Alzheimer’s disease (AD) is the most common form of dementia, characterized by the progressive deterioration of brain cells, primarily affecting memory and cognitive function. While physical symptoms like dizziness are often discussed, dizziness is generally not considered a primary, hallmark symptom used to diagnose AD.
The Core Answer: Dizziness and Alzheimer’s
Dizziness does not appear on the main diagnostic criteria for Alzheimer’s disease (AD). The defining pathology of AD involves the accumulation of amyloid plaques and neurofibrillary tangles, which initially affect areas of the brain associated with memory, such as the hippocampus and the cerebral cortex. The brain regions responsible for balance and the vestibular system, including the cerebellum and brainstem, are typically not the first or most heavily impacted areas in classic AD.
While dizziness is not a standard early symptom, some patients in the later stages of the disease may experience balance issues and gait changes. This change in motor function is often a result of widespread damage to various brain structures. A specific and less common variant of AD, known as posterior cortical atrophy, can cause damage to the cerebellum and other balance centers, leading to vertigo and unsteadiness earlier in the disease progression.
Secondary Contributors to Dizziness in AD Patients
The correlation between dizziness and Alzheimer’s patients is often explained by factors external to the core neurodegeneration. A significant contributor is the side effects of medications commonly prescribed to treat AD symptoms. Cholinesterase inhibitors, such as donepezil, can slow the heart rate (bradycardia). This decrease in heart rate reduces blood pressure, leading to lightheadedness or orthostatic hypotension (dizziness upon standing).
Many older adults with AD also have co-existing health conditions that independently cause dizziness. Vascular issues, often present in mixed dementia, can impede blood flow to the brain and inner ear, directly causing dizziness or vertigo. The inner ear’s vestibular system, responsible for spatial orientation, may also be compromised by age-related changes or co-morbidities, triggering unsteadiness.
Dehydration and nutritional deficiencies are common problems in individuals with advanced cognitive impairment, as they may forget to drink or eat regularly. Dehydration causes a drop in blood volume and pressure, which is a direct cause of dizziness. Additionally, AD-related gait disturbances, which cause people to shuffle their feet and walk unsteadily, may be perceived as a dizzy spell or loss of balance, increasing the risk of falls.
Primary Indicators of Alzheimer’s Disease
The primary indicators of Alzheimer’s disease involve a sustained decline in cognitive abilities that significantly impact daily life. Memory loss is the most common early sign, often manifesting as difficulty remembering newly learned information or recent events. This is distinct from simple age-related forgetfulness because it disrupts a person’s ability to function independently.
Another core symptom is increasing difficulty with planning, problem-solving, and managing complex tasks, such as paying bills or following a recipe. The ability to complete familiar tasks at home or work, like driving a regular route, also becomes increasingly difficult.
Spatial and temporal disorientation is a common feature, where individuals may become confused about the time, season, or their location. A noticeable change in mood, personality, or judgment can also signal the disease’s progression, including becoming withdrawn, anxious, or exhibiting poor judgment.
When to Seek Medical Evaluation for Dizziness
While dizziness in a person with Alzheimer’s disease is often a secondary symptom related to medication or other health issues, all instances of persistent dizziness warrant medical evaluation. Common, non-AD related causes include inner ear infections, benign paroxysmal positional vertigo (BPPV), and temporary low blood pressure. A medical professional can assess these causes and rule out more serious underlying conditions.
Clear warning signs require immediate medical attention, especially if severe dizziness is sudden or accompanied by other symptoms. Seek emergency care if dizziness occurs alongside:
- A severe headache
- Chest pain
- Vision changes like double vision
- Slurred speech
- Weakness or numbness in the limbs
These co-occurring symptoms may indicate a stroke or a serious cardiac event, which requires prompt diagnosis and treatment.