What Caregivers Can Do At Early Stage Alzheimers:
Since the individual is still independent at this stage, a caregivers role can be to provide support and companionship. The person with Alzheimers may need help with things like:
- Planning and organizing
- Keeping track of medication
Its important to allow the person to maintain their independence as much as possible and keep communication open for when they do need assistance.
How Quickly Does Dementia Progress
The speed at which dementia progresses varies a lot from person to person because of factors such as:
- the type of dementia for example, Alzheimers disease tends to progress more slowly than the other types
- a persons age for example, Alzheimers disease generally progresses more slowly in older people than in younger people
- other long-term health problems dementia tends to progress more quickly if the person is living with other conditions, such as heart disease, diabetes or high blood pressure, particularly if these are not well-managed
- delirium a medical condition that starts suddenly .
There is no way to be sure how quickly a persons dementia will progress. Some people with dementia will need support very soon after their diagnosis. In contrast, others will stay independent for several years.
Neuropathology Of Neurodegenerative Disorders
The different forms of age-related dementia, as well as many age-related neurodegenerative diseases, are thought to be caused by changes in various proteins. These diseases are called proteinopathies because they involve the abnormal buildup of specific proteins in the brain. Mutations in genes that provide instructions for making these proteins have been found to cause dementia in families. However, in the vast majority of affected individuals, dementia is not inherited, and the cause is unknown. Alzheimer’s disease, frontotemporal disorders, and Lewy body dementia are proteinopathies.
In some dementias, changes in the tau protein cause it to form clumps inside nerve cells in the brain, which is believed to make the cells stop functioning properly and die. Disorders that are associated with the abnormal buildup of tau are called tauopathies.
In Alzheimer’s disease, the tau protein aggregates and becomes twisted and tangled, forming fibersneurofibrillary or tau tanglesinside neurons. Abnormal clumps of the beta-amyloid protein are prominent in spaces between brain cells. Both plaques and tangles are thought to contribute to reduced function and nerve-cell death in AD and are the hallmarks of the disease.
Beta-amyloid plaques are also seen in some forms of LBD, cerebral amyloid angiopathy, and Parkinson’s disease dementia. They are also common in elderly individuals who do not have dementia.
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Mild Impairment Or Decline
The symptoms of Alzheimers are less clear during stage 3. While the entire stage lasts about 7 years, the symptoms will slowly become clearer over a period of 2 to 4 years. Only people close to someone in this stage may notice the symptoms. Work quality will decline, and they may have trouble learning new skills.
Other examples of stage 3 symptoms and signs include:
- getting lost even when traveling a familiar route
- finding it hard to remember the right words or names
- being unable to remember what you just read
- not remembering new names or people
- misplacing or losing a valuable object
A doctor or clinician may also have to conduct a more intense interview than usual to discover cases of memory loss.
Caregiver support: At this stage, someone with Alzheimers may need counseling, especially if they have complex job responsibilities. They may experience mild to moderate anxiety and denial.
Stage : Moderate Dementia
When a person has moderate dementia due to Alzheimers disease, they become increasingly confused and forgetful. They may need help with daily tasks and with looking after themselves. This is the longest stage and often lasts around 24 years.
Symptoms of moderate dementia due to Alzheimers disease include:
- losing track of the location and forgetting the way, even in familiar places
- wandering in search of surroundings that feel more familiar
- failing to recall the day of the week or the season
- confusing family members and close friends or mistaking strangers for family
- forgetting personal information, such as their address
- repeating favorite memories or making up stories to fill memory gaps
- needing help deciding what to wear for the weather or season
- needing assistance with bathing and grooming
- occasionally losing control of the bladder or bowel
- becoming unduly suspicious of friends and family
- seeing or hearing things that are not there
- becoming restless or agitated
- having physical outbursts, which may be aggressive
As Alzheimers progresses, a person may start to feel more restless toward evening and have difficulty sleeping. This is sometimes called sundowners syndrome.
During this stage, physical and mental functioning continue to decline.
If a person has severe dementia during the later stages of Alzheimers disease, they might:
Other common causes of death among people with Alzheimers disease include dehydration, malnutrition, and other infections.
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Very Mild Impairment Or Common Forgetfulness
Alzheimers disease mainly affects older adults over the age of 65. At this age, its common to have slight functional difficulties such as forgetfulness.
But for people with stage 2 Alzheimers, this decline will happen more quickly than it will for similarly aged people without Alzheimers. For example, a person may forget familiar words, a family members name, or where they placed something.
Caregiver support: Symptoms at stage 2 wont interfere with work or social activities. Memory troubles are still very mild and may not be apparent to friends and family.
