Alzheimer’s disease is usually discussed in terms of memory loss, confusion, and the heartbreaking moment when someone forgets where the coffee mugs live even though they’ve been in the same cabinet since 1998. But there’s another issue that deserves more attention: seizures. They are not the first symptom most families think about, and they can be surprisingly easy to miss. In some people with Alzheimer’s, seizures are obvious. In others, they are quiet, strange, and fleeting, more like a brief brain “glitch” than the dramatic scene many people picture from TV.
If you are caring for someone with Alzheimer’s, or you have recently heard that seizures may be part of the picture, here’s the good news: knowing what to watch for can help you act faster, describe symptoms more clearly to a doctor, and avoid mistaking a seizure for “just another confusing day.” That distinction matters. Seizures can affect safety, quality of life, and sometimes even the pace of cognitive decline.
Can Alzheimer’s cause seizures?
Yes, Alzheimer’s disease can be linked with seizures. The risk is higher than it is in older adults without dementia, and experts increasingly recognize that seizure activity may be underdiagnosed in people with Alzheimer’s. Part of the reason is biological: Alzheimer’s changes the brain in ways that can make nerve cells more excitable. When brain circuits become overly active or disorganized, seizures can happen.
That does not mean everyone with Alzheimer’s will develop seizures. Many never do. But the connection is real enough that it should be on every caregiver’s radar, especially as the disease progresses or if unusual episodes begin showing up out of nowhere.
Some research suggests seizures may be more common in people with younger-onset Alzheimer’s, familial Alzheimer’s, or more advanced disease. Seizures can also appear earlier than many families expect. In other words, this is not only a late-stage issue. Sometimes seizure-related activity shows up before anyone uses the word “epilepsy,” and before a family realizes that a strange spell is not just fatigue, stress, or a rough afternoon.
Why seizures can be hard to spot in Alzheimer’s
Here’s where things get tricky. Many seizures in Alzheimer’s are not the full-body convulsions people imagine. They can be subtle, brief, and easy to confuse with the symptoms of dementia itself. A person may stare, stop speaking mid-sentence, become suddenly unresponsive, smack their lips, fumble with their hands, look frightened for no clear reason, or seem “off” for a minute and then return to baseline. If that sounds vague, welcome to the challenge.
Some people have nonconvulsive seizures, which may show up as:
- staring spells
- sudden pauses in speech
- brief confusion that is different from usual confusion
- unexplained fear, dread, or panic
- odd smells or tastes no one else notices
- repetitive mouth or hand movements
- short amnestic episodes, where the person loses a slice of time
Because Alzheimer’s already affects memory, language, behavior, and attention, these episodes can blend into the background. Families may think, “Well, dementia is weird,” which is true, but also not always helpful. The biggest clue is often a distinct pattern: a spell that starts suddenly, lasts seconds to a couple of minutes, and then ends, sometimes followed by extra fatigue or increased confusion.
Seizure vs. myoclonus: not always the same thing
Late-stage Alzheimer’s can also involve myoclonus, which means sudden jerks or spasms of the arms, legs, or body. Myoclonus can look like a seizure, but it is not always one. This is an important distinction because treatment decisions depend on what is actually happening. If a loved one develops jerking movements, do not assume it is “just part of aging” or “just nerves.” It deserves medical attention.
A practical rule: if movements are new, repetitive, or paired with changes in awareness, call the doctor. Bring details. Neurology loves details almost as much as coffee.
What causes seizures in someone with Alzheimer’s?
Alzheimer’s-related changes in the brain are one explanation, but they are not the only possible cause. In an older adult with dementia, seizures can also be triggered or worsened by other medical problems, including stroke, infection, fever, head injury, medication side effects, alcohol withdrawal, sleep deprivation, metabolic imbalance, or other neurological disease.
That is why a seizure should not automatically be blamed on Alzheimer’s alone. A thorough evaluation matters. Sometimes the brain is waving a tiny flag that says, “Excuse me, something else is going on here.”
