Alzheimer’s disease (AD) is a slowly progressive disease that occurs in stages. Initially, the disease is mild, but, with time, it progresses and the symptoms of the final stages of Alzheimer’s disease can become severe. Eventually, Alzheimer’s disease affects most areas of your brain. Memory, thinking, judgment, language, problem-solving, personality, and movement can all be affected by the disease. The disease can last anywhere from 6-10 years and the duration of each stage may vary from 6 to 24 months in most cases. Observation of patients reveals the stages of Alzheimer’s disease with some overlap. Each person has a different experience with Alzheimer’s and its symptoms. Knowing the different stages allows healthcare workers to predict the prognosis. The five stages of AD include the following:

 

1. Preclinical AD

It is now known that Alzheimer’s disease starts way before any symptoms become obvious; this is known as preclinical AD. This stage is only identified by imaging studies done for some other reason. At this stage, the affected individual is asymptomatic. The preclinical stage may last 2-3 years, and, in some cases, it, may never progress. The only way to know if you have preclinical AD is to undergo a PET (positron emission tomography) scan, which can detect a protein called beta-amyloid. This protein is a hallmark of the disorder. Statistics have shown that close to 30 percent of individuals with preclinical AD will not have amyloid plaques in the brain. PET scans are now utilized for select patients only with early Alzheimer’s disease for clinical trials. The ability to identify these patients is especially important because today there are several novel therapies that can help break up the amyloid plaques.  In addition, several additional biomarkers of the disease have been identified but usually, they only are positive in the presence of symptoms.

There are genetic tests to determine if one is at a higher risk for early-onset Alzheimer’s disease. However, these tests are only recommended for a few select patients and are not for routine use. They are more applicable in families with a high incidence of AD at a young age.

2. Mild Cognitive Impairment (MCI)

In most cases, individuals with early-stage Alzheimer’s disease may have mild cognitive impairment (MCI). These mild changes may affect the ability to think clearly and are also associated with intermittent forgetfulness. These effects are so mild that they do not impact work or personal relationships. The memory loss is usually linked to short-term memory, like forgetting where the car keys are kept, not remembering to turn off the water tap, or forgetting to switch off the TV. Further, these individuals may not have a proper grasp of the time it takes to accomplish a task or may not be able to complete a task that requires multiple steps. Finally, these individuals also have difficulty making sound decisions.

It is important to understand, however, that not all individuals with MCI have Alzheimer’s disease. The diagnosis of MCI is based on the history and clinical presentation. Healthcare workers may utilize a variety of screening tools to determine the presence of memory loss and cognitive dysfunction.

3. Mild Dementia 

The majority of individuals with Alzheimer’s disease are diagnosed when they have mild dementia. The family notices that the individual is forgetful, losing things, having difficulty remembering recent events, and may also have mild problems with daily living activities. Individuals with mild dementia may experience the following:

• Loss of recent memory. For example, the individual may not remember what he or she did over the previous weekend or may not remember that he or she was at the doctor’s office four days ago. They may repeatedly ask the same questions.
• Having a hard time making sound decisions and solving complex tasks. For example, the individual may no longer be able to balance his/her monthly bills despite having done so for decades. Often, they are simply not able to make sound decisions. For example, he or she may be considering installing a treadmill in the home even though the individual has difficulty walking and uses an ambulatory device.
• Altered personality. Some individuals may suddenly become withdrawn or shy usually in social situations or they may become angry or irritable. 
• Low motivation. Another feature of this stage is the lack of motivation to complete a task.
• Difficulty expressing thoughts.  He or she may have difficulty organizing or expressing thoughts.
• Lose things.  He or she may frequently lose or misplace belongings like eyeglasses, watch, house keys, etc. 

4. Moderate dementia 

As the disease progresses, moderate dementia will set in, which is marked by frequent episodes of forgetfulness and more confusion. The individual will start to need help for most daily living activities, like dressing and self-care. In general, individuals with moderate dementia will show the following features:

• Confusion and poor judgment. Most will have no idea of the day of the week, season, or year. They may confuse family members and friends for one another or even mistake strangers for family members.
• Wandering. A universal feature of this phase of the disease is the wandering that can occur day or night. The individual may get lost even in familiar surroundings.
• Moderate to severe memory loss. Besides just forgetting their address or phone number, they may no longer be able to remember their past history. They may make up tales to fill in the missing memory gaps.
• Inability to perform daily living activities.  At this stage, many individuals may need help with daily living activities, like dressing, bathroom use, and self-care. They may start to show signs of loss of control over bladder and bowel movements.
• Behavior and personality changes. As dementia progresses, it is not unusual to note drastic changes in behavior and personality. The individual may become paranoid and complain that the caregiver is hurting or stealing from him or her. He or she may blame his or her spouse for having an affair. Others may develop delusions but one universal feature of this stage is the restlessness and agitation that is typically seen during the day. Aggression and outburst of random anger are also not uncommon.

5. Severe Dementia

Severe dementia is the last stage of the disorder. At this stage, severe compromises in mental function and behavior are common. Some common symptoms of the final stages of Alzheimer’s disease include:

• Inability to communicate coherently. Most AD patients in this stage will not be able to hold coherent communication; the words and phrases may be jumbled and may not make any sense.
• Total care is needed.  Care is usually required to perform all the daily living activities, including feeding, dressing, bathing, and even ambulation.
• Marked decline in physical abilities. The individual may not be able to get up from the bed, walk, or even hold their head up without support. The muscles are often stiff and rigid, there is a loss of bladder and bowel control and severe loss of weight. At this stage, many are bedfast and rarely speak.

THE RATE OF PROGRESSION OF THE STAGE

The rate of progression through the stages of Alzheimer’s disease varies from individual to individual. On average, once a diagnosis of AD is made, the individual may survive 3-10 years, but the rare individual may survive even longer. As the stages progress, and the symptoms of the final stages of Alzheimer’s disease persevere, the degree of mental and physical impairment becomes severe, and the quality of life is very poor. Other comorbid factors that worsen the prognosis of AD include:

• Hypertension
• Diabetes
• Peripheral vascular disease

The majority of Alzheimer’s patients have difficulty swallowing and aspiration of food and saliva into the lungs is not uncommon. The most common cause of death is pneumonia. Other causes of death include failure to thrive, malnutrition, falls, and infections.

CONCLUSION

Alzheimer’s disease is an agonizingly painful disorder for both the affected individual and the family/caregivers. As the stages of Alzheimer’s disease progress, these individuals are no longer able to live independently and most end up in a long-term care facility or hospice care, where the treatment is focused on comfort, easing pain, and meeting the emotional, physical, and spiritual needs of the individual and the family.

The professional staff at Cano Health stands ready to assist seniors with all their healthcare needs.  Cano Health is dedicated to offering the best medical care and programs to seniors.  During the difficult times of health crises, you need a support staff who will be there for you and your family.  Discuss your options with the experts at Cano Health today by calling 1-855-208-7877.