Image by david.nikonvscanon used under the creative commons attribution license.

Sometimes it's the little things that get you with Alzheimer's. Phone challenges, for example. Difficulty using the telephone is an early sign of Alzheimer's disease. But even once you already know someone has dementia, phone issues can be an ongoing source of trouble.

Any of the following "ring a bell" in your house?

• Not recognizing the voice on the other end.

Before she died at 99, my grandmother's deafness had made our weekly phone calls harder as the years went on. But between my shouting and repeating, we somehow managed to have a talk that made us both feel good. Then sometime in her early 90s, Alzheimer's disease made her less likely to answer a ringing telephone, and when she did, she didn't always understand who I was. Eventually it got too hard, and looking back, was sadly the factor that changed our relationship most.

• Not recognizing the phone.

Another personal story: My siblings and I began to expect the same drill every time we called home. Moments after answering the phone and saying hi, our mom would say, off to the side in an increasingly agitated tone, "Dear, pick up the phone...no, not that one...that's the TV remote!...no, that's the other TV remote...yes, that one...your daughter's on the phone...." It was funny the first time, and then more and more worrisome as it went on. My dad had then only seemed "forgetful" to us. In his defense, all those black wands with buttons do look a bit alike, but this wasn't a case of occasional misidentification. In hindsight, his telephone confusion was a clear sign of Alzheimer's.

• Not saying anything at all.

Gary Joseph Leblanc, who writes a caregiving column for the Tampa Tribune, deserves a shout-out for bringing up this topic of Alzheimer's phone issues, in a reminiscence about his father. His Dad, who had Alzheimer's, would answer the phone at the bookstore they ran together, and remain completely voiceless before hanging up. When asked who it was, "he'd just nonchalantly respond, 'Heck if I know.'"

• Dialing 911.

LeBlanc also mentions this risk: Lonely people with dementia who dial 911 just to have someone to talk to. (Maybe because it's an easy and ingrained number?) He also mentions his dad randomly punching numbers which led to accidental international calls.

• Picking up the extension to listen in.

Later, when my dad lived with my brother, I'd suddenly notice a raspy breathing while I was chatting with him or his wife. Turns out Dad would sometimes pick up an extension but not announce himself. He wasn't being sly; he simply lacked the wherewithal to join the conversation but liked to listen to us. Of course I always asked to talk to him anyway after I'd get the scoop from my brother, but I learned to ask them to make visual contact on Dad's activity before we discussed any nitty-gritty details about how he was really doing.

• Not taking messages.

Another early-stage problem is that someone might seem to manage phone use just fine – but is incapable of writing anything down or remembering to tell anyone else in the house there was a call.

• Calling randomly and often.

Sometimes people with dementia remember long-dialed numbers (or how to use speed-dial) and fall into a groove of calling an adult child, friend, doctor's office, or some other target over and over, often at inappropriate times, a behavioral tic.

So what can you do?

How to best deal with Alzheimer's phone problems depends on your specific situation. Some ideas to consider:

• Switch to cell-only service, if you live in the same house as someone with Alzheimer's.
• Place phones only in the rooms where the person who has Alzheimer's doesn't go (for example, in your bedroom and in a landing at the top of the stairs).
• Use call-forwarding so that home calls go to your cell.
• Turn down ringers. This may prevent the phone from being answered but not prevent outgoing calls.
• Use caller ID to follow up on who phoned.
• Consider an easy-to-use model like this Memory Phone which has visual-cue buttons so the user can easily dial family members or emergency help (for people in earlier disease stages).
• Another option: a dialless phone, which receives calls but doesn't permit dialing – a possible substitute for those who like to call at all hours.
• Realize that not being able to dial for help or emergency services is not merely a sign of Alzheimer's but a sign that someone may no longer be able to live alone.

Alzheimer's phone problems can be annoying -- and, even more important, dangerous.