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 Cognitive Declinemoderate Dementia
In this stage, deficits are of sufficient magnitude as to prevent catastrophe-free, independent community survival. The characteristic functional change in this stage is early deficits in basic activities of daily life. This is manifest in a decrement in the ability to choose the proper clothing to wear for the weather conditions or for everyday circumstances. Some persons with Alzheimers disease begin to wear the same clothing day after day unless reminded to change. The mean duration of this stage is 1.5 years.
The person with Alzheimers disease can no longer manage on their own. There is generally someone who is assisting in providing adequate and proper food, as well as assuring that the rent and utilities are paid and the finances are taken care of. For those who are not properly supervised, predatory strangers may become a problem. Very common reactions for persons at this stage who are not given adequate support are behavioral problems such as anger and suspiciousness.
Cognitively, persons at this stage frequently cannot recall major events and aspects of their current life such as the name of the current head of state, the weather conditions of the day, or their correct current address. Characteristically, some of these important aspects of current life are recalled, but not others. Also, the information is loosely held, so, for example, the person with moderate Alzheimers disease may recall their correct address on certain occasions, but not others.
What Are The Stages Of Alzheimers
Alzheimers disease slowly gets worse over time. People with this disease progress at different rates and in several stages. Symptoms may get worse and then improve, but until an effective treatment for the disease itself is found, the persons ability will continue to decline over the course of the disease.
Early-stage Alzheimers is when a person begins to experience memory loss and other cognitive difficulties, though the symptoms appear gradual to the person and their family. Alzheimers disease is often diagnosed at this stage.
During middle-stage Alzheimers, damage occurs in areas of the brain that control language, reasoning, sensory processing, and conscious thought. People at this stage may have more confusion and trouble recognizing family and friends.
In late-stage Alzheimers, a person cannot communicate, is completely dependent on others for care, and may be in bed most or all the time as the body shuts down.
How long a person can live with Alzheimers disease varies. A person may live as few as three or four years if he or she is older than 80 when diagnosed, to as long as 10 or more years if the person is younger. Older adults with Alzheimers disease need to know their end-of-life care options and express their wishes to caregivers as early as possible after a diagnosis, before their thinking and speaking abilities fail.
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Stage : Very Mild Changes
You still might not notice anything amiss in your loved one’s behavior, but they may be picking up on small differences, things that even a doctor doesn’t catch. This could include forgetting words or misplacing objects.
At this stage, subtle symptoms of Alzheimer’s don’t interfere with their ability to work or live independently.
Keep in mind that these symptoms might not be Alzheimer’s at all, but simply normal changes from aging.
Support For Families And Alzheimer’s Disease Caregivers
Caring for a person with Alzheimers can have significant physical, emotional, and financial costs. The demands of day-to-day care, changes in family roles, and decisions about placement in a care facility can be difficult. NIA supports efforts to evaluate programs, strategies, approaches, and other research to improve the quality of care and life for those living with dementia and their caregivers.
Becoming well-informed about the disease is one important long-term strategy. Programs that teach families about the various stages of Alzheimers and about ways to deal with difficult behaviors and other caregiving challenges can help.
Good coping skills, a strong support network, and respite care are other things that may help caregivers handle the stress of caring for a loved one with Alzheimers. For example, staying physically active provides physical and emotional benefits.
Some caregivers have found that joining a support group is a critical lifeline. These support groups enable caregivers to find respite, express concerns, share experiences, get tips, and receive emotional comfort. Many organizations sponsor in-person and online support groups, including groups for people with early-stage Alzheimers and their families.
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Genetic Testing And Alzheimers Disease
Testing can show whether you have a version of a gene that increases your risk of Alzheimers. Testing can also uncover the rare cases when an inherited genetic change, or mutation, causes Alzheimers.
At OHSU, we generally do not recommend routine genetic testing for Alzheimers because:
- Many factors can lead to the disease.
- Most people who develop Alzheimers do not have a related genetic variant.
- Most people who have a variant do not develop the disease.
Talk with your primary care doctor or to a medical geneticist to learn more or to better understand your risk if youve taken a test on your own.
Genetic testing can show whether you carry an inherited gene mutation that causes early-onset Alzheimers. In some cases, we may recommend testing to confirm a diagnosis in someone who has signs or symptoms of early-onset Alzheimers.
