Stage : Severe Cognitive Declinemoderately Severe Dementia
At this stage, the ability to perform basic activities of daily life becomes compromised. Functionally, five successive substages are identifiable. Persons initially in stage 6a, in addition to having lost the ability to choose their clothing without assistance, begin to require assistance in putting on their clothing properly. Unless supervised, the person with Alzheimers disease may put their clothing on backward, they may have difficulty putting their arm in the correct sleeve, or they may dress in the wrong sequence.
The total duration of the stage of moderately severe Alzheimers disease is approximately 2.5 years in otherwise healthy persons.
At approximately the same point in the evolution of AD, but generally just a little later in the temporal sequence, AD persons lose the ability to bathe without assistance . Characteristically, the earliest and most common deficit in bathing is difficulty adjusting the temperature of the bath water. Once the caregiver adjusts the temperature of the bath water, the AD person can still potentially otherwise bathe independently. As this stage evolves, additional deficits occur in bathing and dressing independently. In this 6b substage, AD persons generally develop deficits in other modalities of daily hygiene such as properly brushing their teeth.
Stages 6c, 6d, 6e
Stage : Noticeable Memory Difficulties
Unlike basic forgetfulness, noticeable memory difficulties actually affect an individuals daily routine. Things like forgetting words, challenges at work or in social settings, forgetting plans, difficulty organizing, and struggling to remember information are all considered noticeable memory difficulties.
Very Advanced And Terminal Dementia
You may also encounter terms such as very advanced dementia,very late-stage dementia,end-stage dementia or terminal dementia.
Very advanced and late-stage usually mean the person has become bed-bound, cannot speak, and has to be spoon-fed. Eventually, people in this stage will have difficulty swallowing as well.
How long this very advanced stage of dementia lasts really depends on the person, and on their other health conditions. In this stage, the mind seems gone but the body remains able enough to keep living, as long as food and a safe, supportive environment are provided.
Because in otherwise healthy people this stage can last for a few years, I dont consider very advanced dementia to be synonymous with end-stage or terminal dementia.
Now, its important to remember that Alzheimers and most other dementias are technically terminal diseases, meaning that unless another health problem kills someone first, the dementia does inevitably progress and results in the persons death.
But, we dont usually refer to people with dementia as terminally ill. Thats because Alzheimers and other dementias usually progress very slowly. So it can take ten years or even longer for a person to die of Alzheimers.
How to know if its end-stage or terminal dementia?
Doctors generally refer to someone as terminally ill when we have reason to believe they are likely to die within the next 6-12 months of their disease.
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What Is The Role Of Genetic Testing In The Revised Guidelines
A rare type of familial Alzheimers disease, called Early-Onset Alzheimers Disease , is caused by mutations in the amyloid precursor protein, presenilin 1, or presenilin 2 genes. A person who inherits any of these mutations from a parent will almost surely develop Alzheimers dementia before age 65. Genetic testing for the disease is common in families with a history of EOAD.
The major genetic risk factor for the more common, sporadic form of the disease, or Late-Onset Alzheimers disease , is the 4 allele of the APOE gene. But carrying this allele by itself does not mean a person has or will develop Alzheimers dementia, so genetic testing for APOE 4 is not recommended outside of a research setting.
Stage : More Than Just Memory
At this stage, there has been more damage to the brain that will start to affect cognition in addition to memory. As a result, people tend to have a harder time remembering day to day information and will start to experience other symptoms of Alzheimers. They may become confused about what day it is and/or where they are, may have trouble choosing appropriate clothing for the weather or occasion, and tend to wander off and get lost. Additionally, they may reverse their sleeping patterns, becoming sleepy during the day and restless at night. You may also notice personality changes at this stage.
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Stage : Mild Cognitive Impairment
Persons at this stage manifest deficits which are subtle, but which are noted by persons who are closely associated with the person with mild cognitive impairment. The subtle deficits may become manifest in diverse ways. For example, a person with mild cognitive impairment may noticeably repeat queries. The capacity to perform executive functions also becomes compromised. Commonly, for persons who are still working in complex occupational settings, job performance may decline. For those required to master new job skills, such as a computer or other machinery, decrements in these capacities may become evident.
MCI persons who are not employed, but who plan complex social events, such as dinner parties, may manifest declines in their ability to organize such events. This may be an early stage of Alzheimers, however, it is important for the person to seek medical help as soon as possible, to determine if a broad variety of medical conditions may be causing or contributing to the persons difficulties. Blood tests and an MRI of the brain should be obtained to assist in determining if the individual has MCI due to Alzheimers and whether there are other causes or contributing conditions to the persons cognitive decline.
Some MCI persons may manifest concentration deficits. Many persons with these symptoms begin to experience anxiety, which may be overtly evident.
Stage : Moderately Severe Dementia
When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:
- Delusional behavior
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What Conditions Can Be Mistaken For Dementia
The term dementia refers to a specific group of symptoms related to a decline in mental ability. Often, people who experience subtle short-term memory changes, are easily confused, or exhibit different behaviors or personality traits are mistakenly thought to have dementia. These symptoms could be the result of a variety of other conditions or disorders, including other neurocognitive disorders such as Parkinsons disease, brain growths or tumors, mild cognitive impairment , and mood disorders, like depression.
