What is Alzheimer's Disease?
Alzheimer's disease is a disease that affects your memory, your concentration, thinking, and even your behavior. Many times, Alzheimer's starts with just forgetting recent events and a couple of details about yourself and your loved ones, but soon, it progresses into severe dementia where patients cannot remember who they are or recognize any of their loved ones.
Alzheimer’s is a prevalent form of dementia and according to the World Health Organization (WHO), about 60%-70% of elderly people with dementia have Alzheimer’s. This article seeks to provide a detailed explanation about the stages of Alzheimer's Disease and the care that can be used to manage those stages. But before we start explaining the stages, let's try to understand the causes of Alzheimer's.
The Causes of Alzheimer’s Disease
Alzheimer's is a disease that has affected an abundant array of people, especially older people. Therefore, it is inevitable that many scientists and healthcare personnel have tried their best to identify the causes of the disease. Although the exact causes of the memory loss disease have not yet been fully understood, scientists believe that this disease can be caused by genetics as well as environmental and lifestyle factors that affect the brain.
However, what can surely be understood is that Alzheimer's disease is caused by gradual brain cell death and nerve damage, where the proteins in the brain fail to function properly and disrupt the work usually done by the brain cells.
Two proteins that researchers are convinced are hallmarks of Alzheimer's are Plaques and Tangles.
- Plaques occur when beta-amyloids, which are leftover fragments, form large clusters of protein deposits in the brain, which then disrupt communication between the cells and have a toxic effect on neurons in the brain.
- Tangles, on the other hand, have to do with Tau proteins which usually carry nutrients and other essentials to neurons. When Tau proteins organize themselves into structures called Neurofibrillary tangles, they disrupt the neuron’s transport system and become toxic to the cells.
2 Main Types Of Alzheimer’s Disease:
- Late onset Alzheimer's: This is the most common form of Alzheimer's that affects people ages 65 and above.
- Early onset Alzheimer's: Most times, Alzheimer’s affects older adults above the age of 65 years. However, there are patients below the age of 65 who have this memory loss disease. In fact, only about 5% of people with Alzheimer’s have early onset Alzheimer's disease. Scientists have found that early onset Alzheimer's is linked closely to a defect in a person's DNA called Chromosome 14, or the twitching and spasm of the Myoclonus muscle.
The Stages of Alzheimer’s Disease
Patients have varying experiences with the memory loss disease known as Alzheimer’s. However, there are inevitable similarities that every patient experiences as the illness progresses. Different researchers have different methods and criteria that they use to classify the different stages of Alzheimer's. Some use the three-phase model (early, moderate and end) to explain the stages of Alzheimer's.
However, others have found ways to systematically break down the stages in order to offer a better understanding about the progression of the disease. An example of such a systematic breakdown which is most commonly used is the Global Deterioration Scale for Assessment of Primary Degenerative Dementia (GDS) developed by Dr. Barry Reisberg of New York University, also called the Reisberg Scale. We'll be using this seven-stage GDS to explain the progression of Alzheimer's disease from the beginning to the end.
However, it is important to note that these seven stages of the GDS may not apply to people with early onset Alzheimer's disease.
Alzheimer’s Stage 1: Preclinical Stage (A Period Without Cognitive Decline and Impairment)
Although most senior citizens only begin to realize that they have Alzheimer's disease when they start experiencing mild cognitive impairment evident in the second stage of the disease, the disease begins in the preclinical stage. In this stage, most Alzheimer's patients do not show signs or symptoms of having Alzheimer’s disease. In fact, they function normally in all aspects of their life. However, this is the stage where changes begin to occur in the brain that eventually lead to the early stages of Alzheimer's disease. The only way to diagnose the disease at this stage is through some of the new imaging technologies in advanced research settings.
The beta-amyloid plaque is the hallmark of the memory loss disease and imaging technologies may be able to identify the deposits of the protein that causes the disease. Apart from brain imaging tests, there are also biomarkers that can be used to support the diagnosis of Alzheimer's. Because sometimes Alzheimer's runs in some families' genetic link, genetic tests can also be used to identify people with a high risk of getting Alzheimer's during this preclinical stage.
Alzheimer’s Stage 2: Very Mild Cognitive Impairment
In this stage, subtle symptoms of Alzheimer's disease may begin to appear. The symptoms may seem natural, especially if your elderly loved one is a senior citizen. This is because the symptoms may include just mild forgetfulness that people expect to come with aging. So, most times, they are usually overlooked. Patients may find themselves forgetting the right words to say during a conversation or where they left an important item, like their keys or wallet. Sometimes, they may end up forgetting recent events, conversations, and even important doctor appointments that they would usually remember.
