- Alzheimer’s Disease, a progressive disease of the brain is the most common form of dementia
- The underlying causes for Alzheimer’s are genetics, age-related changes, and health/environmental factors
- The most common framework is a a seven-stage system, developed by Dr. Barry Reisberg of New York University
- The 7 stages are: No Impairment, Mild Decline, Continued Mild Decline, Moderate Decline, Moderately Severe Decline, Severe Decline and Very Severe Decline
- The symptoms in each stage can vary from person to person. Stages can also overlap considerably which makes it difficult to place an Alzheimer’s patient in a specific stage
- Although there is no cure for Alzheimer’s disease, the right mix of medications and compassionate caring can alleviate some of the symptoms
Alzheimer’s is a progressive disease of the brain that slowly causes impairment in memory and cognitive function. Alzheimer’s Disease is the most common form of dementia, and it is a disease that drastically changes the lives of patients and their families.
There are currently more than 24 million people with dementia worldwide, and this number is expected to increase to more than 81 million by 2040 -if, that is, a cure is not found. Dementia is the term applied to a group of symptoms that negatively impact memory.
According to the National Institute on Aging, the causes of Alzheimer’s are not completely understood. There has been some evidence to support genetics, age-related changes, and health/environmental factors as essential underlying causes. What scientists do know is that Alzheimer’s disease involves an unexplained failure of brain cells. Research is ongoing for why brain cells fail, a phenomenon that is not clearly understood.
There are two categories of genes that have been found to influence whether a person develops a disease:
- Risk Genes
- Deterministic Genes
According to the Alzheimer’s Research Center, Alzheimer’s genes have been identified in both these categories. Risk genes increase the likelihood of developing a disease, but they do not guarantee that it will happen. Deterministic genes directly cause a disease and guarantee that anyone who inherits these genes will develop the disease.
Alzheimer is not a normal part of aging. One of the greatest risks for developing the disease however has to do with aging. Research has shown that the risk of getting Alzheimer’s doubles every five years after age 65, and the risk increases by 50 percent after age 85.
There is research to support the relationship between cognitive decline and other conditions such as heart disease, high blood pressure, strokes and obesity. Reducing the risk factors for these chronic conditions may also reduce the risk for Alzheimer’s.
As with any dementia, each individual’s experience with Alzheimer’s is unique. With that in mind, there are some similarities that can be identified in each stage of the disease. The precise number of stages could be debated, with some experts preferring to keep it simple, presenting a three-stage breakdown (early, moderate and end). We will be looking at the most common system developed by Dr. Barry Reisberg of New York University who developed a seven-stage system as a framework to understand the progression of Alzheimer’s disease.
The rate of progression of the disease varies. Once a person is diagnosed with Alzheimer’s disease, they can live as long as 20 years depending on other factors. Because stages overlap considerably, it can be difficult to place an individual with Alzheimer’s disease in a specific stage at any given time.
During this stage, there are no detectable memory problems or other symptoms of dementia. This stage could also be referred to as the pre-clinical phase. It has been found that changes in the brain begin years before any actual signs of the disease develop.
Forgetfulness can be brought on for a number of reasons including normal aging, head injuries, vitamin deficiencies, medication side-effects, depression, meningitis, syphilis, drug-interactions, dehydration, brain tumors and the effects of alcohol and/or drug abuse. Some of the causes are reversible that is why it is important for the patient to follow-up with their primary care-giver to find the cause.
Symptoms of Stage 1 Alzheimer’s:
You may be wondering which symptoms a person may have at this stage, and how we can differentiate between normal forgetfulness that comes with aging and Alzheimer’s. Examples of the differences between forgetfulness in normal aging and Alzheimer’s are:
In normal aging, you may not be able to find your keys, and you may have “senior moments” where you can’t remember a name or a word and can’t find a recipe. You may also forget to make a record of a check you issue.
