He thought he was just getting older
Walter, 71. Came in because his wife insisted. His complaint: "I don't really have a problem. I'm just slower than I used to be." His wife's version was different. "He's lost two sets of car keys this year. He stopped going to his Tuesday card game because he couldn't keep up. He gets agitated in the afternoons and snaps at me, which has never been him." I asked Walter what a typical day looked like. "I wake up around 6. Read the paper. Used to do the crossword but I don't bother anymore. Watch TV. Take a nap. Watch more TV. Go to bed." I asked when he last initiated something. A phone call. A project. A trip. He couldn't remember. This is the symptom most families miss. Apathy is not depression. Walter wasn't sad. He wasn't hopeless. He just didn't care enough to start anything. Apathy is one of the earliest and most reliable signs of neurodegeneration. It often shows up before memory loss is obvious. And it gets dismissed as personality, aging, or laziness for years. Here's what apathy really looks like: Stops initiating activities they used to enjoy Drops out of social commitments without explanation Sits for hours doing nothing in particular Doesn't respond emotionally to good or bad news Lets hobbies, projects, and friendships quietly fade If you are watching this happen to someone you love, do not let a doctor write it off as normal aging. It might be. But it might not be. Walter had early Alzheimer's disease. We caught it years before it would have been obvious to anyone but his wife. Treatment helped. Planning helped more. His wife told me later: "I thought I was overreacting. I'm so glad I didn't listen to that voice." 📌 Follow me (Reza Hosseini Ghomi, MD, MSE) for the symptoms most doctors miss 💬 Comment below to share what you've noticed