuals may become unusually irritable, withdrawn, or apathetic. Some develop subtle personality changes: they may lose empathy, behave in socially inappropriate ways, or become suspicious and paranoid. These changes are not simply “coping reactions” to forgetfulness. They are rooted in the neurological degeneration occurring in parts of the brain that regulate emotion and behaviour, especially the frontal and temporal lobes.
Why Timely Diagnosis Of Alzheimer’s Is Often Delayed
Delusions and hallucinations can also appear, and patients might accuse others of stealing from them or conspiring against them. Sleep disturbances, including night-time restlessness and confusion (known as “sundowning”), are common. At times, illness can look like a primary psychiatric condition—depression, late-onset psychosis, or even a frontotemporal dementia. This overlap makes diagnosis especially challenging in the early stages, and underscores the need for thorough clinical assessment, imaging, and sometimes biomarkers.
One of the most complicated aspects is anosognosia—a lack of awareness of one’s own illness. A person with Alzheimer’s may insist there is nothing wrong and may even react angrily to attempts to help. This makes management difficult and is often frustrating and painful for caregivers.
And we cannot speak of Alzheimer’s without acknowledging the toll it takes on families. Watching someone you love slowly to change before your eyes—losing not just their memory, but their very essence—is an emotionally exhausting experience. Caregiver burnout, depression, and anxiety are common, and often go unaddressed.
Alzheimer’s is a neuropsychiatric disorder with far-reaching implications. It affects not just memory, but mood, insight, behaviour, and relationships. Treatment has to go beyond pills—it must involve structured environments, behavioural strategies, emotional support, and above all, compassion for both patient and caregiver.
We need to widen our understanding of Alzheimer’s. It is not just about forgetting, it is about slowly losing parts of the self. Recognising that complexity is the first step toward better care.
The author, Dr Kersi Chavda, is a Consultant, Psychiatry, at P. D. Hinduja Hospital & Medical Research Centre, Mahim.
[Disclaimer: The information provided in the article is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.]
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