What do people with Alzheimer’s forget first?

People with Alzheimer’s disease typically first forget recent events and newly learned information. As the disease progresses, they experience increasing memory loss and confusion. The earliest symptoms often include difficulty remembering recent conversations, names or events as well as apathy and depression.

Short-Term Memory Loss

One of the earliest signs of Alzheimer’s is short-term memory loss. This involves difficulty recalling information from minutes or hours ago. A person may repeat themselves frequently in conversation, forgetting they already mentioned something. They may also struggle with learning new information and retaining it over short periods of time.

Difficulty performing familiar daily tasks can also indicate short-term memory issues. A person may get lost driving a familiar route or forget the rules of a favorite game. Misplacing items around the house and being unable to retrace steps to find them is another indicator. Relying heavily on reminder notes and aids is common.

Long-Term Memory Loss

As Alzheimer’s progresses, memory loss expands to include events and information from further in the past. Long-term memories and personal histories start to disappear. The person may forget major life events like marriages, divorce, children’s birthdays, military service, or career history.

Loss of long-term memory advances from recent information to older memories. Childhood and early adulthood memories, as well as very ingrained memories, tend to be forgotten last. But eventually much of a person’s personal life history becomes a mystery to them.

Memory Tests

Doctors use various tests to evaluate short and long-term memory loss when diagnosing Alzheimer’s disease. Some common tests include:

  • Repeating a set of words, numbers or names immediately after hearing them and again five minutes later. This checks ability to acquire and recall new information over a short timeframe.
  • Completing a written form with personal information such as address, occupation and family. Inability to accurately fill out basic personal facts indicates long-term memory loss.
  • Identifying photos of famous people or events. Struggling with historic figures and news events signals fading remote memories.
  • Retelling a story recently read aloud. Recalling all the details tests short-term memory.
  • Answering questions about your personal history. Gaps in remembering basic life events points to loss of long-term memory.

Other Early Symptoms

While memory loss is one of the first signs, other cognitive and behavioral changes often accompany it in early Alzheimer’s:

  • Difficulty planning and problem-solving – Steps to complete familiar tasks get confusing. Solving basic problems becomes challenging.
  • Trouble with spatial orientation – A person may get lost easily even in well-known places. Understanding spatial relationships becomes difficult.
  • Language problems – Finding the right words in conversation or naming familiar objects and people becomes increasingly hard.
  • Poor judgement – Decision-making ability declines. Social behavior may be inappropriate.
  • Withdrawing from work or social activities – A person may experience apathy, depression or loss of interest as the disease develops.

What Gets Forgotten Later On?

As Alzheimer’s enters the middle and late stages, memory loss becomes severe and other functions further deteriorate:

  • Entire personal history – All memories of childhood, school, work, marriage and other life events disappear.
  • Names of close family members – Eventually a person cannot recognize their spouse, children or other close ones.
  • Everyday skills – Feeding, dressing, bathing, toilet use and other self-care abilities become lost.
  • Physical abilities – Walking, sitting and swallowing control grows impaired. Muscle coordination diminishes.
  • Senses and reflexes – Vision, hearing, taste and smell decrease. Reflexes like gagging and coughing fade.
  • Speech and comprehension – Conversation ability gets lost. Understanding spoken or written words is extremely limited.
  • Recognizing surroundings – People, places and objects become unidentifiable. The environment seems alien.

The Hippocampus and Memory Loss

Research indicates Alzheimer’s disease begins in the hippocampus region of the brain. The hippocampus plays a central role in forming memories and linking aspects of an experience together. As Alzheimer’s spreads through the hippocampus and surrounding areas involved in memory, people lose the ability to acquire and retain new information.

Short-term memory depends on the hippocampus temporarily storing recent experiences so the brain can access and process them. But the hippocampus becomes damaged early in Alzheimer’s. So this memory function fails first.

Encoding long-term memories also requires the hippocampus. It links together sensory input, emotions and knowledge from other brain areas and organizes them into a memory. So as the disease encroaches on the hippocampus, older memories disintegrate and permanent storage of new experiences is impossible.

