ALL ABOUT ALZHEIMER'S: Stages
By Betty Weiss
Few people know what to expect when there is a diagnosis of Alzheimer’s. Many have heard it’s about forgetting, that you can forget your own children or where you live. But most believe there’s no way you can really forget your children--not me, not us, not mine. It is almost impossible to understand that someone can forget how to chew, put on a jacket, open a window, but these things happen.
In an effort to understand what to expect, experts have devised stages of symptoms as they usually occur. These stages are not in locked boxes, they often spill over into each other and some things never happen. But they are a useful frame of reference for families and doctors. Some individuals stay in certain stages for a longer or shorter period of time and they can move slowly from stage to stage or rapidly; there are no exact timetables. The duration of these stages, collectively, can easily vary anywhere from three to twenty years.
The Seven Stages of Alzheimer’s were developed by Barry Reisberg, M.D. and are based, in a general way, on the pattern of progression that corresponds to brain cell degeneration that typically begins with damage to cells involved in learning and memory, gradually spreading to every aspect of thinking, judgement and behavior, and eventually to the cells that control and coordinate movement.
Stage 1: No impairment.
Stage 2: Very mild cognitive decline is easily confused with normal aging. Problems are not evident to family, friends and even doctors; but patients will feel they are having memory lapses and forgetting familiar words and locations of ordinary items.
Stage 3: Mild cognitive decline is noticed by co-workers, friends and family. Patients have trouble remembering names of newly introduced people, losing valuable objects, and a decline in their ability to plan and organize.
Stage 4: Moderate cognitive decline brings the inability to remember recent events; cannot do simple arithmetic like counting backwards from 100 by 7’s; unable to plan meals, pay bills, make change or do marketing; and losing memory of personal history. They may seem subdued and apart from others during social gatherings or mentally challenging situations.
Stage 5: Moderately severe cognitive decline will have major memory gaps and deficits in cognitive function. Patients are unable to recall important personal details, such as phone number and address, but will still know some things about themselves and names of spouse and children. They will be confused about the day, date or season, need help with selecting appropriate clothing and some other day-to-day activities. They are still able to eat and use the toilet by themselves.
Stage 6: Severe cognitive decline will show significant personality changes and more memory difficulties. Individuals need extensive assistance with common daily activities. They lose awareness of recent experiences; do not remember personal history correctly, forget name of spouse—but usually still remember their own, can generally distinguish between familiar and unfamiliar faces; without supervision will put clothes on incorrectly and backwards, shoes on wrong feet; sleep patterns become interrupted; need help with all phases of toileting and increasing urinary and fecal incontinence; become suspicious, delusional, have hallucinations, can be compulsive with repetitive physical behaviors, and tend to wander and get lost.
State 7: Very severe cognitive decline is the final stage. Individuals lose the ability to speak, although words or phrases may occasionally be heard, need help with eating, unable to walk without assistance, to sit without support or hold head erect, unable to smile, reflexes become abnormal, muscles grow rigid and chewing and swallowing is impaired.
Sometimes Three Stages are used but follow the same general progression of loss. Adding to the above, Early Stage affects job performance, making bad decisions, loss of initiative; Middle Stage brings refusal to bathe, repetitive statements, problems with reading; Late Stages has weight loss, unable to recognize self in mirror and can’t communicate verbally.
Keep in mind that stages overlap, some things never happen and not all individuals do all the same things at the same time. But do remember that all normal people have memory lapses and other such problems from time to time, don’t jump to the conclusion that they have Alzheimer’s.
Betty Weiss is the author of the best selling Alzheimer's Surgery: An Intimate Portrait, and When The Doctor Says, "Alzheimer's:" Your Caregiver's Guide to Alzheimer's & Dementia. She does not give medical advice. www.geocities.com/caregiving4alz