During this stage, the symptoms of Alzheimer's disease don't actually interfere with the patient's lifestyle and their ability to work or live independently. Most times, a doctor or even a caregiver may not be able to pick up on the fact that your elderly loved one has Alzheimer’s. Only the patient will begin to realize gradually that something is amiss because of the mild changes to his or her memory and ability to think.
However, it is important to note that there are other illnesses that can cause mild cognitive impairment other than Alzheimer's. And this is why it is so tricky to identify whether mild cognitive impairment is due to Alzheimer's or another mental health condition. The only way to diagnose the source of mild cognitive impairment is by using the same imaging tests and procedures usually used to test patients in the preclinical stage.
Alzheimer’s Stage 3: Mild Cognitive Decline
At this stage, the mild cognitive impairment caused by Alzheimer's disease becomes more and more obvious to loved ones of the seniors. This is because senior citizens begin to experience increased cognitive declines that begin to affect their daily life, ability to independently perform activities of daily living, and their performance with instrumental activities of daily living. It is mostly during this stage that the senior caregivers or family members may recognize the signs of Alzheimer's. It is important to speak up if you observe your elderly loved one seeming a bit different and exhibiting Alzheimer’s symptoms, as this may lead to doctors diagnosing the disease. With a doctor’s diagnosis, you will be able to implement the proper care plan to ensure your loved one has the best possible care for their unique situation. This may also be the stage when you may need to discuss with your loved one about considering retirement and ensuring their legal and financial affairs are in order.
The symptoms of mild cognitive decline during the third Alzheimer’s stage may include:
- Forgetting something they just read or a place they just went to.
- Asking the same or similar questions repetitively.
- Having difficulties organizing and making plans.
- Problems with remembering the names of new acquaintances.
- Forgetting the right word to say or the right name for something.
- Misplacing valuable objects.
- Having difficulties driving.
- Having difficulty concentrating.
- Confusing time and places.
- Impaired reasoning and judgment.
Patients in the first three stages of Alzheimer’s are classified as being in the early stage of Alzheimer’s and they need to be carefully taken care of with companion care, before they need skilled nursing care or any other type of senior care.
Alzheimer’s Stage 4: Moderate Cognitive Decline (Early Dementia)
During the fourth stage, you may more clearly notice concerns with your loved one’s reasoning and thinking ability. It is at this stage that dementia begins to set in, and your elderly loved one begins to forget details about themselves, financial and legal matters, and friends and family for brief moments. Sometimes, your loved one may even forget the season, date, time, or place.
At this stage, any Alzheimer's patient should not be working, driving or executing any complex task by themselves. They should receive support with instrumental activities of daily living and various activities of daily living. And if possible, for the sake of their safety, patients should be closely monitored and cared for. This is because at this stage, patients are extremely forgetful, have difficulty concentrating, and need support with paying their bills and managing their finances.
There is also the fact that there are senior citizens in stage four of Alzheimer's that are in complete denial of their forgetfulness, other symptoms, or the fact that they even have Alzheimer's. This denial comes with impediments on their socialization and they may begin to withdraw from their friends and family, resulting in senior isolation and loneliness.
The moderate decline stage of Alzheimer’s disease is part of the middle stages of the memory loss disease which can last for many years, during which your elderly loved one may begin to develop more progressed symptoms and stages of dementia. Therefore, stage four of Alzheimer's disease is usually referred to as early dementia, and is very different from early-onset dementia or early onset Alzheimer's, which will be explained later on in this article. It is also the stage when you need to start giving proper dementia care to cater to dementia behavior as you may notice the following symptoms:
- Memory loss.
- Confusions about their surroundings, events, and details about their life.
- Poor short-term memory.
- Difficulty with simple arithmetic.
- Experience some personality changes (showing subdued or withdrawn behavior or uncharacteristic anger and agitation).
- Lapses in judgment.
- Lack of motivation. Senior is not motivated to start and complete tasks.
- Signs of delusional behavior, depression, apathy, anxiety, and agitation as the disease progresses past the fourth stage.
- Wandering around their familiar living area and start getting lost in their familiar areas
- Slight baseless suspicions about their family members, friends, and caregivers.
- They may develop a difficulty to express their thoughts and ideas.
