The progression of Alzheimer’s disease unfolds over the course of decades. We lose valuable time by ignoring changes in memory and waiting for a medical diagnosis to take action. By the time current medical screenings detect significant decline we have lost years of valuable time and quality of life. We are too conservative about rigorously evaluating memory but appropriately careful about making a medical diagnosis such as Alzheimer’s disease. By treating Alzheimer’s disease as a medical rather than a memory problem, we miss the opportunity to get ahead of the changes and directly treat memory while the mind still works well. We lose the opportunity to build skills we will need to protect our family and ourselves.

The unfolding of early Alzheimer’s disease overlaps with normal aging. This process can be described in alternative ways. One way of viewing the changes that occur in Alzheimer’s disease is to think of progressive decline as reverse development. Development and aging progress over the course of decades with basic skills like sitting up and walking occurring early. Language unfolds over the course of many years with increasing complexity added each year through at least adolescence. During early development we learn by means of tasks, tools, and projects that actively engage us with the world. We learn to do basic skills early and only later do we add the complexity such as travel, financial planning and management. We move from the simple to the complex, from the concrete to the abstract, from mere productivity to competence. These changes were well described by Marie Montessori who developed educational strategies that can be equally effective at the beginning as well as at the end of life. Her methods require only engagement with the world. They do not rely on memory or competency.

Alzheimer’s disease progresses in reverse. It shows as declining ability to perform complex tasks such as using computers, financial planning, and complex thinking. Early on the changes are very subtle, there is fluctuation in performance, and complex thinking is compromised. At this stage, it is very difficult to distinguish from the slowing that normally occurs from aging. You can’t run as fast or think as fast as you did when you were 20.

But now is also the time when you are most in control and can be proactive about your future. Take action and formulate advanced directives. Start with a thorough evaluation of your life style, your desires, your plans for the future, and your memory. Advanced directives need to do much more than provide a living will and a durable power of attorney. Set the course for your future as you grow older. Build skills based on the passions that you want to protect as long as possible as well as on your ability to learn remember. And finally include plans to stay engaged in the world even if your memory declines sometime in the future.