Alzheimer's disease, symptoms, causes, stages and life expectancy
How to tell Alzheimer's from normal forgetfulness, what the first signs are, how the disease progresses and what treatment and support options are available in Romania today.
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What Alzheimer's disease is
Alzheimer's disease is a progressive neurodegenerative condition that mainly affects memory, thinking and behaviour. It is the most common cause of dementia in older people and is characterised by the build-up of beta-amyloid plaques and neurofibrillary tangles in the brain, which destroy neuronal connections and gradually lead to the death of nerve cells. Although the onset can be subtle, as it progresses the disease affects the person's independence, communication and everyday activities.
Alzheimer's is not a “normal” part of ageing, even though the risk increases with age. Besides genetic factors, environmental and lifestyle factors can also contribute. Although there is currently no curative treatment, there are therapies and interventions that can slow the progression of the symptoms and improve quality of life.
In short
- Alzheimer's is the most common cause of dementia, that is, of losing memory and independence. It is not a normal part of ageing.
- The first sign is usually forgetting recent things: the same questions, lost conversations, objects put in odd places.
- The risk rises sharply with age, and part of it comes down to factors you can influence: blood pressure, hearing, cholesterol, physical activity.
- How long people live depends mainly on their age at diagnosis: about 8 years when the disease is found at 65 and about three and a half years at 90.
- There is no cure yet. Medicines ease the symptoms, and since 2025 two new treatments slow the disease in its early stages.
Alzheimer's or dementia: what is the difference
Dementia is not one specific disease. It is the name for a decline in memory, thinking and independence large enough to get in the way of everyday life. It has several causes, and Alzheimer's is the most common of them: according to the World Health Organization, it lies behind 60–70% of cases. Most of the rest come from vascular disease, dementia with Lewy bodies or frontotemporal dementia, and many older people have two causes at once, a situation called mixed dementia. The difference has practical consequences, because treatment and the course of the illness are not the same.
Healthy brain vs. brain with Alzheimer's
The first signs of Alzheimer's and ordinary forgetfulness
Alzheimer's starts slowly, almost imperceptibly. The first signs are easily mistaken for tiredness or for “that's just how it is at this age”. The difference does not lie in the fact that you forget. It lies in what you forget and in how much it gets in your way. The table below follows the list of warning signs used by the Alzheimer's Association in the United States.
| Ordinary forgetfulness with age | A sign worth checking |
|---|---|
| You forget a name or an appointment and remember it later. | You forget things you learned recently and ask the same question several times a day. |
| You make the occasional mistake when paying a bill. | You can no longer follow a plan you used to know well: a recipe, the monthly budget, your pills. |
| You need help with a new setting on your phone. | You get muddled over things you have done for years, such as the way to a familiar place. |
| You forget what day it is and realise a little later. | You lose track of the days and the seasons, or no longer know how you got somewhere. |
| Sometimes you cannot find the right word. | You stop in the middle of a sentence, repeat ideas or call ordinary objects by the wrong name. |
| You misplace your glasses and retrace your steps to find them. | You put things in odd places, cannot retrace your steps and sometimes suspect that someone has taken them. |
| You make a bad decision now and then. | Your judgement weakens steadily, for example in the way you hand out money or look after yourself. |
| You sometimes feel worn out by social obligations. | You give up hobbies, get-togethers and things you used to enjoy. |
| You get annoyed when your routine is disrupted. | You become confused, suspicious or anxious, or take offence easily, especially in new places. |
There is one more sign that families rarely notice at first. It is difficulty judging distances, reading or telling colours apart, which often shows up behind the wheel. When the disease starts before the age of 65 it is called early onset, and in that case the first problems sometimes involve speech, vision or organisation rather than memory.
A single sign does not mean Alzheimer's. If, however, several of them are new, have lasted a few months and are adding up, it is worth talking to your GP, who can refer you on to a neurologist. Some causes of forgetfulness, such as a lack of vitamin B12, thyroid problems or certain medicines, can be treated.
The stages of Alzheimer's disease
- The preclinical stage - brain changes appear before the symptoms, but the person functions normally; these changes can be detected only through special investigations.
- Mild cognitive impairment (MCI) - the first difficulties with memory, attention and orientation appear, but the person can still go about daily life relatively normally.
- The early stage - memory problems become obvious, along with difficulty finding words, losing objects and disorientation in time and space.
