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What Stage Of Alzheimer’s Is Aphasia

Support In Later Stages

HealthTalk 544 – Primary Progressive Aphasia

This page aims to guide all those affected by a diagnosis of primary progressive aphasia through the later stages of the condition. This includes carers, family and friends.

This page covers the three most common forms of PPA progressive nonfluent aphasia , semantic dementia and logopenic aphasia .

Stage Seven: Very Severe Decline

This last stage of Alzheimers is often the most difficult, not just for the individual with the condition, but for their loved ones, as well. Caring for a person at this stage of Alzheimers is extremely challenging, which can lead to family members seeking support services like hospice care. As the individual loses their ability to speak, eat, and drink, these services continue to provide care and comfort. Even as Alzheimers diminishes their cognitive ability, people at this stage still benefit from activities like listening to music and having conversations. Support services encourage families to continue interacting with their loved ones, even if they do not seem to respond.

What Causes Alzheimer’s Disease To Progress So Quickly

The progression of Alzheimers disease varies widely between individuals, with most people living with the condition for between 3 and 11 years after the initial diagnosis. In some cases, people may survive for more than 20 years. When Alzheimers is detected early, there are possible treatments that can help to slow the progression of the disease and contribute to a longer life expectancy.;;

It is therefore crucial to plan for the future and follow the progression of the disease through each stage. Alzheimers disease first begins with physical changes in the brain. This can happen at a gradual pace before any noticeable symptoms appear. In fact, this pre-clinical Alzheimers disease stage can begin 10 to 15 years before any symptoms appear.

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Strategies To Help Aphasia In Later Stages Of Dementia

  • Use more non-verbal communication both to tell the person things and to help understand what they might want.; Words are barely needed . For example,
    • Show the person their 2 choices when offering lunch options – the sandwich meat and the can of soup .
    • Watch the person for non-verbal things like gestures, facial expressions, or tone of voice when the person is trying to communicate something.; And be a detective. Might the person be hungry when they are hollering and grabbing their stomach?
    • Use gestures and demonstrate!: Point to where you want the person to go; reach out hands and pull them to you when you want the person to stand up; take your own drink of water when you want them to take a drink.

Stage 5: Moderately Severe Decline

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During the fifth stage of Alzheimers, people begin to need help with many day-to-day activities. People in stage five of the disease may experience:

  • Difficulty dressing appropriately
  • Inability to recall simple details about themselves such as their own phone number
  • Significant confusion

On the other hand, people in stage five maintain functionality. They typically can still bathe and toilet independently. They also usually still know their family members and some detail about their personal histories, especially their childhood and youth.

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How Does Primary Progressive Aphasia Progress

PPA tends to start as a subtle language disorder. For some people, this can be fluent aphasia where they have normal or an increased word production rate.

Others begin with non-fluent aphasia where they produce fewer words and they have challenges with speech.

In rare cases, a person will start by having a difficult time finding the right words to use coupled with progressive deterioration of comprehension and naming.

Over time, the situation becomes worse and in its severe stages, a person is not able to speak nor understand written or spoken language.

The progression patterns are different for different people. It is important to note that while Alzheimers causes PPA, it is not a neurodegenerative disease.

A huge percentage of people who have PPA remain independent can stay employed, and can also pursue hobbies and other interests.

Benefits Of Achei Pharmacotherapy On Language Function

Currently there are three AChEIs approved by the US Food and Drug Administration for the treatment of AD in use in clinical practice. Donepezil, rivastigmine, and galantamine are indicated for the treatment of mild to moderate AD. Donepezil is also approved for the treatment of moderate to severe and severe AD. Although these agents have been approved for more than 10 years, to date, no clinical trial has been performed to evaluate the effects of AChEIs on language specifically, and the focus has been primarily on the overall effects of AChEIs on cognition. However, based on several cognitive domain analyses and the recent development of SIB-derived language scales, it is now possible to review the data for the benefits of AChEIs on language function in patients with AD.

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Stages 7: Very Severe Decline

Stage seven is the final stage of Alzheimers. Because the disease is a terminal illness, people in stage seven are nearing death. In stage seven of the disease, people lose the ability to communicate or respond to their environment. While they may still be able to utter words and phrases, they have no insight into their condition and need assistance with all activities of daily living. In the final stages of;Alzheimers, people may lose their ability to swallow.

Need Alzheimers Care?

Mild Alzheimers Or Moderate Decline

Aphasia: A loss of words, not thoughts

Stage 4 lasts about two years and marks the beginning of diagnosable Alzheimers disease. You or your loved one will have more trouble with complex but everyday tasks. Mood changes such as withdrawal and denial are more evident. Decreased emotional response is also frequent, especially in a challenging situation.

New signs of decline that appear in stage 4 may include:

  • losing memory of personal history
  • trouble with handling finances and bills
  • inability to count backward from 100 by 7s

A clinician will also look for a decline in areas mentioned in stage 3, but theres often no change since then.