Some family members, after careful discussion with a genetic counselor, may also want testing to find out whether they carry the mutation.
At-home tests from DNA analysis companies can give consumers access to limited genetic testing, without guidance from a genetic counselor. An at-home test can detect variants that increase the risk of late-onset Alzheimers disease.
Is There Treatment Available
At present there is no cure for Alzheimer’s disease. However, one group of drugs called cholinergeric drugs appears to be providing some temporary improvement in cognitive functioning for some people with mild to moderate Alzheimer’s disease.
Drugs can also be prescribed for secondary symptoms such as restlessness or depression or to help the person with dementia sleep better.
Community support is available for the person with Alzheimer’s disease, their families and carers. This support can make a positive difference to managing dementia. Dementia Australia provides support, information and counselling for people affected by dementia. Dementia Australia also aims to provide up-to-date information about drug treatments.
For more information contact the National Dementia Helpline on 1800 100 500.
For a range of books and videos contact our Library.
For advice, common sense approaches and practical strategies on the issues most commonly raised about dementia, read our Help Sheets.
Definition Of Alzheimer Disease Over Time
In 1984, the National Institute on Neurological and Communicative Disorders and Stroke and the Alzheimers Disease and Related Disorders Association criteria were created conceptualizing Alzheimer disease as a clinicopathological entity for over 30 years . With advancing technology allowing in vivo detection of amyloid with PET and CSF as well as measurement of neurodegeneration, in 2011 revised AD criteria were proposed by the National Institute on Aging-Alzheimers Association. Individuals were characterized by their clinical state with biomarkers of amyloid and neurodegeneration providing the likelihood that their clinical state was due to Alzheimer disease. For example, if amyloid and neurodegeneration biomarkers were present in conjunction with the clinical syndrome of dementia, the diagnosis of dementia due to AD with high likelihood could be made . But the diagnoses of MCI and dementia due to AD were still clinical-pathological conditions.
Fuhai Song, … Hongxing Lei, in, 2015
Role Of Oxidative Stress
Cognitive impairment has been attributed to oxidative stress, inflammatory reactions and changes in the cerebral microvasculature. The exact impact of each of these mechanisms in affecting cognitive aging is unknown. Oxidative stress is the most controllable risk factor and is the best understood. The online Merriam-Webster Medical Dictionary defines oxidative stress as, “physiological stress on the body that is caused by the cumulative damage done by inadequately neutralized by antioxidants and that is to be associated with aging.” Hence oxidative stress is the damage done to the cells by free radicals that have been released from the oxidation process.
Compared to other tissues in the body, the brain is deemed unusually sensitive to oxidative damage. Increased oxidative damage has been associated with neurodegenerative diseases, mild and individual differences in cognition in healthy elderly people. In ‘normal aging’, the brain is undergoing oxidative stress in a multitude of ways. The main contributors include protein oxidation, lipid peroxidation and oxidative modifications in nuclear and mitochondrial DNA. Oxidative stress can damage DNA replication and inhibit repair through many complex processes, including shortening in DNA components. Each time a replicates, the telomeric DNA component shortens. As telomere length is partly inheritable, there are individual differences in the age of onset of cognitive decline.
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Common Forms Of Dementia
There are many different forms of dementia. Alzheimer’s disease is the most common form and may contribute to 60-70% of cases. Other major forms include vascular dementia, dementia with Lewy bodies , and a group of diseases that contribute to frontotemporal dementia . Dementia may also develop after a stroke or in the context of certain infections such as HIV, harmful use of alcohol, repetitive physical injuries to the brain or nutritional deficiencies. The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.
Impact On Families And Carers
In 2019, informal carers spent on average 5 hours per day providing care for people living with dementia. This can be overwhelming . Physical, emotional and financial pressures can cause great stress to families and carers, and support is required from the health, social, financial and legal systems. Fifty percent of the global cost of dementia is attributed to informal care.
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What Is Alzheimer Disease
Alzheimer disease, which affects some older people, is different from everyday forgetting. It is a condition that permanently affects the brain. Over time, the disease makes it harder to remember even basic stuff, like how to tie a shoe.
Eventually, the person may have trouble remembering the names and faces of family members or even who he or she is. This can be very sad for the person and his or her family.
