A new study, published last week in the journal Neurology, says cognitive signs can begin 18 years in advance of a diagnosis.
Earlier research had pinned the disease sometimes starting 10 to 12 years before symptoms appeared.
The number is based on memory tests administered to elderly people every three years for 18 years.
"The changes in thinking and memory that precede obvious symptoms of Alzheimer's disease begin decades before," said study author Kumar Rajan of Rush University Medical Center in Chicago.
But the results just paint a broad picture of Alzheimer's and cannot determine an individual's risk, he added.
The good news is that doctors may now have more time to intervene in a prospective patient's care to delay the effects of the degenerative disease, which affects 5.3 million Americans.
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