In early Alzheimer, you commonly misplace items, e.g. you may place your keys in the refrigerator or in the oven; you also forget the names of people well-known to you, and you start substituting for words you cannot recall. You may also dress inappropriately, like wearing your top coat in summer. And even when someone shows you where a recipe is, you can’t follow it. If you have Alzheimer’s, you can also experience rapid mood swings that may at times take you rapidly from a happy demeanor to anger and raging.
Treatment of Stage 1 Alzheimer’s:
As previously stated, the first stage is the pre-clinical stage, and there is often no necessary treatment. The first stage does not involve a decline in a patient’s mental ability. The plaques and tangles associated with the disease can however be present in the brain several years before there is any noticeable effect to the patient or their abilities.
Caregivers and Activities for Stage 1 Alzheimer’s:
It is important to stay mentally and physically active at every stage, not just with dementia, but generally in life. Provide your loved one with activity books that help memory and word recall. Encourage physical activity such yoga, walking, and stretching. Stay active with social groups, go out to lunch and dinner with friends and family. And periodically have your family member checked by their primary care physician.
A Day in the Life (stage 1 Alzheimer’s) – the story of James
James was a 55 year old engineer. He would occasionally forget the name of a colleague. This concerned James, since he was known for his good memory, and because he had a family history of Alzheimer’s disease. Both of James’ parents were diagnosed with the disease in their sixties and James and his siblings took care of them until they were admitted to a long term care facility. James went to his primary care physician to find a cause for his forgetfulness. After going through a battery of tests at his doctor’s office, James found out that he was diabetic and made the necessary changes to his diet and started taking medication. His doctor encouraged him to stay active and to take his medications and to return for a follow-up appointment. In this case, James did not have Alzheimer’s disease. He did have concerns because of his age and family history. He found out that his forgetfulness could be attributed to diabetes. Continuing to monitor himself and remain aware of his health will help both James and his family.
At this stage, the individual may still do well on memory tests and people close to the individual may not notice any significant changes. The individual is still able to function. Also at this stage, memory loss can’t be easily differentiated from normal age-related forgetfulness. The individual is still able to work and live independently. The patient will be the first to notice changes that no one else can identify including the physician.
Symptoms of Stage 2 Alzheimer’s
In stage 2, the patient may:
- Forget words
- Forget names
- Misplace common objects
- Have difficulties in concentration
- Have problems remembering recent events
Caregivers and Activities for Stage 2 Alzheimer’s:
The family can help the patient by taking them to their primary care provider to make sure that there are no reversible reasons for the changes. The physician is important at this stage to make sure that the patient is not misdiagnosed. There are conditions that can mimic dementia that are reversible, like urinary tract infections. Treatment will depend on the cause of the symptoms, and other conditions that the patient may have, such as hypertension, diabetes, stroke, and heart disease to name a few. Work to ensure that the patient maintains autonomy and dignity.
A Day in the Life – The story of Ella
Ella is a 60 year-old widow who lives with her son and his wife. Ella loves to do puzzles with her 11 year-old granddaughter. Recently, Ella found it difficult to complete this activity with her granddaughter. She speaks to her son about her loss of concentration, and they make an appointment with her primary physician for further evaluation.
People in this stage will begin to notice of changes in their loved one. The individual will have difficulty on cognitive tests, and doctors will be able to detect a decline in functioning. Performance in demanding situations may weaken, and the individual may be unable to learn new job skills. This is the stage when Alzheimer’s disease is diagnosed.
Symptoms of Stage 3 Alzheimer’s:
The individual may still drive an work. Patients in stage 3 will have a lot of difficulties including:
- Finding the right word during conversations
- Planning and organizing
- Remembering the name of new acquaintances
- Difficulty performing tasks in social or work settings
- Losing or misplacing valuable objects
- Forgetting material that one has just read
- Asks the same questions over and over
- Inability to maintain a thought long enough to act on it
The family can help their loved one by making sure bills are paid, and making sure he/she gets to appointments on time. In order to help the patient mitigate stress, this may be a good time to retire and to get legal and financial matters taken care of. Adjust home surroundings so that patients don’t get confused. Keep their choices simple, regularly assess their ability to drive safely, reduce clutter, and place lists of contact numbers at convenient spots so that they can call when they need help.