Alzheimer’s Stage 5: Moderately Severe Dementia Decline (Early Dementia /Middle Dementia Stage)
When seniors reach the fifth stage of Alzheimer's, they become more confused and forgetful about everything. At this stage, your loved one needs to be monitored very closely and they need even more help with their activities of daily living, like choosing the appropriate clothing for the occasion or season, bathing, grooming, using the bathroom and self-care. It is very possible that some elderly adults may even experience incontinence and lose control over their bladder and bowel movements. However, most patients still maintain minimum functionality at this stage.
An Alzheimer's senior at the fifth stage might have trouble remembering how to get home after they left home, their phone number, their identity and who they are. At this stage, it is recommended you provide the necessary emotional support to your loved one, as this is a particularly emotionally challenging stage. For example, if your loved one with Alzheimer's asks you the same questions repeatedly over and over again, you should make sure you answer their questions in an even and reassuring tone. Sometimes, your elderly loved one might have actually forgotten the answer and sometimes, he or she might be trying to reassure himself or herself that they still remember the answer to that question.
Regardless of their confusion and memory loss, some seniors in the fifth stage of Alzheimer's may still remember part of their personal history and details about their family. However, many times, they may experience blanks in the information they can still remember. They also might not be able to recognize their children or spouse, and they may start mistaking other people or strangers as their close family members. Also, some patients with Alzheimer's disease at this stage usually have trouble sleeping. By better understanding the reasons for their challenges, you may be able to create an action plan to best support them.
Alzheimer’s Stage 6: Severe Cognitive Decline
When Alzheimer's Disease progresses to the sixth stage, many patients hardly recognize their loved ones. For example, a male patient might see his daughter and call her his wife, or see his son and call him his brother. Even strangers bearing any kind of resemblance to family members or no resemblance at all are not spared from being mistaken as family members.
At this sixth stage, a senior citizen may also develop delusions and hallucinations. This usually leads to a lot of wandering around and getting lost if they are not closely monitored. It is also very likely that at this stage your senior loved one may lose control over many aspects of their life, such as their ability to independently dress, bathe, and toilet.
Your loved one with Alzheimer's may also find it difficult to talk, but it would be great for you to sit with them and talk to them. Activities like playing the music they enjoy, or reading the news or a book to them work effectively. If they discover the blanks in their memory at this stage, you can either give them old photos to help recall their memories and address those blanks, explain the blanks very calmly, or allow them to use their imagination to fill the blanks.
Alzheimer’s Stage 7: Very Severe Dementia Decline
At this seventh stage of the disease, your elderly loved one may begin to lose weight. They may lose the ability to carry out daily activities, such as walking, eating, or sitting up. Most seniors with Alzheimer’s can only be spoon-fed easy-to-swallow food at this stage of the disease. During this seventh dementia stage, your loved one needs your emotional support the most because they may have lost all knowledge or memory of who they are and who their loved ones are.
However, the care from a loved one can never be underestimated as seniors tend to eat more when fed by their loved ones, and feel more comfortable when surrounded by their loved ones. You may also consider checking with your doctor about their thoughts on who should be around your loved one. Your elderly loved one should only be surrounded by smiling and reassuring faces. At this seventh stage, many patients may also be restless or anxious, with occasional irritation or angry outbursts because of their confusion. Your loved one may exhibit symptoms of the seventh stage of Alzheimer’s, such as:
- Decreased ability to express themselves coherently. Many times, they may mumble a few words but they can no longer converse in a way that makes sense.
- Require full-time care. There must be someone always available to see to your loved one's needs and daily self-care. If you are not able to provide full-time care, consider hiring a caregiver from one of your local home health care agencies, or start looking into nearby senior living options such as local personal care homes.
- Decline in ability to perform any of their regular physical ability as their muscles become rigid. They may lose the ability to swallow, along with the ability to control their bowels and bladder.
- Increased vulnerablity and susceptiblity to infections, if they are not guarded carefully.
How to Care For Your Loved One Who Experiences Late Stages of Alzheimer’s Disease
Even though many seniors with this memory loss disease may lose their ability to talk and perform their basic daily self-care tasks, part of the core of their personality still remains. Therefore, you can still try to connect with your elderly loved one by playing their favorite music, reading their favorite books, preparing their favorite food, brushing their hair, pushing their wheelchair around or, enjoying time together in the beautiful natural wildnerness.
Monitor their eating: Many Alzheimer's disease seniors tend to lose their appetite and many just forget to eat. It is up to the caregiver to regulate their eating habits with a time table for their meals. It is also best to cook your loved one’s favorite meals and to add supplements to the meals, especially if your loved one is losing weight too fast.