What seizures may look like in real life
Obvious seizures
These are easier to recognize. A person may stiffen, jerk, fall, lose consciousness, bite their tongue, or be confused for a longer time afterward. These are frightening and usually prompt immediate medical attention.
Subtle seizures
These are the sneaky ones. A person might stop responding, stare into space, mumble, make chewing motions, pick at clothing, or suddenly seem terrified. The episode may last less than two minutes. Later, the person may have no memory of it.
After-effects
Following a seizure, a person may be extra sleepy, more confused than usual, weak, irritable, or slow to speak. In someone with Alzheimer’s, that recovery period can be mistaken for a normal bad day unless the event was witnessed clearly.
How doctors diagnose seizures in Alzheimer’s
Diagnosis usually starts with the story. What happened? How long did it last? What did the person look like? Did they fall? Stop talking? Stare? Smack their lips? Was there shaking? Did they seem exhausted afterward? If possible, record a video. A short phone clip can be more helpful than a heroic paragraph that begins with, “Well, it was kind of strange.”
The workup may include:
- a medical history and witness description
- a medication review
- blood tests to check for infection, dehydration, or metabolic problems
- brain imaging such as MRI or CT in some cases
- an EEG, which records electrical activity in the brain
One important detail: a routine EEG can miss seizure activity. In some patients, longer monitoring, repeated EEGs, sleep studies, or video EEG may be more useful, especially if symptoms are subtle or happen during sleep. That is one reason seizure disorders in Alzheimer’s may go undetected for a while.
Do seizures make Alzheimer’s worse?
They may. Research suggests that seizures and silent epileptiform activity may be associated with faster cognitive decline in some people with Alzheimer’s. That does not mean every person who has one seizure will suddenly worsen, but it does mean seizure recognition is not a side issue. It is part of protecting brain function, safety, and day-to-day stability.
Think of it this way: if the brain is already under pressure from Alzheimer’s, repeated bursts of abnormal electrical activity are not exactly ideal houseguests.
How seizures are treated
Treatment depends on the cause, the seizure type, the person’s age, and the overall medical picture. If the seizure happened because of an infection, medication issue, or metabolic problem, the doctor will address that first. If the person is diagnosed with epilepsy or recurrent seizures, antiseizure medication may be recommended.
In older adults with Alzheimer’s, doctors usually try to choose medications that are effective but gentle on cognition, balance, and behavior. Two medicines often discussed more favorably in this setting are levetiracetam and lamotrigine, because they are generally better tolerated than some older drugs. Even so, there is no perfect medication. Levetiracetam, for example, can sometimes worsen agitation or mood symptoms in people with advanced dementia, so clinicians have to watch carefully.
Other drugs may be less appealing because they can increase sedation, balance problems, drug interactions, or cognitive side effects. This is one reason treatment in Alzheimer’s should be individualized rather than copied from a generic seizure handout.
What caregivers can do at home
1. Track patterns
Write down when episodes happen, how long they last, what the person was doing before, and what they were like after. Include sleep problems, missed medications, illness, and stressors.
2. Prioritize safety
If a seizure happens, guide the person away from hard objects, cushion the head if they are on the floor, turn them onto their side if possible, and do not put anything in their mouth. That old movie trick is not helpful and has retired from respectable medical advice.
3. Time the event
Most seizures end within a couple of minutes. If it lasts more than five minutes, call emergency services. Also seek urgent help for a first seizure, repeated seizures without recovery in between, injury, trouble breathing, or a seizure in water.
4. Get video if you can
Only if it is safe. A short recording can help the clinician tell the difference between seizure, fainting, myoclonus, medication reaction, and other neurological events.
5. Review medications regularly
People with Alzheimer’s often take multiple prescriptions. A periodic medication review can help reduce interactions and side effects that may complicate diagnosis or treatment.
Special note on newer Alzheimer’s drugs
Families should also know that some amyloid-targeting Alzheimer’s treatments can rarely be associated with serious brain swelling or bleeding complications, sometimes called ARIA. In uncommon cases, these complications can be linked with seizures and other serious neurological symptoms. This does not mean these drugs are off the table for everyone, but it does mean careful screening and MRI monitoring matter. If a person receiving these therapies develops new confusion, severe headache, vision changes, or seizure-like activity, medical evaluation should happen quickly.