Stage 4 Late Confusional/mild Alzheimer’s Disease
Mathematical challenges can cause problems with handling finances. Increasingly, the person will forget recent events and conversations, although most people in this stage still know themselves and their family members.
Problems carrying out sequential tasks, including cooking, driving, ordering food at restaurants, and shopping are common. The person often withdraws from social situations, becomes defensive, and denies any problems.
Duration: roughly 2 years.
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Stage : Very Severe Decline
Many basic abilities in a person with Alzheimer’s, such as eating, walking, and sitting up, fade during this period. You can stay involved by feeding your loved one with soft, easy-to-swallow food, helping them use a spoon, and making sure they drink. This is important, as many people at this stage can no longer tell when they’re thirsty.
In this stage, people with Alzheimer’s disease need a lot of help from caregivers. Many families find that, as much as they may want to, they can no longer take care of their loved one at home. If thatâs you, look into facilities such as nursing homes that provide professional care day and night.
When someone nears the end of their life, hospice may be a good option. That doesn’t necessarily mean moving them to another location. Hospice care can happen anywhere. Itâs a team approach that focuses on comfort, pain management and other medical needs, emotional concerns, and spiritual support for the person and their family.
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Stage : Preclinical Alzheimer’s
In stage 1, your brain may have begun to change. For example, imaging studies may reveal changes in nerve cells and the build-up of amyloid-ß , an abnormal protein that forms masses in the brain called plaques.
During this stage, you may have no symptoms or symptoms that are too mild to notice. Your ADLs remain unimpaired. Stage 1 can last for many years or even decades.
This stage is most often diagnosed in research studies, not in clinical practice.
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What Caregivers Can Do At Late Stage Alzheimers:
Intensive, around-the-clock care is usually required at this stage and can last from several weeks to several years. The role of the caregiver is to preserve the quality of life and dignity for the individual. People in this stage will need help with most activities including eating, dressing, and even walking. At this stage, the world is mainly experienced through the senses. Caregivers can connect and help an individual by:
- Playing his or her favorite music
- Reading excerpts of their favorite books
- Looking at old photos with them
- Preparing a favorite meal
- Brushing the persons hair
- Sitting outside together
Although an individual in this stage is unable to communicate, research shows that some core of their self may still remain. Caregivers and loved ones may be able to connect on some level even in this stage of the disease.
Please remember that only a doctor can effectively diagnose which stage a person may be experiencing. You can visit for a doctors appointment checklist to assist with the evaluation and prepare a caregiver and their loved one with the right questions to be asked.
Additionally, a caregiver can administer the Clock Test or the Mini-Mental State Examination at home to help identify the seriousness of the symptoms prior to a doctors appointment.
Home Care services can help help by reminding those with cognitive impairment to take medications, eat, and drive.
What Caregivers Can Do At Middle Stage Alzheimers:
Individuals at this stage will require a greater level of care. The person with Alzheimers may become frustrated and upset when they have difficulty remembering things and names or trouble with daily activities such as getting dressed. You will most likely have to adjust your daily routine to include more structure for the individual with Alzheimers. At this stage caregivers can:
- Use a calm voice when responding to questions to help the person from getting upset or frustrated.
- Respond to the persons emotion, instead of the question asked. The individual may need reassurance.
- If the individual can still read, write out reminders for them.
Practice patience and sensitivity with patients in this stage. They may become increasingly upset or frustrated as they lose more brain function as well as their independence.
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Stage : Severe Cognitive Declinemoderately Severe Dementia
Stage 6a
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.
Stage 6b
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
Behavioral And Cognitive Symptoms Of Dementia
Behavioral Symptoms
Michelle Niedens, L.S.C.S.W., in The Neuropsychiatric Symptoms of Alzheimers, states that 80% of individuals with dementia will experience neuropsychiatric symptoms.
Personality changes such as anxiety, depression or irritability are common in the early stages of the disease. Later, agitation, physical or verbal outbursts, pacing and restlessness are more common.
Behavioral symptoms have been identified as the most challenging and distressing for caregivers and family members. They are oftentimes the determining factor in deciding to move a family member with Alzheimers into a structured living environment.
Cognitive Symptoms
Cognitive symptoms start out mild in the early stages of Alzheimers and gradually worsen as each stage progresses. In the late stages of Alzheimers, the person with the disease is no longer able to form new memories or access old ones. Language abilities become worse until the person is no longer able to communicate. Judgment and reasoning skills continue to diminish and eventually, the person with dementia loses the ability to reason altogether.