- The moderate stage - short-term memory deteriorates significantly, confusion and personality changes appear, together with major difficulties in everyday activities (managing money, cooking, getting around).
- The severe stage - the person needs permanent care; swallowing difficulties, loss of mobility and the inability to recognise close relatives may appear.
Causes and risk factors for Alzheimer's
Alzheimer's disease is a complex neurodegenerative condition caused by the interaction of several biological, genetic and environmental factors. Although no single cause has yet been demonstrated, research shows that the development of the disease is influenced by a combination of factors.
1. Advanced age
The most important risk factor for Alzheimer's is getting older. After the age of 65 the risk rises significantly, and after 85 almost one third of people may show symptoms. The natural ageing process weakens neuronal resilience, increasing vulnerability to the disease.
2. Genetic predisposition
Certain genes, such as APOE-e4, increase the likelihood of developing Alzheimer's. Although they do not guarantee that the disease will appear, inheriting them significantly raises the risk. In addition, there are rare early-onset forms of Alzheimer's directly linked to specific genetic mutations.
3. Imbalances at brain level
Alzheimer's disease is associated with the build-up of beta-amyloid plaques and tau protein tangles in the brain, which impair communication between neurons and lead to cell death. These biological changes underlie the cognitive decline.
4. Vascular and metabolic factors
High blood pressure, diabetes, high cholesterol and obesity are major risk factors. They affect blood flow to the brain and favour degenerative processes, speeding up the destruction of nerve tissue.
5. Head injuries
Strong blows to the head or repeated accidents can increase the likelihood of developing Alzheimer's later in life. The link between brain trauma and the onset of neurodegenerative processes is increasingly supported by studies.
6. Lifestyle and environment
Smoking, a sedentary life, an unbalanced diet and the lack of cognitive stimulation increase the risk of the disease. Regular physical activity, a healthy diet and keeping the mind active, on the other hand, can have a protective effect.
7. Psychological and social factors
Social isolation, untreated depression and the lack of emotional connections can speed up cognitive decline. The brain needs stimulation and interaction in order to stay healthy.
Alzheimer's disease does not have a single cause; it is the result of a combination of genetic, biological and environmental factors. Although we cannot control every risk factor, a healthy lifestyle, the prevention of cardiovascular disease and a rich cognitive and social life can significantly reduce the likelihood of symptoms appearing.
The largest analysis on the subject, the 2024 report of the commission set up by The Lancet, counted 14 risk factors that we can influence. Across the course of life, they are: little education in childhood, hearing loss, high LDL cholesterol, depression, head injuries, physical inactivity, diabetes, smoking, high blood pressure, obesity, excessive alcohol, social isolation, air pollution and untreated vision loss. They do not all carry the same weight. The authors estimate that, in theory, almost 45% of dementia cases could be prevented or delayed if all of them were removed. The figure refers to dementia in general, not only Alzheimer's, and it is an estimate at population level, not a guarantee for any one person.
Alzheimer's symptoms
Alzheimer's sets in gradually and affects memory and thinking as well as behaviour and personality. Recognising the symptoms early is important both for the diagnosis and for managing the disease.
Cognitive symptoms
- Loss of recent memory - frequently forgetting conversations, repeating questions, losing objects.
- Difficulty planning and solving problems - simple tasks such as cooking or paying the bills become complicated.
- Disorientation in time and space - confusion about the day, the month or the place where the person is.
- Communication problems - difficulty finding the right words or repeating the same sentences.
- Reduced judgement - making inappropriate or risky decisions.
Physical and functional symptoms
- Difficulty carrying out daily activities (dressing, personal hygiene, cooking).
- Reduced coordination and spatial orientation.
- Sleep problems.
Personality and behaviour changes
One of the most painful manifestations of Alzheimer's disease is the change in the personality of the loved one. As the disease advances, the affected brain can no longer regulate emotions and reactions normally.
The following may be noticed:
- Irritability and anger with no apparent reason.
- Suspicion and paranoia (for example, they believe their belongings are being stolen, even though they have hidden them or forgotten about them).
- Anxiety and restlessness - sometimes shown through repeated pacing or the inability to sit still.
- Apathy and social withdrawal - losing interest in activities that used to be enjoyable.
- Unusual behaviours - from repeating words and gestures to aggressive behaviour or behaviour that does not fit the context.
Alzheimer's disease affects far more than memory - it transforms the way a person thinks, feels and relates to those around them. Understanding these symptoms, especially those related to personality and behaviour, is essential in order to offer patience, support and a suitable environment to those living with this disease.
