By David Buice
Alzheimer’s disease. There are few word pairings more dreaded in the English language. First identified in 1906 by Dr. Alois Alzheimer, this insidious malady attacks the brain without warning, has no known cure to date, and progresses through stages until it finally kills everyone it afflicts. Once diagnosed, an Alzheimer’s patient typically lives anywhere from three to nine years, though some survive for 20 years or longer.
Dr. Alzheimer discovered what would later be called the two hallmarks of the disease. The first of these is plaques which are actually multiple, tiny, dense protein deposits in the brain which over time become toxic. The other marker is tangles of nerve cells, called neurofibrillary tangles, which interfere with vital processes and eventually kill off living brain cells.
According to the Centers for Disease Control and Prevention (CDC), currently about five million Americans suffer from Alzheimer’s, and deaths related to it have increased over the past 16 years in every race, sex, and ethnicity category—and will likely continue to increase as our population ages. In 2014, 93,500 Americans died from the disease, and it is the sixth-leading cause of deaths in the United States. Between 1999 and 2014 the number of Alzheimer’s deaths occurring at home increased from 14 percent to 25 percent. And that upsurge in deaths taking place at home increases the burden on caregivers.
When a loved one is diagnosed with Alzheimer’s, it is natural to want to know what the future holds. What’s going to happen, and when will it happen?
Every person diagnosed with Alzheimer’s disease is affected differently, but patients tend to experience a similar trajectory from the beginning of the illness until its fatal end. The precise number of stages is somewhat arbitrary, with some using a simple three-stage model (early, moderate, and end) while others use a more precise breakdown to better understand Alzheimer’s progression.
The most common system is that developed by Dr. Barry Reisberg of New York University, and he breaks the disease’s progression into seven stages. The Alzheimer’s Association (AA) and many other health care providers have adopted his progression, but there is an important qualifier to keep in mind. Namely, people are not programmed to follow this progression in a straight line. On a given day, a loved one may appear to be in stage six, and the next day seem to have improved temporarily to stage four, before regressing the next day to a more advanced stage.
With that caveat in mind, the following is a summary based on Dr. Reisberg’s research.
Stage 1: No impairment
During this stage, Alzheimer’s disease is not detectable and no memory problems or other symptoms of dementia are present. Through research we know that Alzheimer’s can begin years or even decades before we have a clue that anything is wrong. So for now, most of us will never know if we are in the beginning stages of the disease.
Stage 2: Very mild decline
A person may notice minor memory problems or lose things around the house, but not to the point that these lapses can be distinguished from normal, age-related memory loss. They will still do well on memory tests and the disease is unlikely to be detected by either physicians or loved ones.
Stage 3: Mild decline
In this stage, friends and family may notice a senior’s memory and cognitive problems. Performance on memory and cognitive tests declines, and physicians are able to detect impaired cognitive function.
In this stage they may also frequently lose personal possessions and have difficulty in several areas including:
- Finding the right word during conversations
- Remembering names of new acquaintances
- Planning and organizing
Stage 4: Moderate decline
Clear-cut symptoms of Alzheimer’s disease are now apparent, and patients in this stage:
- Have difficulty with simple arithmetic
- May forget details about their past
- Have poor short-term memory, forgetting, for instance what they had for breakfast
- Inability to manage their finances and pay bills
Stage 5: Moderately severe decline
At this stage, Alzheimer’s patients begin to need help with many day-to-day activities, and they may experience:
- Significant confusion
- Inability to recall simple personal details such as their phone number
- Difficulty dressing appropriately
On the other hand, patients in this stage often maintain a degree of functionality. Typically, they can still bathe and take care of toilet needs. They also usually know family members and some details about their past, especially their childhood and youth.
Stage 6: Severe decline
In this stage patients need constant supervision and frequently require professional care. Their symptoms include:
- Confusion or unawareness of environment and surroundings
- Major personality changes and potential behavior problems
- A need for help with daily activities such as bathing and using the toilet
- Loss of bowel and bladder control
- Inability to recognize faces except closest relatives and friends
- Cannot remember details of their personal history
In this stage, late day or early evening can bring on an additional symptom known as “sundowning.” The cause is unknown, but the patient will become upset when the sun goes down, and the situation may last all night.
Finally, in this stage the patient may become increasingly paranoid and suspicious. Hallucinations are not uncommon, and compulsive behavior such as picking at skin or nails, scratching and hand-wringing can occur.
Once the disease has progressed this far, caregivers may well need to consider moving the patient to an Alzheimer’s facility, giving the caregiver much-need relief from their round-the-clock responsibilities.
Stage 7: Very severe decline
This is the final stage of Alzheimer’s disease, and patients are nearing death. In this stage, patients lose the ability to respond to their environment or communicate. While they may still utter words or phrases, they have no insight regarding their condition and need help with all the activities of daily life. In this final stage they may lose the ability to swallow. As a consequence, many in Stage 7 die from pneumonia as food and beverages get trapped in the lungs leading to a life-ending infection.
From Stage 3 on, Alzheimer’s places an ever-increasing strain on caregivers. To avoid burnout, remember to take care of yourself. Stay in touch with friends, keep up with hobbies and activities, and don’t try to do it all alone. One source of support at your fingertips is the Alzheimer’s Foundation of America. The organization maintains a national toll-free hotline at (866) 232-8484, as well as providing live chat and email contact on their website. And they want you to know that “no question is too big or too small.” Help is available, and you shouldn’t hesitate to use it.