Alzheimer: The First 5 Signs Families Overlook — and What to Do When You Notice Them

Alzheimer: the first 5 signs families overlook — and what to do when you notice them

„We thought it was tiredness. Or old age. Or that she was simply becoming a bit forgetful." This is the most common thing doctors hear from the families of Alzheimer's patients diagnosed at advanced stages. The signs were there months, sometimes years, before. Nobody had recognised them.

Estimated reading time: 10 minutes · Sources: INSP, Societatea Română Alzheimer, WHO

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Why Alzheimer's is the disease Romania ignores until it is too late

Romania faces a difficult and rarely discussed reality: 80% of Alzheimer's patients in this country remain undiagnosed, according to the Societatea Română Alzheimer. Not because doctors are unavailable, not because tests do not exist — but because families, and sometimes patients themselves, fail to recognise the early signs of the disease or mistakenly attribute them to the normal ageing process.

The figures are alarming. In 2024, GPs in Romania reported 11,286 new cases of Alzheimer's — almost double the 6,299 cases reported in 2014 (source: Institutul Național de Sănătate Publică). Specialists warn that the true number is far higher, as most cases are either unreported or diagnosed at advanced stages, when therapeutic interventions are considerably less effective.

According to estimates from the Institute for Health Metrics and Evaluation, Romania will reach 577,177 dementia cases by 2050 — up from 341,195 in 2019. An increase of nearly 70% in three decades. A public health crisis that almost nobody is talking about.

Alzheimer's disease accounts for 60–70% of all dementia cases and is, according to the World Health Organisation, the seventh leading cause of death worldwide. Pathological changes in the brain begin 15 to 20 years before the first symptoms become visible — meaning the window for early intervention is far wider than most families realise.

This is precisely why knowing the early signs of Alzheimer's disease is not an academic exercise. It is, quite literally, the difference between years of quality life and a rapid, uncontrolled decline.

„An early diagnosis and early treatment do not cure Alzheimer's disease, but they can significantly delay the point at which patients require institutional care and can improve long-term quality of life."

— Prof. Bogdan O. Popescu, President of the Societatea de Neurologie din România

Sign 1: Forgetfulness that does not pass — and how to distinguish it from normal forgetting

Everyone forgets things occasionally. We forget where we put the keys, forget a name, forget to call someone. This is normal forgetfulness, associated with ageing or tiredness, and we usually remember later.

The forgetfulness characteristic of Alzheimer's is fundamentally different: newly acquired information is not stored at all. The person does not remember later — there is simply nothing to recall. They ask the same question ten times in one day. They cannot remember having eaten an hour ago. They forget receiving a phone call, a visit, an important piece of news.

What this looks like in real life:

→ Mum asks every morning what time her daughter is coming, even though she was told the day before

→ Dad cannot remember having eaten lunch and insists he has not had anything to eat

→ Grandma tells the same story from her youth three times in the same conversation, without realising she has already told it

→ The person forgets significant recent events — an anniversary, a holiday, an operation

The golden rule: if forgetfulness is affecting daily functioning and is progressively worsening over the course of several months, it is not „normal old age". It is a signal that requires medical assessment.

Sign 2: Difficulty carrying out familiar tasks and planning

Another early sign of Alzheimer's, often overlooked, is difficulty doing things the person has managed effortlessly throughout their life. Cooking, driving on familiar routes, handling personal finances, filling in a simple form — activities that were once automatic suddenly become complicated, confusing, impossible.

A brain affected by Alzheimer's gradually loses the ability to carry out sequences of actions. A recipe cooked for 40 years becomes incomprehensible. The next step in a routine action is forgotten before it can be performed.

Specific examples to watch for:

→ Difficulty managing a budget or paying bills, despite having handled finances independently throughout their life

→ Getting lost while driving on familiar routes or forgetting the rules of the road

→ Difficulty following simple steps: making coffee, starting the washing machine, using the telephone

→ No longer able to play games they knew well (rummy, chess, backgammon)

„My grandmother had been making bean soup her whole life. One day I found her in the kitchen, crying in front of the pot, because she no longer knew what to do next. That was when I understood something was wrong."

— Family member's account, published on the Societatea Română Alzheimer forum

Sign 3: Disorientation in time and space

People with early-stage Alzheimer's begin to lose their sense of time and place in ways that confuse and frighten them. They may know their grandchildren's birthdays but not know what month it is. They may recognise the home they have lived in for 30 years but be unable to find their way back if they have walked a few streets away.

Temporal disorientation manifests as confusion about seasons, years, and decades — an 80-year-old may believe they are 40 and that their children are still small. Spatial disorientation, more alarming for families, includes episodes of wandering: the person goes to the market or out for a walk and cannot find their way home.

Signs of disorientation to watch for:

→ Does not know what day, month, or year it is, despite previously being a very organised person

→ Confuses seasons and dresses inappropriately (a winter coat in summer, a light jacket in winter)

→ Gets lost in the neighbourhood where they have lived for decades

→ Wakes during the night convinced they must „go to work" or „pick the children up from school"

→ Does not recognise familiar people or confuses them with others (children with parents, a husband with another man)

Episodes of disorientation pose a major safety risk: domestic accidents, wandering, falls, and incorrect medication use. This is often the point at which families realise that home care has become dangerous and that a specialist setting is needed — such as the specialist medical care for seniors provided by Centrul Maria Theresia in Sibiu, where round-the-clock supervision and a secured environment are part of the standard protocol.

Sign 4: Changes in personality, mood, and behaviour

This is the sign families overlook most often — or attribute incorrectly to external factors: „she's upset with us", „she's stressed", „she's depressed about getting older". But personality and behaviour changes in Alzheimer's are not reactions to external circumstances. They are direct neurological symptoms, caused by the deterioration of specific regions of the brain.

A person who has been calm and patient throughout their life may suddenly become irritable, aggressive, suspicious, or anxious for no apparent reason. A sociable, active person may become withdrawn, apathetic, and disinterested in activities they once enjoyed. The changes are all the more confusing because the person may seem perfectly normal at certain times of day and entirely different at others.

Behavioural changes characteristic of Alzheimer's:

→ Unwarranted suspicion towards family members or carers („you've stolen my money", „you want to get rid of me")

→ Marked anxiety and agitation, especially in the evening (the „sundowning" phenomenon — a worsening of symptoms at sunset)

→ Depression, apathy, loss of interest in previously enjoyed activities