The diagnosis of Alzheimer's disease
How the diagnosis of Alzheimer's is made
The diagnosis of Alzheimer's disease is not based on a single test, but on a complex assessment carried out by a neurologist or a geriatrician. The process usually starts with a detailed discussion about the patient's medical history, the symptoms observed and the behaviour changes reported by the family. It is essential to analyse how memory, language and orientation have been affected over time.
Cognitive and psychological assessment
The patient goes through standardised cognitive tests designed to assess memory, attention, problem-solving ability and language skills. Examples of such instruments are the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA). On their own they do not establish the diagnosis, but they help outline the level of cognitive impairment and differentiate it from other disorders.
Medical and imaging investigations
In order to rule out other possible causes of the symptoms (for example vitamin deficiencies, hormonal imbalances, thyroid conditions or neurological disorders), the doctor may recommend blood tests. A brain MRI or CT scan shows structural changes, such as shrinkage of the hippocampus, and rules out other causes, from a stroke to a tumour. In some cases a PET scan is also used, which shows how the brain uses glucose or where abnormal proteins have been deposited. The brain's electrical activity can be seen through an EEG or qEEG BrainMap assessment, which adds to the overall picture but does not on its own make the diagnosis of Alzheimer's.
The conclusion of the diagnosis
The diagnosis of Alzheimer's is based on a combination of clinical observations, cognitive test results and data from medical investigations. For a long time it was said that the disease could only be confirmed with certainty after death. That is no longer the case. Analysis of the cerebrospinal fluid and an amyloid PET scan show during life whether the changes specific to the disease are present, and since 2025 the Alzheimer's Association in the United States has also had a guideline for blood tests (those that measure p-tau217), used in memory clinics for people who already have symptoms. With these tools, specialists can establish the diagnosis and recommend treatments and interventions that slow the progression of the disease and improve the patient's quality of life.
Treatment options for Alzheimer's
Drug treatment
The medicines that have been used for many years do not stop the disease, but they can improve memory, attention and orientation for a while. In the mild and moderate stages, donepezil, rivastigmine or galantamine are usually given; they increase the amount of a chemical messenger that is important for memory. In the moderate and severe stages, memantine may be added or used on its own. The effect varies a great deal from one person to another, and the choice of medicine and the doses are decided by the neurologist or psychiatrist.
What is new in recent years are treatments that target the amyloid plaques themselves. In the European Union, lecanemab (April) and donanemab (September) were approved in 2025, only for the early stages, meaning mild cognitive impairment or mild dementia, with amyloid confirmed by tests, and only in people who have at most one copy of the ApoE4 gene. So they are not for everyone. They are given by infusion, slow the decline without stopping it and require repeated MRI scans, because they can cause swelling or small bleeds in the brain. Whether and where they are available in Romania, and on what terms, is a question to put directly to the neurologist.
Psychosocial interventions
Occupational therapy, cognitive activities and psychological support play an important role in managing the disease. Memory exercises, music therapy, art and other stimulating activities can reduce anxiety, improve mood and help maintain essential skills. In addition, the involvement of the family and of caregivers is essential, both for emotional support and for creating a safe and stable environment.
Lifestyle and secondary prevention
Adopting a balanced lifestyle can have a positive influence on the course of the disease. A brain-healthy diet, regular movement, keeping up social ties and activities that challenge the mind (reading, puzzles, conversations) all help delay cognitive decline. These simple habits can bring major benefits when they are combined with other forms of treatment.
Neurofeedback therapy
Neurofeedback is a modern, non-invasive treatment option based on training the brain through real-time feedback on its electrical activity. Through monitoring and regulation, the patient learns to stabilize their cognitive and emotional functions, which can reduce symptoms such as anxiety, confusion or the sleep disturbances associated with Alzheimer's disease.
A major advantage of neurofeedback is that it involves no medication and produces no pharmacological side effects, making it a safe method that is tailored to each individual. By stimulating the affected brain areas, the therapy supports neuronal plasticity and can bring a better quality of life, reducing the risk of overload and helping the patient cope better with the challenges of the disease.
How long people with Alzheimer's live
There is no single number. What matters most is the age at which the diagnosis is made. An American study that followed people diagnosed over time found a median survival of 8.3 years when the diagnosis comes at 65 and 3.4 years when it comes at 90. This is also where the often quoted figures come from, an average of 4 to 8 years, with some people living more than 20 years with the disease.
