Caring for and supporting a friend or loved one with Alzheimer’s Disease can be a daunting and uncertain task. Often, it’s hard to know what to expect – a person’s behaviors and abilities can change each day, sometimes rapidly, and being responsible for that person can certainly put you on your toes. Unfortunately, there’s no roadmap to Alzheimer’s: it’s a disease that can develop differently for each person, and the symptoms can manifest themselves in varying ways. But the good news is that there is a general progression that most patients with Alzheimer’s take as their disease moves forward with them. A nationally-recognized staging system set forth by the National Alzheimer’s Association is now used by both caregivers and healthcare providers alike to set expectations, monitor progression, and offer a frame of reference to this frustrating and confounding disease.
Stage 1: No Impairment Displayed
It is now understood that Alzheimer’s Disease begins in a person years (or sometimes decades) before any symptoms are detected. This is unfortunate – it means there’s no way for an individual to be diagnosed with the disease as soon as it begins, and often even when symptoms begin to manifest themselves, a doctor can only suggest a probable diagnosis. Our current understanding of Alzheimer’s means we can’t even offer a definitive diagnosis until we examine a patient’s brain post-mortem.
Stage 2: Mild Cognitive Decline Detected
Here, the patient might begin to notice some increased forgetfulness. Yet at this point, a diagnosis of Alzheimer’s Disease is no more certain, as many patients and physicians alike tend to chalk these symptoms up to other things. The normal process of aging, the potential of dementia, or even stress or depression could cause increased forgetfulness, and so it’s hard to assert with conviction that Alzheimer’s is the culprit. Some patients will experience more telling signs at this stage, such as changes in behavior or judgment. These red flags give physicians a more definite sign that Alzheimer’s may be the underlying issue, though diagnosis at this point is still unlikely.
Stage 3: Moderate Cognitive Decline Occurs
Stage 3 is a tricky place: symptoms make evident that the patient is cognitively struggling in some respects, but pinning down an Alzheimer’s diagnosis is still not certain. Patients might have trouble recalling particular words, struggle with remembering names or a person they just met, and have difficulty stringing together the events of the previous day. Cognitive tests at this stage can still be inconclusive, as symptoms could still be attributed to aging or dementia.
Stage 4: Moderately Cognitive Decline Occurs
At this stage, definite symptoms of Alzheimer’s will have emerged and doctors will consider the disease progression mild or “early stage Alzheimer’s Disease.” Forgetfulness that extends to knowledge of recent events, both in one’s personal life and current events overall, is one sure sign. The patient’s ability to engage with daily activities of living or organizational activities may also have declined (for example, it may become a real challenge to do something like plan a dinner party or organize one’s weekly calendar). Standardized mental status tests can be administered to determine if significant cognitive decline has occurred, and at this stage, it’s likely that patients would see substantial decreases in performance.
Stage 5: Moderately Severe Cognitive Decline Occurs
At this stage, it is abundantly clear that something is amiss with the patient and quite likely that he or she can be diagnosed with Alzheimer’s, as general activities of daily living are substantially impeded. The patients themselves will, at this point, realize that their functioning is subpar, but be unable to control or improve their condition. It’s a time of real frustration for patients as well as caregivers and family. Things like recalling an address, counting backward from 20, or recalling something that occurred only this morning will pose a real challenge.
Stage 6: Severe Cognitive Decline Occurs
Here, forgetfulness is no longer the most problematic symptom patients display. Many will experience behavioral changes and may become combative or belligerent. They will be incredibly confused and frustrated and may exhibit behaviors like “escaping” their home or living environment, as wandering becomes an increasingly tell-tale behavior. Caregivers and family must be on high alert during this stage as their charges and loved ones are incredibly susceptible or injury. Recalling names, dates, addresses, is incredibly unlikely, though many Alzheimer’s patients at this stage can still identify faces. Tasks of daily living like dressing and undressing, showering, and using the toilet are almost impossible to do alone and require assistance. Patients may also “sundown” during this stage: they’ll feel at times that there is something they must do, but be unable to recall what it is or how to do it. It’s a very frustrating time for both patients and caregivers.
Stage 7: Very Severe Cognitive Decline Occurs
In this final stage of Alzheimer’s Disease, a patient will require assistance with all aspects of their lives. They’ll become incredibly weak and may not even be able to stand. Their speech will have become unrecognizable, and they’ll become increasingly susceptible to disease, illness, and injury. Death will eventually occur in this stage. It is, undoubtedly, an incredibly trying time for caregivers and loved ones, though hospice can offer incredible assistance to patients and their families during this stage.
It is incredibly challenging to care for a person suffering from Alzheimer’s Disease, but there is help out there. If you have a loved one who is struggling, or that you suspect may need assistance in the face of progressing Alzheimer’s, talk to Angels on Call. We’re here to help you ensure your loved one receives the best care for them, and that you’re given the support and relief that you need.