by David Herman
Here it is September, and summer is nearing an end for this year. September is World Alzheimer’s month. There is, as yet, no cure for Alzheimer’s, but there are some easy steps that we all can take to reduce the risk. They are: look after your heart, be physically active, follow a healthy diet, challenge your brain, and engage in social activity. During September, I plan to write some informational articles to, hopefully, clarify your understanding of the disease.
Although the progression of Alzheimer’s can be slowed down with the help of modern medication, as yet there is no cure. This progression is described in general terms as Mild Alzheimer’s, Moderate Alzheimer’s, and Severe Alzheimer’s. My wife is living with Vascular Dementia, and so I attend a support group for male caregivers. It is at these meeting I hear men describing their loved one’s condition as Stage 4, or Stage 7, etc., and I thought it might help if I explained what the various stages denote, so that, if someone uses these terms to describe their loved one’s condition, you will have an idea of what they are speaking.
Stage 1- Normal – this person exhibits no problems with memory, orientation, communication, judgment, or activities of daily living.
Stage 2 – Normal Aged Forgetfulness – This will encompass more than half of the population aged 65 or older and is considered a normal part of aging. These people exhibit slight cognitive problems, or occasional lapses in memory, usually undetectable to family or friends, and may not even be detected in a medical exam.
Stage 3 – Mild Cognitive Impairment – Family and friends are now starting to notice changes in memory, behaviour, or communication skills. Symptoms may, or may not, be noticed by the family physician. Some signs might be repeating questions, difficulty performing activities at work or in social events, misplacing important items like watches or glasses.
Stage 4 – Mild Alzheimer’s – By this stage, a neurologist can reliably make a diagnosis of Alzheimer’s disease. This is generally where medication to slow the progression would be recommended. The person exhibits signs of confusion, trouble with mathematics and financial management. They may be prone to bouts of moodiness or depression and social withdrawal.
Stage 5 – Moderate Alzheimer’s – A person at this stage is not safe to be living on their own. By now, they are no longer safe to cook; they are at risk of wandering and may get lost once they have left home. Severe memory loss and disorientation (unable to tell you what season, date or even day it is, or what town, county, province, or even country they are in). You may notice an increased interest in sleep and a decrease in personal hygiene.
Stage 6 – Moderately Severe Alzheimer’s – This stage is particularly difficult on family members, because the person with dementia loses much of their ability to recognize their family members, and personality changes are also commonly displayed. The symptoms of previous stages become more pronounced. They might also begin to experience “Sundowning”, if it has not already been observed. This is an increase in agitation and restlessness in the late afternoon towards dusk, as the sun goes down and thus the name.
It may become necessary for the person to wear diapers as they struggle with performing the bathroom duties by themselves. They may experience extreme anxiety, and follow a loved one around the house because of a fear of being alone. This is called “Shadowing”.
Stage 7 – Severe Alzheimer’s – This is the last stage of Alzheimer’s disease. The Alzheimer’s patient at this stage may be able to understand what you are saying to them, but they are not able to respond, other than to possibly speak a word, or a few words, that may or may not apply to what has been said to them.
The last stage of Alzheimer’s disease, as with all the other stages and, in fact, other diseases, may present differently for each person. By now, their physical systems are deteriorating, communication is very limited, swallowing may become difficult and choking is a risk, and their gross motor coordination stops and they may not even be able to sit.