Caregiver support: Itll still be possible for someone to recall weather conditions, important events, and addresses. But they may ask for help with other tasks such as writing checks, ordering food, and buying groceries.

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What To Do Next After Learning What Stage Of Alzheimer’s Disease Your Loved One Is In

As mentioned, learning about the stage of Alzheimers disease that a loved one is experiencing helps provide perspective and context. This knowledge makes it easier to have conversations with doctors about the patients condition and how to approach future treatment options. Understanding the later stages of the disease also helps when planning for lifestyle changes, new equipment, and other items that may be needed. One of the other major benefits in understanding the overall progression of Alzheimers disease is preparing for future living arrangements, such a memory care community, that could become a preferred option during later stages of the disease. Because the cost of dementia care is high, families should begin planning as soon as possible following a diagnosis.

What Happens Over Time

Because PPA is progressive, language ability continues to decline. Additionally, changes in non-language abilities may occur.; Movement or swallowing may also become challenging for some individuals. The rate of decline is variable from person to person and unfolds over years. Scientists are working to understand why some people progress more rapidly than others.

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Strategies To Help Aphasia In Earlier Stages Of Dementia

Patients in the earlier stages of dementia and their support team can use strategies to help minimize the effects of aphasia. Some strategies to try include:

  • Give the person time to process what was said and to form a response. This can take twice as long or longer for the person with Alzheimer’s disease. Be patient and wait before you start talking again.
  • LESS IS MORE! Cut your messages from 3 or more sentences to 1. Skip the whole background story and just get to the point!
  • Carry a card that says “Be patient, my Alzheimer’s brain takes longer to communicate” that the person or caregiver can show at restaurants or stores.
  • Focus on the person when they are trying to get a message across.; Often you can figure out what they mean from the context of conversation or with their gestures .
  • Do not use open-ended questions but rather give multiple verbal choices for the person to choose from. For example, instead of “What do you want for lunch?”, say “Do you want a sandwich or soup?”.

Stage 3: Mild Decline

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At this stage, the family members and friends of the senior may begin to notice cognitive problems. Performance on memory tests are affected and physicians will be able to detect impaired cognitive function.

People in stage 3 will have difficulty in many areas including:

  • Finding the right word during conversations
  • Organizing and planning
  • Remembering names of new acquaintances

People with stage three Alzheimers may also frequently lose personal possessions, including valuables.

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Receptive Aphasia In People With Dementia

  • Misunderstanding what other people say or hearing only parts of the messages
  • Not answering a question or answering incorrectly. This can be due to the person not understanding the question in the first place. Sometimes patients with Alzheimer’s will just nod their head to cover up the fact that they do not understand or to give a response in the only way then know how.
  • Answering “I don’t know”, “I don’t care”, or “You Choose” when asked what they want.; Again, the problem is in understanding what the question is.
  • Increased anxiety in settings with lots of people, as the person cannot correctly filter the many sounds and words that they hear.

What Is Primary Progressive Aphasia

Primary Progressive Aphasia is a neurological syndrome in which language capabilities become slowly and progressively impaired. Unlike other forms of aphasia that result from stroke or brain injury, PPA is caused by neurodegenerative diseases, such as Alzheimers Disease or Frontotemporal Lobar Degeneration. PPA results from deterioration of brain tissue important for speech and language. Although the first symptoms are problems with speech and language, other problems associated with the underlying disease, such as memory loss, often occur later.

PPA commonly begins as a subtle disorder of language, progressing to a nearly total inability to speak, in its most severe stage.;The type or pattern of the language deficit;may differ from patient to patient.;The initial language disturbance may be fluent aphasia or non-fluent aphasia .;A less common variety begins with impaired word-finding and progressive deterioration of naming and comprehension, with relatively preserved articulation.

As with aphasia that results from stroke or brain trauma, the manifestations of PPA depend on what parts of the left hemisphere are relatively more damaged at any given point in the illness. The person may or may not have difficulty understanding speech. Eventually, almost all patients become mute and unable to understand spoken or written language, even if their behavior seems otherwise normal.

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Primary Progressive Aphasia: Diagnosis Symptoms And Treatment

We can divide primary progressive aphasia into three categories namely:

1. Semantic PPA: This is where affected people can no longer voice out certain words. Their ability to recognize words may also start to decline.

2. Agrammatic/nonfluent PPA: Persons with this type of PPA have a hard time forming complete sentences.

3. Logopenic PPA: It is where a person may struggle to locate the right words to speak but still retain the ability to comprehend what other people say.

Progressing Through The Stages

Primary Progressive Aphasia, What Is The Disease?