Alzheimer's shortens life mainly through what it brings in the late stages: swallowing deteriorates and the risk of pneumonia rises, mobility declines, and falls, infections and weight loss set in. So besides age, a great deal depends on the stage at which the disease was caught, the person's other illnesses and day-to-day care, from nutrition to preventing falls. This is where the family can do a lot.
Complications associated with Alzheimer's disease
1. Cognitive loss and marked confusion
As the disease progresses, people with Alzheimer's experience increasingly severe memory loss, difficulty concentrating and confusion about time and space. These symptoms affect not only personal life, but professional life as well, making it difficult to keep a job or to take part in everyday activities. How long people live after diagnosis depends mainly on age, as shown above, and the cognitive losses build up over that whole period.
2. Behaviour disturbances and personality changes
Patients may show irritability, anxiety, depression or apathy, as well as personality changes. These manifestations affect relationships with family and friends and can cause considerable emotional stress for those close to them. Behaviour disturbances can stand in the way of an independent lifestyle, and the constant support of caregivers becomes essential throughout the disease.
3. Mobility problems and accidents
As Alzheimer's advances, motor difficulties, loss of balance and loss of coordination appear. This increases the risk of falls and accidents, affecting daily safety both at home and in social settings. Physical complications can lead to frequent hospital admissions and a lower quality of life, contributing to a general frailty over the years of illness.
4. Sleep disturbances and chronic fatigue
Alzheimer's can cause insomnia, frequent awakenings and poor quality sleep. The lack of restful sleep increases tiredness, confusion and irritability, affecting both mental functioning and the ability to manage daily activities. These difficulties are felt both by the patient and by their family throughout the disease.
5. Loss of independence and social impact
As the symptoms progress, patients become increasingly dependent on caregivers for basic activities such as eating, hygiene or taking medication. This loss of autonomy affects social and professional life, limiting participation in the community or the ability to keep a job. The social impact is felt over the long term, as the disease advances towards its final stages.
6. Nutrition and physical health problems
Coordination difficulties, loss of appetite or inattention can lead to malnutrition, dehydration or weight loss. These physical complications increase the risk of associated illnesses and affect the patient's quality of life, reducing the length and the stability of their general state of health.
Can Alzheimer's be prevented?
There is no method that reliably prevents the disease. What we do know is that the risk of dementia falls when you keep the factors above under control. The tips below work on those factors and are good for the brain either way.
1. Keep up regular physical activity
Regular physical exercise increases blood flow to the brain and stimulates the formation of new neuronal connections, thereby protecting memory and cognitive functions. Even a daily 30-minute walk can help reduce the risk of cognitive decline.
Physical activity also helps control weight, lower blood pressure and improve cardiovascular health, factors that are linked to a lower risk of Alzheimer's. Keeping an active lifestyle brings both short-term and long-term benefits for brain health.
2. Adopt a healthy, low-sugar diet
Excessive consumption of sugar and processed foods can cause chronic inflammation and impairs cognitive function. Cutting down on sugar and choosing foods rich in antioxidants, fibre and healthy fats supports brain health.
A balanced diet with fruit, vegetables, fish and nuts helps maintain a healthy weight and protects neurons from damage. Avoiding excess sugar helps regulate blood sugar, thereby reducing the risk of long-term cognitive impairment.
3. Stimulate your brain with intellectual activities
Logic games, reading, learning a foreign language or taking up new hobbies stimulate neuronal connections and can delay cognitive decline. The brain, just like muscles, becomes more resilient if it is trained constantly.
Intellectual activities reduce the risk of Alzheimer's by building a cognitive reserve, which helps the brain compensate for neuronal losses. Constantly taking on mental challenges keeps the mind active and adaptable.
4. Keep your social ties active
Frequent social interaction and keeping close relationships reduce stress and improve emotional health. Socially involved people have a lower risk of cognitive decline and Alzheimer's.
Taking part in groups, volunteering or meeting friends stimulates the brain through communication, empathy and solving social problems. Healthy relationships contribute to general wellbeing and so protect cognitive functions.
5. Get enough sleep
Restful sleep is essential for consolidating memory and for clearing toxins from the brain, including the proteins associated with Alzheimer's. Lack of sleep has a negative effect on cognitive processes and increases the risk of the disease.
