Alzheimer's and Dementia

Dementia is a term that describes different diseases and symptoms related to brain functions, such as memory loss or problem-solving skills.

Alzheimer's disease is a progressive type of dementia, which means the person's memory gets worse over time. No one knows exactly what causes Alzheimer's disease. Genes, lifestyle habits and overall health may all play a role.

Alzheimer's disease symptoms develop differently in each person. Most people live for an average of eight years after symptoms appear, but some people can live as long as 20 years with the disease.

Alzheimer's disease typically affects people over age 65. In rare cases, it appears in people under age 60. This condition is called early onset Alzheimer's disease.

Common Alzheimer's disease symptoms can include:

• Decision making problems.
• Difficulty with judgement.
• Language difficulties.
• Memory problems.
• Personality changes.

If it’s suspected you or a loved one may have Alzheimer’s disease, your doctor will start with a physical exam. During this exam, he or she will ask about your or your loved one’s medical history, medications and any family history of dementia or Alzheimer’s disease.

You or your loved one may also undergo several tests, including:

• Imaging tests, such as an MRI or PET scan.
• Lab testing, such as blood tests.
• Mental status testing.
• Neuropsychological tests.

There are four stages of Alzheimer’s disease, with three of the stages having symptoms. These stages help doctors and caregivers make decisions on how to care for someone with Alzheimer’s disease.

It’s important to remember that not every case of Alzheimer’s disease is the same. Each person moves through symptoms and stages differently.

Preclinical stage

This is the earliest stage of Alzheimer’s disease. During this stage, the brain is undergoing changes that will later lead to cognitive symptoms, such as memory loss. The preclinical stage can last for many years before symptoms appear.

Mild, early stage

Forgetfulness is the most common symptom in the early stage of Alzheimer’s disease, but it’s often misunderstood as a common sign of aging. A person at this stage can still live independently, but may have problems with:

• Concentration.
• Making plans.
• Managing money.
• Recalling recent events.
• Remembering a name.
• Remembering where a valuable object is stored.
• Staying organized.

Moderate, middle stage

The middle stage of Alzheimer’s disease is usually the longest stage and can last for many years. At this stage, symptoms can include:

• Becoming moody or withdrawn, or having personality changes, such as hallucinations, paranoia or delusions.
• Feeling restless, agitated, anxious or tearful, especially in the late afternoon or at night.
• Having trouble remembering events.
• Having trouble remembering names of familiar people, such as a spouse or a child.
• Losing track of time and place.
• Needing help with daily activities, such as getting dressed or brushing teeth.
• Problems learning new things.
• Problems with reading, writing and working with numbers.
• Sleep problems.
• Trouble remembering one’s name, but not details about one’s life, such as address and phone number.
• Trouble with planning complicated events, like a dinner.

Severe, late stage

Most people at this stage need around-the-clock caregiving. During this stage of the disease a person may:

• Be more likely to get infections, especially pneumonia.
• Be unaware of his or her surroundings.
• Lose bowel and bladder control.
• Lose the ability to walk, sit or eat.
• Need help with activities all of the time.
• Say some words or phrases but cannot have a conversation.

There are seven stages of dementia used to describe a person’s progression through the disease that help doctors and caregivers make decisions about treatment.

Stage 1

When a person is in stage 1 dementia, they have no signs of cognitive decline and don’t show any problems with memory.

Stage 2

Although there often aren’t any signs evident during the doctor interview, people in the second stage of dementia may complain about forgetfulness and very mild cognitive decline. Many people with stage 2 dementia are still able to complete tasks and function socially.

Stage 3

A person at this stage has started to show early signs of confusion and family members may start to notice symptoms, including:

• Memory loss during doctor testing.
• Some denial about their condition.
• Trouble remembering names of new people.

Stage 4

At this stage, a person will continue to show early signs of confusion and problems with cognitive function will become more noticeable. However, most people at this stage are still aware of time and location. Symptoms can include:

• Being unaware of current and recent events.
• Problems concentrating.
• Trouble remembering events from his or her personal history.
• Using denial as a main defense mechanism when asked about symptoms or problems.

Stage 5

This stage indicates early dementia. While those with stage 5 dementia may be able to eat and use the bathroom on their own, they start to show signs of moderate to severe cognitive problems, including:

• Being unable to recall major events in his or her life.
• Feeling disoriented in time or place.
• Feeling tearful.
• Having trouble sleeping.
• Needing help with choosing what to wear.
• Occasionally dressing improperly.
• Resisting the need for caregiving.
• Wandering around and looking for a way out of the room or building.

Stage 6

At this stage, a person shows severe cognitive problems and isn’t able to live independently. He or she may:

• Be unable to recall most recent events.
• Have problems bathing.
• Have sleeping problems.
• Not be able to complete two-step commands.
• Only eat with assistance.
• Remove or not wear clothing properly.
• Repeat conversations.
• Show great resistance to caregiving.
• Wander on purpose.

Stage 7

In the final and most severe stage of dementia, people aren’t able to easily communicate or function on their own, and may:

• Not be able to complete simple tasks.
• Not be able to eat on his or her own.
• Not be able to hold his or her head up.
• Not be able to sit up or walk independently.
• Not smile.
• Speak very little; sometimes as little as one word a day.