For many years, Alzheimer’s disease has been hard to diagnose at an early stage. The best thing doctors and caregivers could do was watch for the symptoms, mainly the cognitive impairments a patient developed over time, and try to piece things together. Things are beginning to change, but even so, the stigma of dementia and the elusive nature of the condition make the early symptoms easy to overlook.
One of the most useful instruments to help care for Alzheimer’s patients is the Global Deterioration Scale (GDS) developed by doctor Barry Reisberg, Director of the Fisher Alzheimer’s Disease Education and Research program at New York University Langone. This scale describes the seven stages of Alzheimer’s disease.
The Seven Stages of Alzheimer’s Disease
According to the GDS, the first three stages are pre-dementia and describe a person who has only mild symptoms and can function almost normally. Starting with stage 4, the disease progresses to true dementia and the once normal person becomes a patient unable to take care of himself or herself.
Stage 1: Normal
A person starting the slow descent into dementia will show no symptoms at this stage, although the disease is already present. Only a PET scan corroborated with a patient’s family history with this disease might prompt a doctor to utter the word Alzheimer’s. Otherwise, the person will speak and behave normally.
Stage 2: Very Mild Changes
At this stage, your loved one might show some very subtle changes, like misplacing objects, forgetting an appointment, or struggling to find a word. Still, it’s too little to ring any alarm bells. Alzheimer’s usually affects people over 65, and the symptoms can be easily mistaken for the cracks and creases of old age.
Stage 3: Mild Cognitive impairment (MCI)
Any suspicions you might have had about someone close to you developing Alzheimer’s will be confirmed by this stage. Those random senior moments will increase in frequency and start impacting the patient’s life.
A person with MCI will experience difficulties in organizing his or her life. If still employed, their job performance will start to decline. The most obvious symptoms at this stage are:
- Inability to learn new skills
- Asking the same question over and over
- Difficulties remembering names, especially when meeting new people
- Forgetting information he or she has just read
Stage 4: Mild Alzheimer’s
By this point, there is no more room for doubts—a doctor will be able to accurately diagnose Alzheimer’s based on the obvious symptoms, without the need of additional PET scans or spinal fluid tests. The cognitive impairment your loved one will manifest will be significant enough to make living independently a real challenge.
At this stage, Alzheimer’s patients start forgetting things about themselves, like a recent holiday or other events, and struggle to remember the day or the month. One of the most important challenges is managing their personal finances. The person in your care might require assistance with writing checks and paying bills.
Other classical symptoms include:
· Trouble cooking a familiar meal or ordering from the menu
· Difficulties driving and finding a location, although the patient can still remember correctly his or her address; at this stage, an AD sufferer should stop driving
· Compulsive, repetitive behavior like hand-wringing or paper shredding
The most troubling symptom can be emotional withdrawal as the patient is aware of his or her cognitive impairments and struggles with anxiety. Being afraid of their deteriorating condition, the patient goes into denial and tries to hide their problems by isolating themselves more and more and refusing to take part in normal conversation.
Stage 5: Moderate Alzheimer’s
Independent living is almost impossible at this stage, as an Alzheimer’s patient starts forgetting even their own address or phone number, though not all the time. Likewise, your loved one might not recall the year or major facts like the name of the current president. Typically, at this stage, you will have to assist the person in your care with managing finances, such as paying the rent or bills.
One of the most obvious symptoms is the inability to remember the weather conditions and dress appropriately, in which case you can help by laying out the clothes for them, to maintain at least the illusion of independence.
Also at this stage, behavioral problems such as anger or being over-suspicious appear.
Stage 6: Severe Decline
This stage is marked by the progressive loss of the abilities to dress or bathe unassisted. Laying out the clothes for the patient will no longer be enough, as he or she will have trouble putting them on.
Your loved one will require assistance with bathing, as they won’t be able to set the right water temperature and, eventually, won’t be capable of washing or even brushing their teeth.
It is at this stage the incontinence appears, first urinary incontinence, followed by fecal one. Other symptoms patients develop include:
- Remembering a face, but forgetting the name
- Mistaking a spouse for a dead relative
- Hallucinations, such as preparing to go to work although they don’t have a job anymore
- Forgetting their former occupation, the school they attended or the country they were born in
- Speech problems appear towards the end of this stage
Stage 7: Very Severe Decline
A person with stage 7 Alzheimer’s disease requires constant supervision and assistance with basic activities. Speech is severely impaired and the patient uses only a few words, often hard to understand, until he or she stops speaking altogether. At this point, your loved one will no longer be able to feed himself and will require mostly soft foods.
As the condition progresses, he will have trouble walking unassisted or sitting in a chair without armrests. Towards the end of this stage, the patient will no longer be able to sit at all and will become bedridden. If the patient survives long enough, his or her body will become increasingly rigid, which often leads to joint deformities.
Alzheimer’s Disease Progression
Every patient is unique and there’s no telling how quickly their condition will degenerate. On average, a person can live with Alzheimer’s for four to eight years after diagnosis, but this can go up to 20 years. This depends on the stage at which the diagnosis is made, as the initial pre-dementia phase can go on for years without being apparent that it’s a disease.
Mild-stage Alzheimer’s is generally the longest one and can go on for many years. For instance, the sixth stage of severe decline can last on average 2.3 years.
The seventh most dramatic stage can also last for years. Progression from each sub-stage to the other, loss of ability to speak, loss of the ability to walk, loss of the ability to sit can each last for approximately one year.
How You Can Help
There is no cure for Alzheimer’s disease yet but that doesn’t mean there is nothing you can do for your loved one. If there are risk factors such as cases of AD in your family, you should encourage your loved one to see a doctor as soon as you notice symptoms like memory loss or inability to complete everyday tasks.
If the disease is diagnosed early, the doctor can prescribe medication to alleviate the symptoms and slow the deterioration of cognitive functions. Medication can improve memory or even fight against the destruction of brain cells. Also, antidepressants and antipsychotics can alleviate behavioral problems and improve mood.
Even if you cannot stop the disease, you can help your loved one make the most of their remaining time.