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Risk Factors For Alzheimers Disease
Increased age is the main risk factor for Alzheimers disease. The frequency of Alzheimers disease continues to increase with the aging of the population. Ten percent of people over 65 years of age and 50% of those over 85 years of age have Alzheimers disease. The number of individuals with Alzheimers disease in the United States is expected to be 14 million by the year 2050 unless new treatments are developed to decrease the likelihood of developing Alzheimers disease.
There are also genetic risk factors for Alzheimers disease. A relatively common form of a gene located on chromosome 19 is associated with late onset Alzheimers disease. In the majority of Alzheimers disease cases, however, no specific genetic risks have yet been identified.
This means that in majority of patients with Alzheimers disease, no genetic risk factor has yet been found. since there is no treatment for Alzheimers disease, most experts do not recommend that adult children of patients with Alzheimers disease should have genetic testing for the apoE4 gene. Genetic testing may be recommended for adult children of patients with Alzheimers disease when medical treatments that prevent or decrease the risk of developing Alzheimers disease become available. Other risk factors for Alzheimers disease include:
- Elevated blood cholesterol.
Stage : Major Memory Loss
In this stage, damage to the brain often affects things other than memory. Language, organization, and calculation skills may all be impacted. Because of this, completing everyday tasks can be difficult.1
Stage 4 can last many years. Major memory problems occur in this stage. People usually remember important details from their life better than everyday details.
For example, they might be able to recall the state where they live or their spouses’s name. But their memory of the distant past will usually be worse than their memory of things from today.1
Other challenges in stage 4 include:1,2
- Being confused about where they are or what day it is
- Getting lost or wandering off
- Sleep problems, like sleeping more during the day and trouble sleeping at night
- Problems choosing the right clothing for the weather
Your loved one might have a tough time with situations that require a lot of thinking. Social gatherings might be especially frustrating. Those in this stage might be:1
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Stage : Noticeable Memory Problems
This stage can bring changes that are noticeable to many people. Diagnosis is common at stage 3 because the person’s daily routine becomes disrupted.1,2
In this stage, people commonly have problems with forgetting names and misplaced objects. Symptoms might include:1,2
- Forgetting recently read material, like news articles or books
- Problems finding and speaking common words
- Forgetting plans
- Difficulty staying organized in daily tasks
- Social or work problems
This may be a difficult time for your loved one. They may deny that anything is wrong. That is normal. But talk to your loved one’s doctor early, before symptoms get worse. Your loved one’s doctor can help guide treatment options, including medicine and care planning.1
Stage : Severe Symptoms
In stage 6, people with Alzheimer’s will have symptoms that will impact their ability to manage their care. They will be more dependent on others for help.1
It can be difficult to communicate with your loved one at this stage. They may still use words and phrases, but it can be hard for them to express specific thoughts. For example, they may be unable to tell you where exactly they are feeling pain.1
Your loved one’s personality may significantly change in stage 6. They might have more:1
- Frustration with you or those around them
Not everyone with Alzheimer’s disease will have severe behavioral changes. But if your loved one is experiencing such changes, try not to take it personally. Their frustrations are part of the disease’s progress and not a reflection on you.1
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Alzheimer Disease Begins Long Before The First Symptoms
Alzheimers disease can begin a decade or more before the first symptoms. Despite a lack of outward evidence, changes are happening in the brain.
Researchers have identified a condition called mild cognitive impairment that in some but by no means all individuals may be the earliest indication of Alzheimers or another type of dementia.
MCI involves lapses in memory, language, thinking, and judgment that are noticeable to the person and his family and close friends yet are not serious enough to interfere with everyday life.
According the Alzheimers Association, approximately one-third of those with MCI develop dementia due to Alzheimers within five years.
Unfortunately, people with MCI who experience symptoms of memory loss or impairment are less likely to recognize their own difficulties than someone with MCI who does not experience such symptoms, which can lead to delays in diagnosis.
One of the highest priorities of Alzheimers research is understanding what happens inside the brain long before the first symptom. The hope is that these insights will lead to more effective treatments that slow or even prevent damage.
After the onset of symptoms, the disease progresses through three main stages: mild , moderate , and severe .
Stage : Decreased Independence
Until this stage, your loved one may have been able to live on their own with no regular help. Checking in on them might have been enough. But by stage 5, your loved one might not remember the people who used to be most important to them. Learning new things is now hard or impossible. Also, basic tasks like grooming and getting dressed may be too hard.1
Common symptoms in this stage include:1,4,5
- Paranoia â Feeling like others are out to get them
- Hallucinations â Seeing, hearing, touching, tasting, or smelling things that are not there
- Delusions â Believing in something that is not true, for example that an imposter has replaced a family member
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