When to call the doctor and when to call 911
Call the doctor soon if:
- there are new staring spells or brief unexplained “check-out” episodes
- jerking movements appear for the first time
- the person has repeated short episodes of odd behavior
- confusion becomes suddenly more episodic or cyclical
- recovery after an event seems different from the person’s usual baseline
Call 911 or seek emergency care if:
- a seizure lasts more than five minutes
- another seizure starts before the person recovers
- the person is injured, has trouble breathing, or turns blue
- it is the person’s first known seizure
- the event happens in water
- the person is pregnant or has diabetes
- there are signs of stroke, major head injury, or severe new neurological symptoms
Real-life experiences families often describe
Families living with Alzheimer’s and seizures often say the hardest part is not the seizure itself. It is the uncertainty before and after. One caregiver may notice that her father keeps having “blank moments” at dinner. He freezes with a fork in midair, stares for 30 seconds, then resumes eating like nothing happened. Another spouse might describe a sudden wave of panic in the person they love: a frightened look, a hand gripping the armrest, a whispered “something is wrong,” and then silence. No dramatic collapse. No warning siren. Just a strange interruption in reality.
Many caregivers first assume these episodes are part of memory loss, fatigue, or medication side effects. That makes sense. Alzheimer’s already rewrites the rules of normal behavior, so it can be difficult to recognize when something new has entered the picture. Several families describe feeling relieved once a clinician identifies possible seizure activity. Not because the diagnosis is easy, but because it explains what they have been seeing. When a symptom finally gets a name, it can feel less like chaos and more like a problem with a plan.
There is also fear. A witnessed convulsive seizure can be deeply unsettling, especially if it happens at home in the middle of the night. Caregivers often remember tiny details forever: the sound of a fall, the confusion afterward, the ambulance lights, the feeling that the disease has somehow expanded its territory. In advanced Alzheimer’s, seizures may be another reminder that this illness does not stay politely in one lane.
Still, families also describe learning a rhythm. They keep logs. They notice patterns. They figure out which events need urgent attention and which details to report at a neurology visit. Some become experts in timing episodes, protecting a head with a folded towel, and calmly saying, “I’m here, you’re safe,” even while their own heart is pounding like a drummer in a garage band.
Another common experience is grief mixed with practicality. Caregivers are often juggling meals, hygiene, appointments, wandering risk, mood changes, and sleep disruption. Adding seizures to the list can feel unfair, because frankly, it is unfair. But families frequently discover that good medical support, better seizure recognition, and a clear emergency plan can reduce that helpless feeling. It does not make the journey easy, but it can make it less chaotic.
Perhaps the most powerful theme is this: people want to be believed when they say, “Something is different.” Even if they cannot describe it in perfect medical language, caregivers are often the first to notice that a person’s confusion has changed shape. That intuition matters. In Alzheimer’s care, observations from loved ones are not background noise. They are often the clue that moves the story forward.
Conclusion
Alzheimer’s and seizures can overlap more than many people realize. Sometimes the signs are dramatic, but often they are subtle: staring, brief unresponsiveness, odd fear, repetitive movements, or sudden jerking. Because these episodes can mimic everyday dementia symptoms, they are easy to miss. That is exactly why awareness matters.
The bottom line is simple: if something seems new, patterned, or distinctly different from the person’s usual Alzheimer’s symptoms, talk to a clinician. A careful evaluation can help sort out seizures from myoclonus, medication issues, infection, stroke, or other causes. And when seizures are present, treatment may improve safety, comfort, and day-to-day function.
Alzheimer’s already asks families to become detectives, advocates, schedulers, and occasional miracle workers. Adding seizure awareness to that toolkit is not glamorous, but it is useful. Sometimes “what to know” turns into “what helped us cope,” and that is where real care begins.
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Note: This article is for informational purposes only and is not a substitute for medical advice, diagnosis, or treatment.
