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Stages of Alzheimer’s Disease

In Alzheimer’s disease, the nerve cells in a person’s brain gradually die off. The changes in the person may be very subtle at first as progression is slow. The disease can last over a period of eight to 20 years, depending on the health and particular circumstances of the affected individual.

"Understanding the various stages of Alzheimer’s disease helps one anticipate the care requirements of the individual."

It is useful to consider the various stages of Alzheimer’s disease, to understand more readily the care requirements of the individual. Researchers may identify three to five stages of Alzheimer’s disease, but division into three stages is already sufficient for the layman. Dr. Roger A. Brumback has described the stages of Alzheimer’s disease as follows.

Characteristics of the early-to-mild stage (generally covers three to five years)

     
  • Death and destruction of nerve cells usually occur first in the hippocampus, the brain’s memory area. The person may confuse dates, appear withdrawn, and may lose interest in playing with grandchildren.
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  • The person’s reasoning, judgment, and social skills are still normal, making it possible to develop coping techniques to compensate for memory problems.
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  • The person may thus deny having a problem and never consult a doctor. No one will suspect otherwise because the person appears normal.

Characteristics of the moderate to moderately severe stage (generally takes three to five years)

     
  • Destruction of nerve cells spreads to other areas of the brain. This results in the person having problems with dressing (motor skills), getting lost in familiar places or becoming disoriented, and being unable to manipulate the hands to use common objects.
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  • The person can no longer integrate visual and sound information with appropriate movements of body and limbs. This particularly makes driving a problematic activity.
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  • May exhibit paranoid behavior, accusing the spouse or friend of stealing or cheating. Easily becomes agitated, particularly toward evening.
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  • It is usually at this stage when the person decides to consult a doctor, giving family and friends their first sign that a problem exists and it needs medical assessment.

Characteristics of the severe to very severe stage

     
  • Destruction of nerve cells is more widespread and the ability to interact appropriately is lost. At this stage, it becomes very difficult for caregivers to manage the person at home. The affected individual totally loses social skills, reasoning and judgment.
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  • At first the person will recognize their spouse or caregiver, but ultimatley will no longer be able to do so.
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  • Normal speech becomes impossible and only grunting sounds can be produced.
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  • The person will need assistance with eating and problems with incontinence (of bowel and bladder) become worse.
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  • The quality of nursing care is crucial to survival during the final stages of Alzheimer’s disease. Patients can no longer function effectively to prevent other illnesses. Death usually is due to other illnesses, but Alzheimer’s disease is the underlying factor because it weakens the brain’s control over the body’s systems.
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  • Individuals lose the ability to walk without assistance,  the ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid. Swallowing is impaired.

Learning about the stages of Alzheimer’s disease enables the family caregiver to have a better idea of what is (and is not) possible to do for the patient.

 



     
  • Caregivers can waste much time “teaching” patients something when it is difficult for them to learn. It’s not that they don’t want to; it’s just that they are n longer able to do so. Understanding the limitations of the patient can help improve quality of life for both.
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  • It can be a struggle getting patients with Alzheimer’s to agree to something or answer a question. Telling them “It is time for dinner now” may be more effective than asking “Would you like to have dinner now?” It saves them the effort of making a decision. Positive statements (e.g. "Let’s go this way") are also more acceptable to them rather than negative ones (e.g. "Don’t go that way").
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  • Stick to routines and familiar activities as much as possible. Changes can produce undesirable behavior, anxiety and other negative reactions.