What Kind Of Doctor Tests For Dementia
A primary care doctor can perform a physical exam and find out more about your symptoms to determine what may be the cause. They will likely refer you to one or several specialists that can perform specific tests to diagnose dementia. Specialists may include neurologists, who specialize in the brain and nervous system psychiatrists or psychologists, who specialize in mental health, mental functions, and memory or geriatricians, who specialize in healthcare for older adults.
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Stage : Moderate Decline
During this period, the problems in thinking and reasoning that you noticed in stage 3 get more obvious, and new issues appear. Your friend or family member might:
- Forget details about themselves
- Have trouble putting the right date and amount on a check
- Forget what month or season it is
- Have trouble cooking meals or even ordering from a menu
- Struggle to use the telephone
- Not understand what is said to them
- Struggle to do tasks with multiple steps like cleaning the house.
You can help with everyday chores and their safety. Make sure they aren’t driving anymore, and that no one tries to take advantage of them financially.
Beyond Memory Loss: How To Handle The Other Symptoms Of Alzheimer’s
There is a lot of talk about the emotional pain patients and caregivers suffer when a loved one loses memories to Alzheimers. But what about the other symptoms? Here are tips from a Johns Hopkins expert on what to watch for and how to manage.
#TomorrowsDiscoveries: From Dysfunctional Cells to Disease Dr. Rong Li
Dr. Li and her team investigate how cells consolidate their damaged proteins and prevent them from spreading freely, in order to understand how to better treat diseases such as Alzheimers and ALS. Another of their interests is how chromosomes are divided up when one cell becomes two. Learning more about how the process can go wrong could lend insight into cancer development.
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Early Warning Signs And Diagnosis
Alzheimers Disease can be caught in the early stageswhen the best treatments are availableby watching for telltale warning signs. If you recognize the warning signs in yourself or a loved one, make an appointment to see your physician right away. Brain imaging technology can diagnose Alzheimers early, improving the opportunities for symptom management.
Why Is Dementia Progressive
In the early stage of all types of dementia only a small part of the brain is damaged. In this stage, a person has fewer symptoms as only the abilities that depend on the damaged part of the brain are affected. These early symptoms are usually relatively minor. This is why mild dementia is used as an alternative term for the early stage.
Each type of dementia affects a different area of the brain in the early stages. This is why symptoms vary between the different types. For example, memory loss is common in early-stage Alzheimers but is very uncommon in early-stage FTD.
As dementia progresses into the middle and later stages, the symptoms of the different dementia types tend to become more similar. This is because more of the brain is affected as dementia progresses.
Over time, the disease causing the dementia spreads to other parts of the brain. This leads to more symptoms because more of the brain is unable to work properly. At the same time, already-damaged areas of the brain become even more affected, causing symptoms the person already has to get worse.
Eventually most parts of the brain are badly damaged by the disease. This causes major changes in all aspects of memory, thinking, language, emotions and behaviour, as well as physical problems.
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What Is Dementia And What Causes It
Dementia is a syndrome that causes a person to develop difficulty and problems with their memory or their ability to think. Unlike the normal changes that happen in a persons memory and thinking over time, dementia affects someones ability to function in their daily life activities and their normal routine .There are different causes of dementia. These causes are typically underlying neurological conditions . One common cause of dementia is Alzheimers disease. Other causes include diseases that impact brain blood vessels. For example, strokes may cause what is commonly termed Vascular Dementia. Some causes include Lewy Body Disease and Parkinsons disease.
Gathering A Complete Medical History
As with the treatment of any medical condition, physicians will ask for a rundown of a patients past and present health issues and all medications they are currently taking. The doctor will also take a brief family medical history to assess the patients risk of developing certain conditions due to genetic, lifestyle and environmental factors. For example, if a patients parent had early-onset Alzheimers disease, it increases the likelihood that the patient will also develop this disease.
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How Will These Guidelines Be Reviewed And Updated In The Future
As results become available, future panels will consider emerging technologies and advances in the understanding of biomarkers and the disease process itself. The diagnostic framework was intended to be flexible enough to incorporate new scientific findings. The Alzheimers Disease Neuroimaging Initiative, funded in part by NIA, is actively researching the field of preclinical disease and biomarkers.
Middle Stage Alzheimer’s Disease
The middle stage is the longestit can sometimes last years.
Alzheimers disease is often diagnosed during this stage, because the symptoms become more evident and it becomes apparent they are not part of the normal course of aging.