A Day in the Life – the story of Amy
Amy remembers when her mother began showing signs of Alzheimer’s Disease. It started shortly after Amy’s father died. Her mother began bouncing checks. This was odd since her mother was always the one who took care of the bills and was always well organized. Amy thought the changes in her mother was due to the recent passing of her father. Her mother’s hygiene was poor, she did not want to eat and she seemed to get easily confused. After convincing her mother to go to the doctor to get checked for depression, her worst fears were realized, her mother had Alzheimer’s.
During this stage, signs and symptoms of Alzheimer’s Disease become obvious. Thinking and reasoning issues become clearer, and new issues appear. Patients in this stage often withdraw from participation in activities they previously enjoyed, like conversing with family.
Symptoms of Stage 4 Alzheimer’s:
Patients with stage four Alzheimer’s disease:
- Have difficulty with simple arithmetic
- May forget details about their life histories
- Have poor short term memory (may not recall what they ate that day)
- Inability to manage finances and pay bills
- Have trouble cooking meals or ordering from a menu
- Forget what month or season it is
Caregivers and Activities for Stage 4 Alzheimer’s:
The family can help the patient by making sure that he/she is safe, assisting with daily chores, making sure that he/she is not driving, and ensuring that the patient is not being taken advantage of financially.
A Day in the Life – the story of Mrs. Smith
Mrs. Smith always enjoyed cooking for her family. Her husband noticed that she would forget food was cooking and had even left the gas on in the kitchen at one point. Mr. Smith has to watch his wife and make sure that they are both safe, and that nothing is left on accidentally.
During this stage, patients begin to need help with normal day to day activities. Patients in this stage are able to bathe and go to the bathroom and are still able to recognize family members. They are also still able to recall their history, especially details about their youth.
Symptoms of Stage 5 Alzheimer’s:
People in stage five may experience significant confusion. They often have an inability to recall simple details like their own phone number. They have difficulty dressing appropriately and require assistance in choosing the right clothes for the right season. They may have difficulty with remembering the time of day and identifying which season they are in. The patient can easily get lost since they do not remember their address.
Caregivers and Activities for Stage 5 Alzheimer’s:
The family can help by laying out appropriate clothing and encouraging the patient to be independent by allowing them to dress themselves. Caregivers should also respond to the patient’s questions, even when he repeats them (this may help reassure the patient). Listen to him/her when they want to tell a story, even when they don’t remember all of the facts. Engaging the family member in conversation helps them to use their imagination. It is important to be there for your loved one and continually reassure them.
A Day in the Life – the story of Mr. Jones
Mr. Jones has Alzheimer’s and difficulty choosing the right clothes. He frequently chooses winter sweaters and winter coats to wear in the summer. His wife helps him by laying out the appropriate clothing for him and reminding him of the time of year.
Patients in the sixth stage of Alzheimer’s disease need constant supervision, and if family are not able to provide care, the patient will require professional caregivers. The patient will require assistance and/or reminders with many of the activities of daily living (bathing, toileting, and dressing). The patient may also experience incontinence of bowel and bladder.
Symptoms of Stage 6 Alzheimer’s
An individual in the sixth stage may experience:
- Confusion or unawareness of environment and surroundings
- Major personality change and possible behavior problems
- The need for assistance with activities of daily living such as toileting and bathing
- Inability to remember most details of personal history
- Loss of bowel and bladder control
At this stage, the patient may need help with going to the bathroom, for they may simply forget how to go to the bathroom. They may have delusions like, needing to go to work when they are well past work, which may cause wandering.
Caregivers and Activities for Stage 6 Alzheimer’s:
You may be able to help by giving them a job in the home, like setting the table or folding the laundry. It is important to remember that your loved one may be easily startled, so approach him/her from the front so that they do not get scared. Your tone of voice is all-important as well. What you say is as important as how you say it. Think of yourself being in a foreign country and not speaking the language, how would you feel if people were yelling at you and frowning. In the same situation, if people are smiling and speaking in calm tones, you would feel comfortable and safe. Treat your loved one as though they are a visitor from a foreign country who does not speak the language.