A regular sleep schedule and healthy bedtime habits (no screens before sleep, meditation or relaxation) help maintain brain health. Quality rest supports the regeneration of neurons and the optimal functioning of memory.
6. Look after your hearing, eyesight, blood pressure and cholesterol
In the 2024 report, hearing loss and high LDL cholesterol carried the most weight of all the factors. A hearing aid worn when your hearing declines, the right glasses or a timely cataract operation, blood pressure kept within the range your doctor recommends and controlled cholesterol may seem trivial. Each one, though, takes a risk factor out of the equation.
Find out how neurofeedback can support brain health and memory in Alzheimer's. Book a free phone call with a specialist and find out how non-invasive treatment can make a difference for you or your loved ones.
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Frequently asked questions about Alzheimer's disease
What are the first signs of Alzheimer's?
Usually forgetting recent things: the same questions asked several times, lost conversations, objects put in odd places. Then come difficulty following a plan, confusion about days and places, words that no longer come and withdrawal from activities. What matters is that the signs are new, have lasted a few months and get in the way of everyday life.
How long does a person with Alzheimer's live?
It depends mainly on age at diagnosis. One study found a median survival of 8.3 years in people diagnosed at 65 and 3.4 years in those diagnosed at 90. The average usually quoted is 4 to 8 years, but some people live more than 20 years with the disease.
What is the difference between dementia and Alzheimer's?
Dementia is the name for a decline in memory, thinking and independence, and Alzheimer's is its most common cause, accounting for 60–70% of cases. Other causes are vascular disease, dementia with Lewy bodies and frontotemporal dementia.
Is Alzheimer's inherited?
Rarely directly. Fewer than 1% of cases come from mutations that are passed down in families, and these usually cause the disease before the age of 65. Otherwise, genes only raise the risk: a variant of the APOE gene, called e4, makes the disease more likely but not certain.
Can Alzheimer's disease be cured?
Not for now. The established medicines ease the symptoms for a while, and lecanemab and donanemab, approved in the EU in 2025, slow the disease in some people in the early stages, without stopping it.
What tests are done for Alzheimer's?
The doctor starts with a conversation and memory tests such as the MMSE or MoCA. Blood tests rule out other causes of forgetfulness, for example a lack of vitamin B12 or thyroid problems, and an MRI or CT scan shows the brain. When needed, biomarkers in the cerebrospinal fluid, an amyloid PET scan or a blood test for p-tau217 confirm the changes specific to the disease.
Sources
- Scheltens, P., De Strooper, B., Kivipelto, M. et al. Alzheimer's disease. The Lancet, 2021, 397(10284): 1577–1590. [online] Available at: pubmed.ncbi.nlm.nih.gov/33667416.
- Dubois, B., von Arnim, C. A. F., Burnie, N., Bozeat, S. Biomarkers in Alzheimer's disease: role in early and differential diagnosis. Alzheimer's Research & Therapy, 2023, 15: 175. [online] Available at: pubmed.ncbi.nlm.nih.gov/37833762.
- Livingston, G., Huntley, J., Liu, K. Y. et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 2024, 404(10452): 572–628. [online] Available at: pubmed.ncbi.nlm.nih.gov/39096926.
- Alzheimer's Association. 10 Early Signs and Symptoms of Alzheimer's and Dementia. [online] Available at: alz.org/alzheimers-dementia/10_signs.
- World Health Organization. Dementia, fact sheet. [online] Available at: who.int/news-room/fact-sheets/detail/dementia.
- Brookmeyer, R., Corrada, M. M., Curriero, F. C., Kawas, C. Survival following a diagnosis of Alzheimer disease. Archives of Neurology, 2002, 59(11): 1764–1767. [online] Available at: doi.org/10.1001/archneur.59.11.1764.
- Palmqvist, S. et al. (Alzheimer's Association). Clinical practice guideline for blood-based biomarkers in the diagnostic workup of Alzheimer's disease within specialized care settings. Alzheimer's & Dementia, 2025. [online] Available at: pubmed.ncbi.nlm.nih.gov/40729527.
- European Medicines Agency. Leqembi (lecanemab) and Kisunla (donanemab), European public assessment reports. [online] Available at: ema.europa.eu/…/leqembi and ema.europa.eu/…/kisunla.
- NICE. Dementia: assessment, management and support for people living with dementia and their carers (NG97). [online] Available at: nice.org.uk/guidance/ng97.
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