These are some of the symptoms of middle stage Alzheimers disease:
- Severe memory loss and confusion
- Difficulty remembering their own name, family members, address, telephone number, and details from their personal history, such as which school they went to
- Tendency to wander and get lost
- Confusion about where they are and what day or time it is
- Inability to understand or learn new things
- Trouble with cognitive tasks like reading, writing, or dealing with numbers
- Altered sleep patterns, which may cause the person to sleep in the day and feel restless at night
- Personality changes, causing the person to become moody, withdrawn, anxious, frustrated, tearful, angry, abusive, or aggressive
- Difficulty with social situations
- Unexpected or inappropriate behavior, such as refusing to bathe or taking off their clothes in public
- Paranoid delusions, causing them to become suspicious of their loved ones
- Repetitive compulsive behaviors, such as shredding tissues or wringing hands
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What Are The Main Differences Between The 1984 Diagnostic Criteria For Alzheimers Disease And The 2011 Guidelines
The 2011 guidelines differ from the 1984 diagnostic criteria in a few key ways. They:
- Recognize that Alzheimers disease progresses on a spectrum with three stagesan early, preclinical stage with no symptoms a middle stage of mild cognitive impairment and a final stage marked by symptoms of dementia. The 1984 criteria addressed only one stage of diseasethe final stage of dementia.
- Expand the criteria for Alzheimers dementia beyond memory loss as the first or only major symptom. They recognize that other aspects of cognition, such as word-finding ability or judgment, may become impaired first. The 1984 criteria focused on memory loss as the central emerging characteristic of Alzheimers dementia.
- Reflect a better understanding of the distinctions and associations between Alzheimers and non-Alzheimers dementias, as well as between Alzheimers and disorders that may influence its development, such as vascular disease. In 1984, these relationships were not well recognized or understood.
- Recognize the potential use of biomarkersindicators of underlying brain diseaseto diagnose Alzheimers disease. However, the guidelines state that biomarkers are almost exclusively to be used in research rather than in a clinical setting. These biomarkers did not exist when the original criteria were developed in 1984, so confirmation of the diagnosis was possible only through autopsy after death.
Stage : Very Severe Cognitive Declinesevere Dementia
At this stage, AD persons require continuous assistance with basic activities of daily life for survival. Six consecutive functional substages can be identified over the course of this final seventh stage. Early in this stage, speech has become so circumscribed, as to be limited to approximately a half-dozen intelligible words or fewer . As this stage progresses, speech becomes even more limited to, at most, a single intelligible word . Once intelligible speech is lost, the ability to ambulate independently , is invariably lost. However, ambulatory ability may be compromised at the end of the sixth stage and in the early portion of the seventh stage by concomitant physical disability, poor care, medication side-effects or other factors. Conversely, superb care provided in the early seventh stage, and particularly in stage 7b, can postpone the onset of loss of ambulation. However, under ordinary circumstances, stage 7a has a mean duration of approximately 1 year, and stage 7b has a mean duration of approximately 1.5 years.
In persons with AD who remain alive, stage 7c lasts approximately 1 year, after which persons with AD lose the ability not only to ambulate independently but also to sit up independently , At this point in the evolution, the person will fall over when seated unless there are armrests to assist in sitting up in the chair.
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How Accurate Is It
This quiz is NOT a diagnostic tool. Mental health disorders can only be diagnosed by licensed healthcare professionals.
Psycom believes assessments can be a valuable first step toward getting treatment. All too often people stop short of seeking help out of fear their concerns arent legitimate or severe enough to warrant professional intervention.
If you think you or someone you care about may be experiencing symptoms of dementia or any other mental health condition, Psycom.net strongly recommends that you seek help from a mental health professional in order to receive a proper diagnosis and support. For those in crisis, we have compiled a list of resources where you may be able to find additional help.
Single Brain Scan Can Diagnose Alzheimers Disease
by Maxine Myers20 June 2022
A single MRI scan of the brain could be enough to diagnose Alzheimers disease, according to new research by Imperial College London.
The research uses machine learning technology to look at structural features within the brain, including in regions not previously associated with Alzheimers. The advantage of the technique is its simplicity and the fact that it can identify the disease at an early stage when it can be very difficult to diagnose.
Although there is no cure for Alzheimers disease, getting a diagnosis quickly at an early stage helps patients. It allows them to access help and support, get treatment to manage their symptoms and plan for the future. Being able to accurately identify patients at an early stage of the disease will also help researchers to understand the brain changes that trigger the disease, and support development and trials of new treatments.
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Early Stage Or Mild Alzheimers Disease
In the early or mild stage of Alzheimer’s disease, patients continue experiencing problems with memory and thinking, and begin developing some or all of these additional cognitive issues:
- Misplacing keys or other important items in unusual places
- Having trouble handling money balancing a checkbook or making change
- Repeating questions without realizing it
- Being unable to follow a recipe
- Needing more time to complete normal daily tasks
People with mild Alzheimers disease might stop doing things that they have always enjoyed, such as playing cards, volunteering or leaving the house alone. This could be because they know that something is wrong and do not want others to see it. Alzheimer’s-related changes in the brain may be altering their mood and personality.
Caring for someone diagnosed with any disease, even one not as challenging as Alzheimers disease, can take a toll on a caregiver, so it is important that you take care of yourself physically, mentally and emotionally and seek help from others from the beginning. This is also good for the loved one with Alzheimers disease.