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The stages of Alzheimer's disease and what kind of agencies can help

by Sue Lanza

The most common form of dementia is Alzheimer's disease which has been around since 1906. Named for Dr. Alois Alzheimer who discovered it, the disease is a progressively fatal brain disorder in which parts of the brain no longer function. Common hallmarks of the disease include memory problems, difficulty in concentrating, and trouble thinking. Alzheimer's affects over 5.3 million Americans and research has been ongoing but has not yet found a cure.

The Stages of Alzheimer's disease

Alzheimer's disease has been studied closely for the last few decades, and researchers have found that most individuals with the disease go through set stages of progression. In simplest terms, Alzheimer's disease has three major phases: early or mild, middle or moderate and late or severe. Breaking these areas into understandable terms for caregivers has been challenging. Dr. Barry Reisberg has been credited with determining a more detailed view of seven stages of dementia called, "The Global Deterioration Scale". The Alzheimer's Association has adopted a modification of these stages to assist family caregivers. A brief summary of the specifics of each stage are spelled out along with suggestions for possible housing placement at each disease phase. As with any medical issue, the duration and symptoms might vary, but the general decline of Alzheimer's remains the same.

  1. No Impairment. Individuals at this stage show no marked decline in their cognitive function. No memory problems show up on a regular basis. In fact, your loved one might show no symptoms and function well at home.
  2. Very Mild Impairment. At this stage, forgetfulness begins. Lapses in memory and basic thoughts might occur, such as forgetting names or familiar words. Forgetting small details, like where they put their glasses or if they took their medication that morning, might be more common. Independent living would still be an appropriate option.
  3. Mild Decline. At this point, family and friends have begun to notice the symptoms. A person who was once able to organize and plan now seems lost with the details. Losing things is more common, and they might begin having performance issues at work. A person at this stage may still be very suitable to remain at home, in independent senior housing or may require supervision of assisted living.
  4. Moderate Decline. The problems are now clear in medical interviews. Forgetting personal history, recent events, and how to handle complex tasks, such as planning dinner or paying bills, happen much more frequently. Your loved one might be very aware something is wrong, and that leads to acting withdrawn or subdued in social situations. During this phase, an individual may benefit from in-home support of a visit from a family member or caregiver while remaining at home. Senior housing or independent living complex may also be an alternative
  5. Moderately Severe Decline. Major details, such as their phone number or address, become hard to remember. While they may remember their own name and the names of those important to them, such as a spouse or a child, this stage of Alzheimer's begins to chip away at basic information, such as the current date, time, or season. Day-to-day tasks, such as cooking, might not be safe any longer. By this point, a live-in situation with family or a home caregiver may be required for supervision of daily tasks. If there are behavior issues, consideration might be given to locate the person to either a specialized assisted living facility or a skilled nursing facility.
  6. Severe Decline. At this point, your loved one might be losing their short-term memory. They may require more help with basic activities, such as dressing and using the toilet. They might also experience behavioral changes, such as feeling suspicious or experiencing hallucinations. Someone at this stage might engage in repetitive behaviors or wander away, only to become confused and lost. The demands of family caregiving become significant at this stage usually prompting the individual with dementia to be placed in a long-term care or skilled nursing facility where specialized care can be offered.
  7. Very Severe Decline. In this final stage, they may lose the ability to speak coherently. They may need help with general hygiene, and may eventually lose muscle coordination and the ability to control movement. Their muscles typically grow rigid, the reflexes become unpredictable, and eventually even swallowing could become be impaired. A person at this phase of the disease is in need of comfort care and pain management available in either a skilled nursing facility or from a hospice provider.

Next Steps

The stages of Alzheimer's disease give you a starting point in identifying issues and what you or your loved one may expect during the progression of the disease. No matter what the stage of the disease, a visit to a physician should be scheduled as soon as possible for a full history and physical. Early detection and intervention can provide information, emotional support and help in anticipating the future.