Beyond Forgetfulness: A Deep Dive into Alzheimer's
Understanding the Stages of Alzheimer's Disease
Alzheimer’s disease is a progressive brain disorder that affects a person’s memory, thinking, and ability to perform everyday tasks. It is characterised by the accumulation of abnormal proteins in the brain, such as beta-amyloid plaques and tau tangles, which lead to the degeneration of brain cells. The disease typically progresses through several stages, which are often described in a continuum. Although the exact progression can vary from person to person. The most commonly used framework to describe the stages of Alzheimer’s disease is as follows:
The preclinical stage is often referred to as the “silent” stage of Alzheimer’s because no clinical symptoms are present. This stage may start many years before any noticeable symptoms appear. Individuals at this stage have abnormal changes in the brain, such as the accumulation of the beta-amyloid plaques and tau tangles, but they are still functioning normally. According to Mayo Clinic, this stage of Alzheimer’s can last for years, possibly even decades. Although the individual won’t notice any changes, new imaging technologies of the brain can identify the plaques and tangles. The tangles develop when tau proteins change shape and organize into structures.
Mild Cognitive Impairment (MCI)
In this stage, individuals may begin to experience subtle cognitive changes that are more noticeable than typical age-related changes. Neelem Sheikh (2022) states, “individuals with MCI due to Alzheimer’s have minor changes to their memory, thinking, and other cognitive abilities” (para. 8). However, these changes are not severe enough to interfere with their normal day-to-day activities.
Symptoms of MCI due to Alzheimer’s disease may include:
Losing or misplacing things often
Forgetting important events, such as social engagements and appointments
Losing your train of thought or having difficult coming up with the right word
Difficulty with decision making or planning
Changes in judgement and impulse control
Changes in mood (i.e. Anxiety, depression, apathy and irritability)
These changes are often subtle; however, you or your loved ones may notice these changes.
Mild Alzheimer’s Disease
In this early stage, memory and cognitive problems become more pronounced. Common symptoms include difficulty remembering recent events, challenges with problem-solving, and getting disoriented more easily. Individuals may have trouble with everyday tasks and may repeat questions or stories. During this stage, a person may function independently. The individual may still drive, work, and be part of social activities. Despite this, the person may feel as if he or she is having memory lapses, such as forgetting familiar words or the location of everyday objects. Symptoms may not be widely apparent at this stage, but family and close friends may take notice and a doctor would be able to identify symptoms using certain diagnostic tools (Alzheimer’s Association)
Moderate Alzheimer Disease
At this stage, the disease progression accelerates, and symptoms become more severe. This stage brings a greater decline in the person’s cognitive and abilities. This stage often seems the longest and everyone involved will need help and support. Memory loss and confusion among other cognitive abilities become more pronounced. According to Canadian Alzheimer’s Society, this is the stage where caregivers are an essential benefit to the individual. A caregiver’s involvement in the person’s care greatly increases. Moving the person to a long-term care home may be considered for the first time as well. Programs and services in your community can be a big help, providing adult day programs, respite care and more. Essentially, everyone involved will need help and support because of the increasing changes experienced by the person living with Alzheimer’s disease.
Severe Alzheimer’s Disease (Late Stage)
In the final stage, individuals are almost entirely dependent on others for care. The person living with Alzheirmer’s disease eventually becomes unable to communicate verbally or look after themselves. They may lose the ability to speak, recognize loved ones, or control basic bodily functions such as swallowing. Nonverbal communications become more important. Because the person with late stage Alzheimer’s disease cannot initiate activity alone, family caregiver involvement is necessary, and in many cases, the person will need to live in a long term care home, or, if at home, live with added support. Whether at home or in a long-term care home, the goal for late stage Alzheimer’s disease care should be the enhancement of the person living with dementia’s quality of life - to be at the highest level of well-being possible, physically, mentally and emotionally. Activities should be tailored to remaining strengths and abilities, taking into consideration the person’s life history, likes and dislikes.
It’s important to note that not everyone with Alzheimer’s disease will experience these stages in the same way or in the same order. The progression can be influenced by various factors, including genetics, overall health, and the effectiveness of interventions and treatment. Early diagnosis and appropriate medical and social support can help improve the quality of life for individuals with Alzheimer’s and their caregivers.