PHILADELPHIA, Pa. (AP) — Anyone can temporarily forget the name of a song, a movie title or a former neighbor’s name every once in a while.

But when a loved one asks you the same question twice in five minutes, seems unusually aggressive and begins to lose things around the house, it may be the earliest signs of Alzheimer’s disease (AD).

Most adults with the disease are 65 or older. However, it is likely that damage to the brain begins much earlier than when symptoms appear. During this preclinical stage of AD, patients may seem fine but brain damage has already begun. Early diagnosis can help the patients and their loved ones begin to plan for their future.

Signs of early-onset AD may begin in a patient’s 30s, according to the NIH. It is these earliest signs that can be the hardest to detect, especially when loved ones don’t want to believe the changes that are happening.

According to the NIH’s National Institute on Aging, the earliest signs of AD include memory loss, repeating questions, trouble handling money and paying bills, losing things or misplacing them in odd places, mood and personality changes and increased anxiety and/or aggression.

“Alzheimer’s is a challenging disease for many of our families,” said Sarah Owens, vice president of Medicare at AmeriHealth Caritas. “Patients can lose the ability to recognize familiar surroundings, even their loved ones, and eventually the ability to communicate at all. It is important to put a plan in place before a crisis occurs. A health plan care manager can help to evaluate the options and assist in this process.”