Alzheimer’s Disease, what are the stages?
In this article, we would like to shed more light on the 7 stages of Alzheimer’s disease that we have briefly mentioned in a previous article. The goal is for you to better understand at which stage your loved one is and, thus, rapidly identify the care and resources needed at each stage.
There is a Global Downgrading Scale (GDS), developed by Dr Barry Reisberg, that provides caregivers with an overview of the stages of cognitive function for those suffering from primary degenerative dementia such as Alzheimer’s disease.
Dr Reisberg’s scale is divided into 7 stages of Alzheimer’s disease; stages 1 to 3 are stages of pre-dementia while stages 4 to 7 are stages of dementia as such and most symptoms of Alzheimer are well-documented.
It is important for family members of people with Alzheimer’s disease, as well as caregivers, to understand how the disease progresses and also, to be aware that at the beginning of stage 5, the patient can no longer survive without assistance, the day-to-day business is now out of reach.
Each stage is described with a short title, followed by a brief list of features for that stage. Caregivers and relatives can have a rough idea of a person’s condition in the evolution of their illness by observing their behavioural characteristics.
Reminder About Alzheimer’s disease
Alzheimer’s disease is a degenerative brain disease that causes the gradual death of brain cells (the neurons) and loss of connectivity which disrupts the cognitive abilities of the person. It is the most common cause of dementia in the elderly. It leads to the gradual and irreversible loss of mental functions, causing especially memory problems.
Loss of memory is one of the best-known symptoms. However, the progression of Alzheimer, including the evolution of lesions in the brain tissue and other parts of the brain, will later prevent other mental abilities from functioning and accelerate cognitive decline.
Hence, a person with Alzheimer’s disease will later experience emotional and behavioural disorders. However, such symptoms are not part of the normal ageing process. It is therefore important to consult a doctor at an early stage to make sure they are not caused by related diseases or other factors.
Main Risk Factors for Alzheimer’s disease
The medical community agrees that a healthy lifestyle can help reduce the risk of Alzheimer’s disease and its related diseases. In addition, we now know that more than half of Alzheimer’s cases are attributable to seven risk factors; these are controllable or modifiable for the most part:
● Diabetes
● High blood pressure
● Obesity
● Smoking
● Depression
● Cognitive inactivity
● Physical inactivity
Taking care of these risk factors can help you prevent Alzheimer’s disease and this list should be shared among family and friends.
The 7 stages of Alzheimer’s disease
To be suffering from Alzheimer’s disease is first to present memory loss and disorders that are important enough to impact everyday life; even what we call mild Alzheimer.
This does not happen overnight; also, it is important to note the frequency and intensity of symptoms or disorders. There is a difference between a small occasional problem (preclinical Alzheimer) and a problem or disorder whose frequency and intensity increase steadily.
Stage 1 – No Cognitive Decline
Normally, there are no subjective complaints of memory loss or deficit at this stage from the patient; nor any obvious memory deficit during a clinical interview with the patient.
Stage 2 – Very mild cognitive decline (age-related memory impairment)
Some subjective complaints of memory loss appear, the patient worries most often about the following situations:
● Forgetting where familiar objects have been placed
● Forgetting the names, we once knew
On the other hand, there is no objective evidence of memory impairment during a clinical interview. Nor will we detect an objective deficit of memory, whether at work or in social situations. No symptoms of dementia are detected during medical examinations or by friends, family or colleagues.
This is a normal decline in memory, related to ageing, which can cause a corresponding but not alarming concern.
Stage 3 – Moderate cognitive decline (mild cognitive impairment)
Whereas in the previous stage, old age, as well as Alzheimer’s disease, could be at the origin of the symptoms, we are here facing the first net deficits of the mental faculties.
