Alzheimer’s disease progresses slowly through a series of stages, gradually worsening over the period of a decade or more. By understanding those stages, a caregiver is better prepared to support his or her loved one, and to benefit from the activities and emotional connections that are still viable in the early and middle stages.
Because experts differ on how precisely they characterize each stage of the disease, opinions as to the actual number of stages vary. The Mayo Clinic, for example, delineates five stages, while other authoritative sources break down the characteristics of the disease into more or fewer categories. For the purpose of simplicity, here are general guidelines that will help the caregiver recognize how far Alzheimer’s has progressed and understand what to expect.
The early stages. As alterations in the brain leading to Alzheimer’s begin to occur, there usually are no recognizable changes in behavior at all. This is called the pre-clinical stage, and it can last for many years. When symptoms do start to appear, they are likely to take the form of mild memory lapses, especially regarding more recent events and discussions, and difficulty with certain cognitive functions. This is called mild cognitive impairment, or MCI. However, it is important to understand that not everyone with MCI is in the early stages of Alzheimer’s disease. These symptoms may simply reflect the aging process or the onset of dementia of a different type. The term dementia is used to describe the symptoms of various diseases or illnesses. It is important to understand that if these symptoms do occur, one should see a medical doctor for a full workup. There are illnesses that mimic Alzheimer’s disease and it is important that treatments are specific to the illness.
Over time, for a person who is actually in the early stages of Alzheimer’s, the problems will grow. Your loved one may begin to have difficulties finding his or her way to and from places away from home, even familiar places, such as favorite stores. He or she may misplace items frequently, have difficulty expressing thoughts clearly, and abandon tasks that require clear thinking and sound judgment. There also may be personality changes, including irritability and a tendency to avoid social situations.
Those are the common characteristics of mild dementia due to Alzheimer’s disease. A caregiver should be prepared to help with certain functions, such as household and finance management, and exercise greater vigilance over the loved one’s day-to-day well-being. There is also much that caregivers can do to help alleviate the anxiety their loved one may be feeling as he or she becomes increasingly aware of these cognitive impairments. It is important to concentrate on providing support rather than just control.
The middle stage. In the middle stage of Alzheimer’s disease, the effects of the disease grow to become moderate, at which point, it likely will be necessary not to leave your loved one on his or own. Memory loss usually starts to encompass details of one’s personal history, and there also may be difficulty in recognizing friends and even family members. In this stage, the person with Alzheimer’s easily can become confused about where they are, the time of day and what day of the week it is, and may show a tendency to wander. Early in the middle stage, a person with Alzheimer’s often retains some level of functionality in terms of hygiene and personal care. A simplified daily routine is beneficial at this point.
Eventually, however, he or she will begin to need assistance with tasks, such as grooming, bathing and selection of proper clothing. In some cases, bouts of aggressive behavior reflecting suspicions of theft or conspiracy may flare up. Restlessness and agitation can become frequent behavioral characteristics, especially as evening approaches. This is a phenomenon known as “sundowning.” In some cases, visual or aural hallucinations may occur. Read our blog on suggested ways to cope with the symptoms of sundowning. Your loved one’s day should include purposeful activities. Continue to encourage independence by concentrating on what a person can do rather than what they can no longer do.
The severe stage. This phase of the disease is marked by an accelerating decline in physical abilities, together with continuing loss of mental function. The person will no longer be capable of coherent speech, and will need daily assistance with eating, dressing and bathroom activities. Incontinence is likely. He or she also may be unable to walk unassisted or to maintain a normal seated posture. In time, an inability to swallow properly, together with lack of physical activity, may lead to pneumonia or other lung infection, which is a frequent cause of death in Alzheimer’s disease.
For the caregiver, it is essential to pay close attention to one’s own physical and mental health throughout the arc of a loved one’s experience with Alzheimer’s. Consider joining support groups and enlist the help of family and close friends to provide periods of relief and diversion whenever feasible. Eat properly, and get as much physical exercise as you can. Do not try to do the impossible. The love and compassion you devote to your loved one will require that you take proper care of yourself.