Other Brain Changes Behind Memory Loss

Destruction of neurons and their connections throughout the brain contribute to Alzheimer’s memory impairment. Some key areas impacted include:

  • Cerebral cortex – This outer mantle of brain tissue is involved in thinking, planning, judgment and personality. As large numbers of cortical neurons die, cognitive functions decline.
  • Amygdala – The amygdala encodes emotional memories. Its damage leads to forgetting experiences associated with feelings.
  • Temporal lobe – This area behind the ears receives sensory input and interprets meanings. Its destruction contributes to language problems and confusion.
  • Parietal lobe – Receiving sensory signals from the body, this region helps identify objects and orient spatially. Its impairment causes navigation issues.

Genetic Risk Factors

Research shows people’s risk for Alzheimer’s has a significant genetic influence. Certain gene variants make it more likely the brain changes of Alzheimer’s will develop. These include:

  • ApoE e4 gene – Having one copy of this variant increases Alzheimer’s risk 2 to 3 times. Two copies raises risk 10 times.
  • TREM2 – Rare mutations in this inflammatory gene significantly increase risk.
  • ABCA7 – Variants in this cholesterol gene double the likelihood of developing Alzheimer’s.

Scientists have identified over 20 genes associated with increased Alzheimer’s susceptibility. Carrying more risk gene variants amplifies the chances of developing memory loss and other disease symptoms.

Factors That Delay Memory Loss

While genetics plays a key role, some lifestyle factors appear to help preserve memory and delay Alzheimer’s onset. Research links the following to reduced risk of memory decline:

  • Education – More years of formal schooling correlates with lower dementia rates.
  • Mentally stimulating activity – Engaging in intellectually challenging activities may build cognitive reserve.
  • Social engagement – Interacting socially seems to decrease risk of memory impairment.
  • Physical activity – Regular exercise may help reduce hippocampal atrophy.
  • Heart-healthy diet – Eating more vegetables, fruit and fish is associated with lower Alzheimer’s risk.

Managing cardiovascular disease factors such as obesity, smoking, diabetes and hypertension also appears helpful. Overall brain health through life likely influences later susceptibility to memory loss.

Coping with Memory Loss

Mild memory lapses are normal with aging. But significant impairment interfering with daily activities may indicate Alzheimer’s or a related dementia. If you notice worsening memory issues, the following tips may help:

  • Keep a calendar, planner, notes or electronic reminders for appointments, tasks and events.
  • Develop routines around daily tasks like getting ready, making meals and taking medication.
  • Put important objects like keys, wallet and glasses in a designated spot.
  • Label drawers, cabinets and doors where things are stored.
  • Use pictures, color coding or location to help find items.
  • Do regular brain exercises like crossword puzzles, reading and card games.
  • Repeat information you want to remember out loud.
  • Get plenty of rest and keep stress in check.
  • See your doctor if memory problems persist or increase.

Let family and friends know about your memory challenges so they can provide reminders and assistance. Try to stay positive and patient with yourself. Remaining socially engaged, pursuing interests, and using memory aids can help you maintain an active life despite Alzheimer’s.


Memory loss represents one of the core symptoms marking the onset and progression of Alzheimer’s disease. Research clearly shows the hippocampus region of the brain, vital for forming new memories, is damaged early in Alzheimer’s. This leads to increasing forgetfulness and confusion as the disease advances.

Typically short-term memory impairment appears first, exemplified by difficulty recalling recent events, conversations and newly learned information. As Alzheimer’s spreads in the brain, loss of long-term memories and personal history follows. In late stages, most memories disappear completely along with other cognitive and physical functions.

While age increases risk for Alzheimer’s, genetics play an important role. Lifestyle factors like education, mental activity and diet may help delay onset of memory decline. And coping strategies can assist with managing worsening memory challenges. Recognizing early symptoms allows patients to access support services and resources aimed at maximizing quality of life despite the disease’s progression.

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