Aim The effects of Alzheimer's disease (AD) are making a major impact on the socioeconomic status of older adults in society. The recognition of early symptoms and clinical presentation are crucial issues to foster early diagnosis and treatment in order to have better therapeutic outcomes. Methods We recruited clinically diagnosed AD patients at the very mild stage in the Clinical Dementia Rating scale 0.5 and mild stage Clinical Dementia Rating scale 1.0 in Taiwan and Japan. Psychometrics including the Ascertain Dementia 8 (AD8) questionnaire were administered to collect and compare the differences of the clinical presentation of the participants from the two countries. Results A total of 1189 participants, 641 from Taiwan and 548 from Japan, were recruited in the present study. In the very mild dementia group with Clinical Dementia Rating scale 0.5, apart from AD8‐2: reduced interest in hobbies/activities (P = 0.056) and AD8‐4: trouble learning how to use a tool, appliance or gadget (P = 0.224), other AD8 subitems were significantly different between the two countries. Japanese participants had a higher reported frequency of AD8‐5: forgetting the correct month or year (82.7%) than that (57.9%) in Taiwanese (P < 0.001). Taiwanese participants had a higher reported frequency in AD8‐1: problems with judgment (20.3%), AD8‐3: repeats questions, stories or statements (67.5%), AD8‐6: difficulty handling complicated financial affairs (32.5%); AD8‐7: difficulty remembering appointments (53.8%); and AD8‐8: consistent problems with thinking and/or memory (89.3%) than those in Japanese participants. Conclusion Early symptoms of AD in both countries are different. The frequently reported early symptoms are important for primary physicians and the general population so that they can recognize the disease in the early stage so as to have a better therapeutic outcome. Such efforts would increase the awareness of dementia in the general population. Geriatr Gerontol Int 2016; 16: 797–803.