A Day in the Life – the story of Tiffany
Tiffany and her sisters have been taking care of their mother in her home. Their mother has Alzheimer’s disease, and the sisters live nearby and take turns staying with her and providing her with daily assistance. Recently, it became necessary to enroll their mother in an adult day care. Their mother always valued education, and they told her that the adult day care was a school. This allowed them to keep their mother safe and socially engaged and stimulated.
This is the final stage of Alzheimer’s disease, with patients nearing death. Patients lose the ability to respond to their environment or communicate, and while they may utter words or phrases, they have no insight; they require assistance with all activities of daily living. In the final stage of the illness, patients lose their ability to swallow.
Symptoms of Stage 7 Alzheimer’s:
- Patients require full-time, around the clock assistance with daily personal care
- They have increasing difficulties communicating
- They experience changes in physical abilities (walk, sit, and eventually swallow)
- They become vulnerable to infections, especially pneumonia
Caregivers and Activities for Stage 7 Alzheimer’s:
Many of the basic functions of daily living are lost in this final stage. The person is no longer able to walk, eat, or sit up. Stay involved by feeding your loved one with soft, easy to swallow food, helping the patient use a spoon, and making sure that they are drinking plenty of liquids, as many people in this stage can no longer tell when they are thirsty. Maintain your loved one’s mobility by assisting them with walking using whatever equipment necessary (walker, gait belt or wheel chair). The progression of this stage will depend on the overall health of the patient and the care that they are receiving.
A Day in the Life -the story of Mr. Grant
Mr. Grant is in the final stage of Alzheimer’s disease and can no longer feed himself. His son comes to the nursing home every day at dinner time and feeds him. It is important that Mr. Grant is sitting up in the wheel chair properly to prevent aspiration.
Alzheimer’s treatment and care are connected. Although there is no cure, there is a lot that can be done. The treatment regimen that is prescribed varies from person to person, and finding the appropriate treatment depends on the patient and any co-existing conditions that he or she may have. There is no cookie cutter treatment, no magic wand. Cholinesterase inhibitors help delay the worsening of Alzheimer’s by preventing acetylcholine from breaking down. Acetylcholine is important for mood, memory and learning. Cholinesterase inhibitors include:
The benefits of taking these medications include anxiety-relief, improved motivation, and better concentration and memory. Some patients are even able to continue with regular activities.
If your loved one has moderate to severe Alzheimer’s, the physician may prescribe memantine. Memantine could help improve memory, language, and reasoning. Glutamate also helps balance memory and learning. It has been shown to curb delusions, hallucinations, agitations, aggression and irritability; it can also help with disorientation and help make performing daily activities easier.
In addition, loved ones with Alzheimer’s disease can easily get anxious or upset. Some of the symptoms they may exhibit are restlessness, pacing, and agitation which can keep them from having normal day and night routines. Possible strategies for dealing with this include:
- Creating a calm and quiet place (cutting out background noise from TV or radio, and clearing away clutter, and making tasks simple).
- Checking for physical reasons for the agitation: hunger, thirst, needing to go to the bathroom. They may not be able to let you know what is wrong.
- Exercising can ease anxiety and stress (help finding an activity that they enjoy).
- Keeping your emotions in check (avoiding criticizing or arguing).
The doctor may prescribe these medicines that can curtail paranoia and confusion:
Antidepressants may be prescribed if your loved one is depressed and irritable. Options include:
Depending on your loved one’s symptoms, the doctor may also prescribe anti-anxiety medications. Possible medications include:
The best way to help your loved is to try and pace your energies and emotions and get as much respite from the disease’s deeply exhausting environment as you can. If you can afford it, hire a professional caregiver to come and give you relief, even if it is only for a few hours a day, two or three days a week. It serves you also to work in close coordination with the medical team, for they can help improve quality of life for everyone involved in your loved one’s care. In the end, the right mix of medications and compassionate caring will see you through your arduous responsibilities.