The Seven Stages of Alzheimer’s.
Alzheimer’s disease is the fifth leading cause of death in people 65-and-older. The National Alzheimer’s Association estimates that about 1-in-8 Americans in that age group has the disease. Among those 85-and-older, more than 47% will have Alzheimer’s or some other form of dementia. Estimates are that by 2030, nearly 8 million Americans will have Alzheimer’s.
While the specific symptoms and rate of decline may vary, researchers have identified seven stages in the progression of Alzheimer’s disease. It is important to note that while symptoms described here are typical of Alzheimer’s, confirmation of the disease requires professional medical diagnosis.
Firsthand experience with people diagnosed with Alzheimer’s can be misleading. Symptoms appear, the diagnosis is confirmed, and the individual soon shows increasingly severe signs of cognitive impairment. As time goes on, the decline becomes even more evident and more rapid. But we’re only seeing the end result of a process long in the making. The fact is that from Stage 1 through Stage 7, the progression of Alzheimer’s disease may take as long as 25 years or more.
Stage 1 – “Business As Usual”
Medical evidence reveals that Alzheimer’s disease may be damaging the brain for nearly two decades before the first symptoms appear. During this time – the period researchers have identified as Stage 1 – the person shows no outward signs. Cognitive function is normal, and for the individual it’s seemingly business as usual.
Stage 2 – “Just Getting A Little Forgetful”
“Forgetfulness” is a familiar complaint among people 65-and-over. In fact, at least half of all persons in this age group report occasional mild difficulty in recalling someone’s name or remembering where they left items such as keys or eyeglasses. Forgetfulness can be caused by any number of factors, many unrelated to Alzheimer’s disease. But while “normal age forgetfulness” is simply another aspect of aging and may not be particularly noticeable to loved ones or even the family physician, persons with these symptoms may later be diagnosed with Alzheimer’s. In confirmed cases of Alzheimer’s, it is routinely discovered that the individual had previously exhibited “Stage 2” symptoms.
Stage 3 – “Symptoms Becoming Noticeable”
In Stage 3, family members and close associates become aware of the person’s difficulty in performing certain mental tasks. The individual may be unable to find the right word when speaking or to recall something they just read. If he or she holds a job, co-workers or supervisors may notice an obvious decline in job performance, particularly if it involves complex planning or organizational skills. The individual may find it increasingly difficult to master new job skills, to comprehend technical data or follow detailed instructions. This inability to concentrate can produce feelings of anxiety. In such cases, professional counseling may recommend taking retirement or withdrawing from demanding activities to ease the psychological stress. For the majority of people in Stage 3, obvious signs of dementia will appear within two-to-four years.
Stage 4 – “Diagnosis: Alzheimer’s”
At this stage, diagnosis of Alzheimer’s disease can be made with considerable certainty. The individual exhibits increased difficulty with numbers, often apparent in their inability to manage finances (e.g., they frequently write the wrong date or wrong amount on checks or payment slips). They may have trouble remembering the day of the week or month of the year. They may forget details from their own past. As their personal frustration with these previously simple tasks increases, they become more reserved and less responsive to others. Rather than acknowledge the pain of their situation, they attempt to deny it; to hide it – even from themselves – by withdrawing from conversations and social interaction. Studies show this stage averages two years.
Stage 5 – “Memory Gaps and Confusion”
The severity of cognitive decline in Stage 5 typically creates difficulties with basic activities of daily living and reduces the likelihood that the individual can safely live alone. Without help, the person may be unable to identify or prepare proper foods. Their ability to recall vital information such as their age, address or the current year is sporadic. They may wear the same clothes day after day, unable to choose apparel appropriate for current weather conditions. Because they are incapable of making reasoned choices, they can become vulnerable to strangers and scam artists. Loved ones and close associates will notice a marked change in the person’s behavior, with increasing instances of unprovoked anger and suspicion. The average duration of Stage 5 is one-and-a-half years depending on other unrelated health conditions.
Stage 6 – “Severe Mental and Physical Decline”
Symptoms at this stage are severe enough to jeopardize the individual’s well-being. Early signs of Stage 6 include an inability to dress without assistance; i.e., dressing backwards or putting street clothes overnight clothes. Hygiene and cleanliness become issues. The person may be unable to brush their teeth or adjust the temperature of bathwater. As the disease progresses, they become incontinent and require assistance with all aspects of toileting. Because of the severity of their decline, they may display little or no knowledge of current circumstances, and may confuse loved ones with deceased relatives, or forget the names of their parents or spouse. They exhibit difficulty in speaking. Their fear and frustration can trigger emotional outbursts and aggressive behavior. Stage 6 lasts an average of two-and-a-half years depending on other unrelated health conditions.
Stage 7 – “Functional Failure and Death”
In Stage 7, or what is often termed “late-stage Alzheimer’s,” individuals require continuous assistance in order to survive. At this stage, speech is limited to a handful of intelligible words at most. The individual subsequently loses all ability to speak. This is soon followed by a decrease in their ability to walk. Eventually movement itself is limited, and they become unable to sit or even hold their head up without assistance. The diminished functioning also affects their ability to smile, with the only observable facial expression being a grimace. Victims of late-stage Alzheimer’s may live on in this tragic condition for many years, although because of other contributing factors such as pneumonia, aspiration, severe flu, infection, cancer, COPD, CHF, etc., this last stage rarely lasts more than two years. Those who do live on are likely to exhibit increased rigidity as well as “infantile” reflexes such as sucking before finally succumbing.
For more information about caring for your loved one with Alzheimer’s, call ComfortCare Homes at 316-685-3322.