Stages of Alzheimer's

by Mark L. Prohaska, Ph.D.

As a caregiver, it is important to understand the stages of the disease and what to look for so that you can adjust you level of care accordingly. Knowing what to expect also help you prepare well in advance to handling the more challenging aspects of care giving that arise as the disease progresses.

THE EARLY STAGE

In the early stage of Alzheimer’s disease, the primary symptoms include forgetfulness, absentmindedness, and fatigue. There may be some difficulty recalling common words, and learning new things may be more difficulty. In addition, judgment may seem impaired, and there may be notable declines in intellectual and social functioning. Important tasks for the caregiver in the early stage include:

• Help with decisions about finances, relationships, and substantial life changes.
• Start thinking about and observing the day-to-day tasks that you will eventually need to provide assistance with such as bathing, grooming, toileting, dressing, eating, exercising, and communicating. Be prepared to intervene when help becomes necessary.
• Begin planning for how caring for your loved-one is going to affect you, and begin developing your support system. Consider issues such as adult day care services, long-term care services, and other placement needs that may be necessary down the road.
• Ensure that a durable power of attorney is in place, and that items such as a living will, last will and testament, and estate planning are updated and complete.
• Identify the stressors you struggle with as a caregiver, i.e., those tasks or behaviors that are most frustrating or anxiety producing. Once identified, think through them and use your support system to help plan your responses to these situations and to get additional help when needed.

THE MIDDLE STAGE

In the middle stage of the disease, memory, logic, and motor abilities deteriorate further. Wandering and pacing may become more evident, and striking out verbally or physically may emerge as the capacity for patience deteriorates and their response to frustration becomes more aggressive. Speech and verbal understanding become slower, making communication more difficult. Performing mathematical operations becomes much more difficult. It is during this stage that psychiatric symptoms often emerge, including suspiciousness and paranoia. Social skills diminish further, and the hiding of objects becomes a frequent problem. Important tasks for the caregiver at this stage include:

• Provide increasing supervision and assistance with daily activities while allowing the patient to be as independent as safely possible.
• Give instructions slowly, clearly, and in writing (when appropriate).
• Control social situations closely.
• Obtain financial and legal advice – at this stage patients are no longer able to manage their own affairs.
• Consult with your physician– medications are often needed at this stage to help control psychiatric symptoms.
• Develop a structured daily routine and try not to deviate from it.

THE ADVANCED STAGE

In the advanced stage, the patient may become incontinent. Communication becomes even more difficult as the ability to speak and follow simple commands diminishes. Psychiatric symptoms now commonly involve hallucinations to which the patient may respond physically. Emotionally, the patient may become abusive, removed, or unresponsive. During this stage, the patient may appear ironically calmer and less distressed because they truly cannot remember how things used to be. There may be periods in which emotional symptoms seem to disappear. Issues for the caregiver in this stage include:

• Assistance will be needed in virtually every aspect of daily activities – utilize your support system to its fullest.
• Maintaining your own emotional well being during this stage is vitally important.
• Initiate the plans for end-stage care.

THE FINAL STAGE

In the final stage of the illness, patients lose almost all intellectual abilities, including memory, speech, and motor coordination. They typically recognize no one and remember nothing. Total care is required. Issues for the caregiver in this stage include:

• Provide comfort care. The patient needs to be bedded, bathed, and protected from harm. At this stage, placement in a nursing home or other long-term care facility is often needed.
• Keep in mind that the suffering for your loved one is now over – they are no longer able to understand what is going on.
• Prepare to resume your normal life-style, including reestablishing friendships and social outlets, and resuming hobbies and other pleasurable activities.
• Recognize that you have done all that you could have possibly done, and give yourself a pat on the back for a job well done.

Although Alzheimer’s disease is a tragic and terrifying illness, one must keep in mind that every journey through the course of this illness in unique. Not all symptoms occur in every patient with Alzheimer’s disease, and often times the imaginings of what may happen are far worse than what actually unfolds. Although it is important to be prepared, it is equally important to take life one day at a time, to be prepared to handle issues as they arise, and to daily look for opportunities to laugh and enjoy a pleasurable moment with your loved one in spite of all you both are going through.