Understanding Dementia

Although Alzheimer’s most commonly affects people over the age of 65, there is a difference between normal memory changes caused by age and memory loss caused by a form of dementia. If you’re concerned that a loved one may have dementia symptoms, it’s important to be able to discern dementia from normal memory changes. Here are a few comparisons, but keep in mind that only a doctor can make an official Alzheimer’s or dementia diagnosis. If you’re concerned that you or a loved one may have dementia, please call your doctor to schedule a full evaluation.

• Forgetting New or Recent Information and Important Dates or Events
  Alzheimer’s warning signs: Repeatedly asking the same information; relying on excessive notes or electronic reminders for things they used to be able to remember.
  Normal memory changes: Occasionally forgetting a name or appointment for a brief period.
   
• Changes in the Ability to Make or Follow Plans and Work with Numbers
  Alzheimer’s warning signs: Difficulty following the steps of a card game or recipe; changes in the ability to do math problems or manage finances; difficulty concentrating on such tasks.
  Normal memory changes: Occasional math errors, such as when balancing the checkbook.
   
• Changes in the Ability to Complete Everyday Tasks
  Alzheimer’s warning signs: Difficulty driving to a place they go often, or remembering how to play a game, or managing budgets at home or work.
  Normal memory changes: Occasionally needing help to figure out how to use electronics.
   
• Losing Track of Time, Disorientation
  Alzheimer’s warning signs: Getting confused with the date or seasons; difficulty keeping track of time and understanding future or past events; forgetting where they are and how they got there.
  Normal memory changes: Getting confused about what day it is, then figuring it out later.
   
• Changes in Vision
  Alzheimer’s warning signs: Changes in the ability to read, see colors and contrast, and judge distance; can lead to problems with driving.
  Normal memory changes: Changes that are related to the development of cataracts.
   
• Trouble Carrying on a Conversation
  Alzheimer’s warning signs: Using the wrong word for things; inability to follow or continue a conversation; stopping abruptly when talking or repeating themselves.
  Normal memory changes: Occasionally struggling for the right word.
   
• Misplacing Things and not Being Able to Retrace Steps to Find Them
  Alzheimer’s warning signs: Placing objects in unusual places; inability to retrace their own steps to figure out where they put things; accuse others of stealing the objects they’ve lost.
  Normal memory changes: Occasionally losing things but retracing steps to find them.
   
• Changes in Decision-Making Skills and/or Judgment
  Alzheimer’s warning signs: Falling for financial scams; making unusually large monetary donations; poor personal hygiene; not wearing clean clothes or putting clothes on wrong.
  Normal memory changes: Occasionally making a poor decision.
   
• Isolation and Withdrawal
  Alzheimer’s warning signs: Less participation in social activities, work, hobbies; can be caused by difficulty remembering how to do a hobby or feeling embarrassed by their memory changes.
  Normal memory change: Occasionally wanting a break from social, work or family commitments.
   
• Mood and/or Personality Changes
  Alzheimer’s warning signs: Becoming depressed, fearful, confused, anxious, suspicious, or aggressive; can get upset with friends and family easily or when in unusual places or situations.
  Normal memory change: Getting irritated when their routine changes or gets disrupted.
   

If you or a loved one is experiencing these symptoms, see your doctor right away. Early diagnosis and therapies can help prolong independence.

Firsthand experience with people diagnosed with Alzheimer’s can be misleading. Symptoms appear, the diagnosis is confirmed, and the individual shows increasingly severe signs of cognitive impairment. As time goes on, the decline becomes more evident and more rapid. Alzheimer’s may take as long as 25 years or more to progress from the initial stages to the end of life.

1. Stage One - Business as Usual
   Medical evidence has shown that Alzheimer’s disease may be present nearly two decades before the first symptoms appear during this preclinical stage. During this time, cognitive function is normal, and the person shows no outward signs of impairment.
2. Stage Two - Getting a Little Forgetful
   Some forgetfulness is common among people 65-years old and over. At least half of this age group report occasional mild difficulty recalling a name or the placement of items. It’s initially difficult to discern normal forgetfulness from Alzheimer’s-related impairment at this stage.
3. Stage Three - Noticeable Symptoms
   In this stage, difficulty performing certain mental tasks become noticeable. There may be an associated decline in job or work performance, comprehension of technical data or the ability to follow detailed instructions. From this stage, obvious signs of dementia impairment may appear within two to four years.
4. Stage Four - Alzheimer's Diagnosis
   Diagnosis of Alzheimer’s disease can now be made with considerable certainty. The person will experience increased difficulty working with numbers, remembering the day of the week or year, and recalling details from their own past. They may become withdrawn out of frustration or embarrassment. Studies show this stage averages two years.
5. Stage Five - Memory Gaps
   The severity of cognitive decline leads to increasing difficulty managing basic activities of daily living and reduces the likelihood that the individual can safely live alone. Typical ability loss includes the ability to identify or prepare their own food, and recalling vital information such as age, address or current year. They may also become more vulnerable to scam artists due to a decline in reasoning.
6. Stage Six - Severe Mental/Physical Decline
   Symptoms at this stage are sever enough to jeopardize the individual’s well-being. Hygiene and cleanliness become issues as they lose the ability to perform basic toileting tasks and become incontinent. They may display little to no knowledge of their circumstances. They may begin to confuse loved ones with deceased relatives, or forget important names. This stage may last an average of two years.
7. Stage Seven - Functional Failure
   This stage is often called late-stage Alzheimer’s. People in this stage require continuous care. They will soon lose the ability to speak and walk, and eventually movement becomes limited. This stage may last many years, although other factors such as pneumonia, flu, cancer or infection may accelerate their decline.

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.