It’s important to know that Alzheimer disease does not affect kids. It usually affects people over 65 years of age. Researchers have found medicines that seem to slow the disease down. And there’s hope that someday there will be a cure.
Causes Of Alzheimers Disease
Researchers are rapidly learning more about the chemical changes that damage brain cells in Alzheimers disease. Apart from the few with familial Alzheimers disease, it is not known why some people develop Alzheimers disease and others do not. It is likely that a number of factors contribute to development of the disease, including environmental, genetic and health factors.Alzheimers disease is characterised by specific changes in the brain that include the formation of amyloid plaques and neurofibrillary tangles . An abnormal build-up of a protein called beta-amyloid causes amyloid plaques to form outside the brain cells. Inside the brain cells, another protein called tau builds up and causes neurofibrillary tangles.These protein accumulations disrupt messages within the brain because they damage connections between brain cells. The brain cells eventually die and brain volume shrinks. These brain changes occur gradually and actually begin many years before the symptoms of Alzheimers disease occur. The brain is able to compensate for the early damage, but eventually the damage becomes too great and brain function is affected.
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Cholinergic Neurotransmission And Alzheimer Disease
The cholinergic system is involved in memory function, and cholinergic deficiency has been implicated in the cognitive decline and behavioral changes of AD. Activity of the synthetic enzyme choline acetyltransferase and the catabolic enzyme acetylcholinesterase are significantly reduced in the cerebral cortex, hippocampus, and amygdala in patients with AD.
The nucleus basalis of Meynert and diagonal band of Broca provide the main cholinergic input to the hippocampus, amygdala, and neocortex, which are lost in patients with AD. Loss of cortical CAT and decline in acetylcholine synthesis in biopsy specimens have been found to correlate with cognitive impairment and reaction-time performance. Because cholinergic dysfunction may contribute to the symptoms of patients with AD, enhancing cholinergic neurotransmission constitutes a rational basis for symptomatic treatment.
Disproportionate Impact On Women
Globally, dementia has a disproportionate impact on women. Sixty-five percent of total deaths due to dementia are women, and disability-adjusted life years due to dementia are roughly 60% higher in women than in men. Additionally, women provide the majority of informal care for people living with dementia, accounting for 70% of carer hours.
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How Is Alzheimers Disease Diagnosed
Doctors use several methods and tools to help determine whether a person who is having memory problems has Alzheimers disease.
To diagnose Alzheimers, doctors may:
- Ask the person and a family member or friend questions about overall health, use of prescription and over-the-counter medicines, diet, past medical problems, ability to carry out daily activities, and changes in behavior and personality.
- Conduct tests of memory, problem solving, attention, counting, and language.
- Carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem.
- Perform brain scans, such as computed tomography , magnetic resonance imaging , or positron emission tomography , to support an Alzheimers diagnosis or to rule out other possible causes for symptoms.
These tests may be repeated to give doctors information about how the persons memory and other cognitive functions are changing over time.
People with memory and thinking concerns should talk to their doctor to find out whether their symptoms are due to Alzheimers or another cause, such as stroke, tumor, Parkinsons disease, sleep disturbances, side effects of medication, an infection, or another type of dementia. Some of these conditions may be treatable and possibly reversible.
In addition, an early diagnosis provides people with more opportunities to participate in clinical trials or other research studies testing possible new treatments for Alzheimers.
What Causes Alzheimer Disease
Lots of research is being done to find out more about the causes of Alzheimer disease. There is no one reason why people get it. Older people are more likely to get it, and the risk increases the older the person gets. In other words, an 85-year-old is more likely to get it than a 65-year-old. And women are more likely to get it than men.
Researchers also think genes handed down from family members can make a person more likely to get Alzheimer disease. But that doesn’t mean everyone related to someone who has it will get the disease. Other things may make it more likely that someone will get the disease, such as high blood pressure, high cholesterol, Down syndrome, or having a head injury.
On the positive side, researchers believe exercise, a healthy diet, and taking steps to keep your mind active may help delay the start of Alzheimer disease.
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What Are The Symptoms Of Small Vessel Disease Of The Brain
CSVD is characterized by neuroimaging findings such as recent tiny subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, microbleeds, and brain shrinkage, as well as other symptoms. Cardiovascular disease is characterized by several clinical symptoms such as stroke, cognitive decline, dementia, mental problems, irregular gait, and incontinence.
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