It is now possible to observe events in the following situations:
● The patient may go astray when moving to an unknown location
● Work colleagues may notice a decline in the patient’s performance; in particular, in the performance of complex tasks
● Forgetfulness and searches for words and names become obvious to loved ones
● The patient retains little memory of reading a passage or a book
● The patient may have difficulty remembering names when introduced to new people
● The patient begins to lose or misplace valuable objects
● The concentration deficit may be evident during a clinical examination by a professional
Objective evidence of the memory deficit can now be obtained through a thorough examination. Denial begins to manifest in the patient, very often accompanied by mild anxiety.
Stage 4 – Moderate Cognitive Decline (Mild Dementia)
There is a net cognitive deficit during a careful clinical interview. The cognitive deficit will manifest itself in the following situations:
● Great decrease in knowledge of recent events and news
● Deficit in memory of his / her personal history, his / her past
● Concentration disorder in serial subtraction tests
● Decreased ability to travel and financial management (to pay bills)
However, there is still retention of the following mental abilities:
● Orientation in space and time
● Recognition of faces and people around you
● Ability to move in-known places
On the other hand, the inability to perform complex tasks has become evident and denial has become a dominant, if not second nature, defence mechanism. There is also a decrease in emotional reactions and frequent withdrawal in difficult situations.
Stage 5 – Moderately Severe Cognitive Decline (Moderate Dementia)
At this point, it is obvious that the patient can no longer live alone; in this respect, caregivers and relatives must be able to recognize this condition.
Thus, during a clinical evaluation interview, the patient may not remember an important aspect of his current life such as his address and his telephone number of several years, the names of his grandchildren, etc.
There is also often disorientation with respect to time (date, days of the week, season …) and place.
Even educated patients may have difficulty counting backwards from 100 to 50 or from 50 to 5.
However, people that have a moderately severe decline of their cognitive abilities still have a good knowledge of many important facts about themselves and their loved ones. Thus, they know their own names and usually those of their spouses and their children. They do not need help with their own bathing and eating but may have difficulty choosing the right clothes.
Stage 6 – Severe Cognitive Decline (Moderately Severe Dementia)
At this point, the impact on cognitive abilities is important enough to make relationships, even with loved ones, difficult. Thus, we note the following behavioural changes:
● Sufferers may sometimes forget the name of the spouse of whom they are entirely dependent for their survival
● They are largely unaware of events and recent experiences of their lives
● They keep some knowledge of their past lives, but it’s very basic
● They are generally no longer aware of their environment, the year, the season, etc.
● They may have difficulty counting down from 20 for example and sometimes even count to 10 simply
● They will need assistance with activities of daily life; for example, they may suffer from incontinence will need help getting around, but they will occasionally be able to get to familiar places
● The day rhythm is often disturbed
● They almost always remember their own name
● They often continue to be able to distinguish people familiar from unknown people in their environment
Personality and emotional changes are highly variable and include:
● Delusional behavior patients may accuse their spouse of being an impostor, talking to imaginary characters or their own reflection in the mirror
● Obsessive symptoms; a person can keep repeating cleaning activities
● Symptoms of anxiety; agitation and even violent behaviour can occur
● Cognitive abulia; that is, they lose the ability to think long enough to determine and carry out deliberate action.
7th Stage or Final Stage – Very severe cognitive decline (severe dementia)
At stage 7, virtually all verbal skills have disappeared and very often there is no language at all, only unintelligible expressions and occasional emergence of forgotten words and phrases.
We also observe the following behaviours:
● Urinary incontinence and a need for help with the toilet and diet (bladder and bowel problems)
● Progressive loss of basic psychometrists such as the ability to walk
● Inability of the brain to control the body
● Generalized rigidity of neurological reflexes
We hope that this post has been helpful and enlightening regarding the 7 stages of Alzheimer’s disease and has thus helped you to better understand the evolution of the disease in your family.
This will allow you to quickly determine the required resources to ensure the wellbeing of both your loved one and family.
N.B. The information presented above does not constitute in any case a medical or scientific opinion; if in doubt, do consult a health professional.