The pace with which someone with Alzheimer’s moves through the stages differs from person to person. Each symptom affects the individual gradually, and not everyone is affected by all of them. On average, an individual with Alzheimers lives four to eight years after diagnosis. However, they may live significantly longer, depending on their overall health and various other factors.

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Stage 1: Normal Outward Behavior

Alzheimerâs disease usually starts silently, with brain changes that begin years before anyone notices a problem. When your loved one is in this early phase, they won’t have any symptoms that you can spot. Only a PET scan, an imaging test that shows how the brain is working, can reveal whether they have Alzheimer’s.

As they move into the next six stages, your friend or relative with Alzheimer’s will see more and more changes in their thinking and reasoning.

How Does Dementia Relate To Aphasia

Most aphasia types are caused by stroke or other acute brain injury that damages brain tissue in areas important for language processing. However, a type of aphasia called primary progressive aphasia is a neurodegenerative disease, which results from progressive deterioration of brain tissue in areas important for speech and language. It is often caused by diseases such as s Alzheimers or Frontotemporal Lobar Degeneration. Although the first symptoms are problems with speech and language, other problems associated with the underlying disease, such as memory loss and personality changes often occur later. Learn more about diagnosing PPA and managing PPA.

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Preclinical Alzheimers Or No Impairment

You may only know about your risk for Alzheimers disease due to family history. Or your doctor may identify biomarkers that indicate your risk.

Your doctor will interview you about memory problems, if youre at risk for Alzheimers. But there will be no noticeable symptoms during the first stage, which can last for years or decades.

Caregiver support: Someone in this stage is fully independent. They may not even know they have the disease.

Is There Any Treatment Or Assistance For People With Ppa

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People with primary progressive aphasia are fighting against a condition in which they will continue to lose their ability to speak, read, write, and/or understand what they hear. Usually;people with aphasia that results from stroke or head injury will experience improvement over time, often aided by speech therapy. This is not the case for people with primary progressive aphasia.;However, individuals with PPA;may benefit during the course of their illness by acquiring new communication strategies from speech-language pathologists. Some families have also learned new strategies through participation in Aphasia Community Groups.

Many people with aphasia find it helpful to carry identification cards and other materials that can help explain the persons condition to others. ID cards are available from the the National Aphasia Association website. Some communication-assistive devices may also be helpful. Non-verbal techniques for communicating, such as gesturing and pointing to pictures, may help people with PPA;express themselves.

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Stage 6: Severe Decline

People with the sixth stage of Alzheimers need constant supervision and frequently require professional care. Symptoms include:

  • Confusion or unawareness of environment and surroundings
  • Inability to recognize faces except for the closest friends and relatives
  • Inability to remember most details of personal history
  • Loss of bladder and bowel control
  • Major personality changes and potential behavior problems
  • The need for assistance with activities of daily living such as toileting and bathing
  • Wandering

Support With Later Stage Symptoms

Some of the symptoms that people living with different forms of PPA might develop are outlined below. These symptoms will not apply to everybody. If you would like to talk to somebody about how the issues raised here have affected you, please get in touch.

As PPA progresses, people can develop problems that go beyond language, such as with memory, behaviour, thinking, and movement.

Progressive nonfluent aphasia

  • difficulty using tools and gadgets
  • difficulty with swallowing
  • symptoms similar to Parkinsons disease such as slowing or clumsiness of movements, falls, shuffling or freezing when walking and/or tremor

Semantic dementia

  • increasing difficulty recognising familiar people or everyday items, by sight or by sound
  • changes in personality, such as becoming more concerned about time and routines, more obsessional or less restrained in public
  • inability to recognise or react appropriately to other peoples emotions
  • changes in appetite or a decline in table manners
  • intense development of new interests, for example in music or puzzles
  • changes in sensitivity to pain, temperature and bodily sensations
  • changes in hearing

Logopenic aphasia

All forms of PPA

Later in the course of PPA, the disease will affect many different parts of the brain beyond the language system. This is true for all the major PPA syndromes and means that similar problems can occur in each subtype, including:

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Living with PPA

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How To Help Someone With Short

  • Create a memory album. As new life events occur, add them to the album.;
  • Make use of memory aids, such as post-it notes, white boards and calendars.
  • Try not to ask questions that rely on new memories.
  • Remind them where they are and what time it is. An orientation board might be useful, listing the date, time and weather.
  • Remind them tactfully what they were talking about during the conversation.
  • Make familiar music and pictures available.;;

Stage Six: Severe Decline

Speech Therapy Primary Progressive Aphasia & Live Demonstrations

Later stages of Alzheimers largely feature an inability to care for ones self, often to the point of needing a full-time caregiver. People who progress to this stage can no longer dress or bathe themselves without help. Because of coordination issues, they may also need assistance navigating their home and using the toilet. Due to poor hygiene, infections become more prevalent. They can still speak, but with a significantly smaller vocabulary, and they may be unable to articulate many thoughts or ideas.

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