Here Are A Few Tips To Encourage Your Loved One with Alzheimer’s / Dementia To Eat:
As a decreased apetite and lack of ability to prepare healthy nutritious meals can be challenging for seniors with Alzheimer’s, consider the following activities to support them as you are their caregiver:
- Prepare their food carefully to adapt to their eating habits. For example, seniors with swallowing problems should be fed soft foods that are easily eaten and swallowed. Liquids taken should also be thickened by adding unflavored gelatin or cornstarch.
- To maintain the dignity of the patient, you can help them eat as independently as possible. It could just be as simple as putting food on a spoon, placing the spoon in the patient's hand and guiding the spoon to their mouth. In an instance where patients cannot hold onto eating utensils, you can consider finger foods to eat.
- You will need to assist your loved one with late-stage Alzheimer's when they're eating. You should remind them to chew and swallow and ensure that they chew, and monitor to make sure they chew and swallow each bite before eating another bite.
- The best way to aid digestion is to keep your elderly loved one upright for 30 minutes after eating.
Many Alzheimer's patients lose the ability to know whether they're thirsty or not, thus leading to severe consequences due to dehydration. You will also need to monitor their hydration and encourage them to drink at least eight 8 ounce glasses of water per day. You must also carefully check the temperature of their drinks before allowing them to drink, to ensure the beverage is not too hot or cold.
Other common issues associated with Late Stages of Alzheimer’s Disease:
Weight loss is one of the symptoms of late-stage Alzheimer's, usually due to another illness, insufficient nutrients in meals, or as a side effect of their medications. As such, you should monitor your loved one’s weight and meet with their doctor to have their weight loss evaluated.
Toileting: Incontinence is pretty common during the late stages of Alzheimer's. You can try to set a toileting schedule or routine, and keep a written record of what, how often, and how much your loved one eats, drinks and goes to the toilet. You can use disposable briefs and other absorbent products as a backup option at night, and limit the amount of liquid taken before bedtime. There might also be a need for you to monitor the patient's bowel movement to watch out for constipation.
Body Health: Most seniors in the late stage of Alzheimer's become bedridden, so you have to relieve their body pressure and improve blood circulation by changing their sitting or sleeping position timely to help keep them comfortable.
You also need to guard your elderly loved one against infections, especially pneumonia because with old age and the last stage of Alzheimer's, they may be vulnerable to infections. You must prevent them from falling or having the flu. As the time to heal wounds takes longer for senior citizens, you should immediately treat any injury, cuts or scrapes, and ensure your elderly loved one maintains proper body and oral hygiene.
Since communication may have become difficult for your senior citizen, you need to watch out for any signs that indicate they may be in pain or have an illness, such as pale skin tones, mouth sores, or modifications to their sound and facial expressions. Also, observe for wincing, signs of pain and anxiety, trembling, acting out, or agitation.
Our elderly loved ones with Alzheimer's disease need a lot of care, especially when the disease progresses to the later stages of dementia. Sometimes, you might be burnt out from caregiving and need to consider the various options available to you to ensure you provide your loved one the best care possible, and the comfort they may need as they go through the various stages of Alzheimer's. When care at home is no longer feasible, start looking into local care options for your loved one with Alzheimer’s:
Assisted living centers near you – they may have memory care units to provide the proper dementia care
Alzheimer’s care facilities near you – these are dedicated facilities that specialize in dementia and Alzheimer’s care. They may be more expensive than assisted living, but they may offer more treatment options for your loved one with Alzheimer’s.
Nursing homes that offer memory care – as a last resort, consider a nursing home for your loved one. If their Alzheimer’s condition is so bad that they require 24/7 nursing care, this may be the proper option for them.
Expert senior caregivers at care facilities have supported dozens or hundreds of cases and have learned the ins and outs of proper dementia care. Consider getting the help you need when you can no longer manage your loved one’s Alzheimer’s condition.
About the Author:
"Alzheimer's Stages, Symptoms, Signs and Proper Care" is authored by Anisha Rao, MPP, Healthcare Consultant, Certified Lean Six Sigma Green Belt Healthcare Professional. Anisha holds a Master of Public Policy from the University of Maryland, Baltimore County, as well as a Bachelor of Arts in Health Administration and Public Policy, a Bachelor of Arts in Psychology, and a Minor in Management of Aging Services. Anisha has extensive experience in Healthcare Services and Aging issues, including dementia care, Alzheimer's care, senior health, and nursing home care. Anisha is passionate about ensuring seniors with Alzheimer's disease receive the best care possible and empowering seniors to become more involved in their care planning decisions.