It’s instinctive to want a map. Where’s the next turn? It’s a human thought pattern. After we find out that a loved one has Alzheimer’s disease it’s only natural to research it. The National Alzheimer’s Association has developed a very useful tool, or “staging system,” to use as a frame of reference when coping with Alzheimer’s disease. The organization will be the first to tell you that people are not programmed to follow these stages in a direct line. With that in mind, we’ll look at the stages as presented by the National Alzheimer’s Association.
Stage 1: No impairment (normal function) There is some thought in the medical community that Alzheimer’s disease may start years, if not decades, before we have even a clue that anything is wrong with ourselves or our loved ones. Genetic research and much more sophisticated technology will no doubt make this an important and focused area of study as we march into the future. But, for now, most of us will never know (would we even want to?) if we are in stage one of Alzheimer’s disease.
Stage 2: Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer’s disease). At this time you or your loved one may have a sneaking suspicion that something sinister is on the horizon. Hmm, maybe we should chat with a doctor. Still, we aren’t likely to get satisfaction. Most likely, we will hear something to the effect that it’s just normal aging, and maybe we should do more crossword puzzles or take a class.
Stage 3: Mild cognitive decline The Alzheimer’s Association says that early-stage Alzheimer’s disease can be diagnose in “some, but not all,” individuals with the symptoms recognizable to family and others close to the person having problems. These symptoms include problems with words and names, decreased ability to remember names of newly introduced people, losing or misplacing something of value to the person and/or a decline in the ability to plan and organize. We can chat with a doctor, but is this conclusive? This is still a point where a diagnosis could be a tough call. I would suggest that if someone is very concerned, he or she should see a team of physicians uniquely qualified to diagnose dementia because this a point where some medications can help maintain better brain function longer into the disease. Just get in, have a good general physical and perhaps see a qualified neuropsychologist that has experience with diagnosing dementia. Schedule all of the tests suggested by this expert. Follow through with all appointments.
Stage 4: Moderate cognitive decline (Mild or early-stage Alzheimer’s disease) The Alzheimer’s Association says that by now there are clear-cut indications that a careful medical examination can detect. There would be an obvious decrease in knowledge of recent events. There would a decrease in the performance of the standard test where they ask someone to count backward from 75 by 7s. Some of us don’t do so well with numbers, yet show no signs of dementia. Some of us don’t comprehend what we read all that well, but that doesn’t mean we have dementia. They are looking for changes here. That’s why they do a lot of tests. These are characteristics that have been with us all of our lives.
Stage 5: Moderately severe cognitive decline (Moderate or mid-stage Alzheimer’s disease) Okay, this is where things get pretty obvious and serious. This is where a great deal of the agitation occurs. People are aware that they aren’t functioning normally, and it understandably makes them angry. They often take it out on the person or people they feel safest with. The Alzheimer’s afflicted person will have major memory gaps, and people at this stage often need some help with daily living .People in this stage are often unable to recall their current address or phone number. They may not remember where they graduated from school, can become confused not only about the date but the season, as well. They have trouble with easier arithmetic such as counting backward from 20 by 2s. They often need help choosing appropriate clothing for the occasion. The Alzheimer’s Association says that in stage 5, people usually retain “substantial knowledge about themselves,” such as their own names and those of their children.
Stage 6: Severe cognitive decline (Moderately severe or mid-stage Alzheimer’s disease) This stage is where really significant personality changes can emerge. That sweet person you used to know suddenly is combative, volatile and possibly violent at times. The Alzheimer’s Association says that at this stage, people lose “most awareness of recent experience as well as their surroundings. They are also prone to wandering. People sometimes get alarms installed that are meant to let you know if someone is breaking in, but they get them so they know if their Alzheimer’s afflicted loved one is breaking out. During this wandering prone stage, an Alzheimer’s afflicted person must be watched carefully. They often don’t remember their own histories and can forget the names of people they love. They need help dressing and toileting. This, too, is the stage where the sleep cycle is greatly disturbed for this person. Late day/early evening confusion, often called “sundowning,” where the person is agitated and confused is thought to have to do with light and/or activity changes that trigger the Alzheimer’s patient’s need to do something important, but they don’t know what . Stage 6 is also the phase where the caregiver will witness more paranoia or suspicions. Hallucinations are not at all uncommon, and compulsive behaviors such as picking, tissue shredding, scratching and hand-wringing can occur. This is often the phase where the person with Alzheimer’s may need to be moved to a secure environment where they are safe.
Stage 7: Very severe cognitive decline (Severe or late-stage Alzheimer’s disease) This phase, before death, is the sad time when speech is often unrecognizable, eating is difficult and swallowing can be impaired. Each stage puts new demands on the caregiver. Contact the National Alzheimer’s Association or the Alzheimer’s Foundation of America. The adjustment to the final stage, which will bring death, is one where hospice can support the caregiver, as well. This is a disease where community support can make all the difference. Get help for your loved one. Get help for yourself.
By AgingCare.com’s Carol Bradley Bursack
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Paul B. Plant, Esq., Harwell & Plant
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