When Alzheimer’s Starts Before You Feel It
Understanding the “Preclinical” Stage
I wish someone had told me sooner that Alzheimer’s doesn’t begin the day you forget a name or misplace your keys. It starts years before that. Sometimes decades. This early phase has a name called Preclinical Alzheimer’s, and it’s where I am right now.
If you’re reading my journey, you’ll see it woven through everything I’m doing: eating differently, exercising more intentionally, sleeping with purpose, joining a clinical trial, fighting like hell for my brain.
So let’s talk about what this stage actually is and why it matters more than most people realize.
What “Preclinical Alzheimer’s” Actually Means
In the simplest, most human terms:
Preclinical Alzheimer’s = Alzheimer’s biological changes are happening in the brain, but you don’t have symptoms yet.
That’s it.
No memory changes.
No cognitive decline.
No dementia.
You look and function like your normal self, but underneath the surface the brain is starting to show early Alzheimer’s markers, the footprints long before the footsteps.
And here’s the part that still amazes me:
This stage can last 10 to 20 years before symptoms ever show up.
For many people, this window is invisible. But I caught mine early thanks to genetics testing, a clinical trial, and a whole lot of curiosity mixed with fear.
Yes, You Have Amyloid and Tau Already, and Yes, That’s Normal
Let me clear something up, because I had to learn it too:
Everyone has amyloid proteins and tau in their brain. These aren’t villains. They’re normal parts of cellular function.
The problem only begins when:
• Amyloid starts to clump (plaques) faster than your brain can clear it
• Tau becomes misfolded (tangles) and gums up the transport system inside neurons
In other words, they go from “normal proteins just doing their job” to “please stop wrecking my neurons.”
Preclinical Alzheimer’s simply means these changes have begun quietly and silently.
How Doctors Know You’re in the Preclinical Stage
This part surprised me: you can have zero symptoms but still test positive for early Alzheimer’s biology. That’s because diagnosis now relies heavily on biomarkers, the biological signatures of the disease.
Here are the tests or biomarkers that were used to identify mine:
pTau
Phosphorylated tau is a major early marker. High levels mean tau is changing shape and tangling inside neurons.Amyloid PET Scan
This imaging test shows amyloid buildup directly on the brain.Genetics (like APOE4)
Genetics alone doesn’t diagnose Alzheimer’s, but APOE4 increases risk and influences how early changes may appear.
These markers don’t mean “you’re doomed.” They mean you have information, and information gives you power.
Why This Stage Matters So Much
This is the part that keeps me motivated on the days I feel scared:
The preclinical window is when interventions work best. Before symptoms, before damage, before neurons are lost. Research shows this is the moment when lifestyle changes, exercise, diet, sleep, and new medications have the highest potential to slow or even stop progression.
It’s the phase where agency still exists.
And I’m clinging to that.
What This Means for Me (And Maybe for You)
I think about my brain every day. Not in a panicked way (though occasionally), but mostly in a determined, roll-up-my-sleeves way.
I’m:
• eating the MIND Diet
• exercising like it’s medicine
• prioritizing sleep
• staying socially engaged
• challenging my mind
• doing a clinical trial
I’m not pretending I’m not scared. I am.
But I’m also hopeful, because science is shifting faster than ever before. And because this stage called preclinical is the part of the story where the future is still unwritten.
The Bottom Line:
Preclinical Alzheimer’s means the biological changes have begun, but you are still fully yourself. Your brain is still strong, adaptable, and capable. And this is the moment when action matters most.
I see what’s coming. I’m not ignoring it. I’m fighting like hell while I still have every tool in my toolbox.