The pattern of initial symptoms reported by caregivers of Alzheimerʼs disease (AD) subjects were described and compared in 45 Spanish-speaking (SS) and 84 English-speaking (ES) caregivers. The majority (56 percent) of SS caregivers were monolingual. All caregivers were given a standard interview in their respective language which included information on the age at onset and initial symptoms observed in the AD subject. First symptoms reported most frequently by ES caregivers fell into the following categories: memory (27 percent), activities of daily living (ADLs, 21 percent), disorientation (13 percent), and personality changes (13 percent). In contrast, SS caregivers reported memory (47 percent), psychological problems (16 percent), and personality changes (11 percent) at the first sign of the disease process. After adjusting for duration of illness, significantly more SS than ES caregivers reported memory loss, and sign ficantly less SS than ES caregivers reported difficulty with ADLs as an initial symptom of dementia. In addition to cultural group, older caregivers were significantly less likely than younger caregivers to report memory loss as a first symptom. Caregivers of AD subjects with onset before, versus after age 70 were more likely to report ADL deficits as thefirst symptom. Finally, the report ofpsychological problems as afirst symptom was related to lower caregiver education and longer duration between disease onset and interview. These results highlight the need for professionals to consider potential cultural differences when assessing impairment in elderly persons. In addition, the high prevalence of non-English-speaking caregivers emphasizes the need for Spanish-speaking professionals to optimally service and research health needs in this growing elderly Hispanic population.