What Are the Stages of Alzheimer's Disease?

Alzheimer's is a progressive and degenerative brain disorder that affects memory, thinking skills, and behavior. It is the most common form of dementia, accounting for 60-80% of all cases of dementia. Alzheimer's disease affects people in different stages, from mild to severe. Knowing the stages can help you better manage the illness and raise the standard of living for afflicted individuals

Stage 1: No Impairment

No Impairment is the first stage in Alzheimer's disease, characterized by no cognitive impairment or observable symptoms. During this stage, people may still experience age-related memory decline, but performance on standardized tests is normal, and there are no changes in daily functioning. People at this stage may also experience subtle changes in their memory and thinking, such as difficulty recalling recent events or taking longer to learn new things.

At this stage, people with Alzheimer's disease show no signs of dementia. They have normal mental functioning, and any cognitive decline does not impact everyday activities. While there are no changes in physical health, people may start to experience social and emotional changes, such as being more forgetful, feeling confused or anxious more often, and having trouble making decisions.

 Stage 2: Very Mild Decline

Very Mild Decline is the second stage of Alzheimer's disease. People with mild decline may experience some symptoms, such as slight forgetfulness and difficulty remembering recent events, names, or conversations. They may also have difficulty focusing on tasks or sustaining attention for long periods. Changes in personality, moods, and behavior may also be seen in people with this stage of the disease.

Some physical changes may manifest as well. These include decreased motor skills and coordination, slowed gait, and difficulty maintaining balance and posture. People with mild decline may have difficulty performing activities requiring more complex multitasking or problem-solving.

In this stage, the symptoms may still be unnoticeable to others and can often be mistaken for normal age-related forgetfulness. Despite this, people with mild decline should receive medical attention to help manage some of the symptoms. Treatment for the very mild decline in Alzheimer's disease may include cognitive training and a combination of medications.

Stage 3: Mild Cognitive Decline

Stage 3 of Alzheimer’s disease is known as Mild Cognitive Decline (MCD). At this stage, the symptoms become more pronounced and noticeable. People in MCD may start having difficulty with memory recall, have trouble learning new things, struggle to remember conversations that took place recently, and experience other problems with language skills. Other common symptoms at this stage include difficulty with abstract concepts, impaired judgment, and decision-making abilities, personality changes, disorientation in time and space (not knowing what day or where they are), and changes to their sleep patterns.

At this point in the disease, people may struggle to keep up with daily activities such as managing finances, using the phone, shopping, or traveling to unfamiliar places. They may also become more withdrawn, disinterested in activities they used to enjoy, and lose their sense of purpose. At this stage, people must receive diagnosis and treatment as early as possible to benefit from available treatments and support services while they can still do so.

Treatment options at this stage may include medications, cognitive and physical therapy, counselling and lifestyle changes to help improve quality of life. It is also important to provide emotional and practical support for the individual, as well as their family and caregivers.

Stage 4: Moderate Cognitive Decline

In this stage of Alzheimer's disease, often known as Moderate Cognitive Decline (MCI), an individual may experience more noticeable symptoms. They may need help remembering recent events or conversations, become disoriented in familiar places, and need help keeping track of their appointments and finances. An early symptom is an inability to recall new information, a condition known as anterograde amnesia. Memory problems may become so significant that the person can no longer remember details of their life history or key facts about family members. They may struggle to plan and have difficulty making decisions.

At this stage of Alzheimer's, individuals may also experience changes in their ability to complete complex tasks, such as balancing a checkbook or driving to familiar places. They may experience difficulty understanding new concepts and have trouble communicating their thoughts and feelings. Some people may start to withdraw from social activities, become easily confused in conversations, or become agitated when trying to express themselves.

Stage 5: Moderately Severe Decline 

Moderately Severe Decline is a stage of Alzheimer's disease where the person experiences more severe cognitive decline and memory impairment. Daily tasks, including dressing, eating, bathing, and using the restroom independently, could no longer be possible for them. At this stage, people cannot recognize family members or familiar places, and they may become disoriented in time or place. They have difficulty expressing their needs, speaking in complete sentences, and often become agitated or aggressive when confused.

People living with Stage 5: Moderately Severe Decline of Alzheimer's disease require around-the-clock care and supervision to ensure their safety. Due to their decreased mobility, they are prone to developing other medical complications, such as urinary tract infections and pressure ulcers.

In this stage of the disease, people may benefit from certain medications that can help manage behavioral symptoms, including anxiety and insomnia. Family members and caregivers should also provide a safe environment, connect the person with normal activities or objects, and offer reassurance and comfort.

Stage 6: Severe Cognitive Decline

Severe Cognitive Decline is the final stage of Alzheimer's disease. At this stage, individuals experience a significant decline in memory and communication abilities and a decrease in their ability to care for themselves. As cognition declines, individuals may become unable to recall important information, such as family members' names or addresses. They may also be unable to recognize familiar faces or understand simple instructions.

During this stage, individuals will experience a marked decrease in their ability to complete everyday tasks such as dressing and bathing independently. They may need help with eating, using the toilet, and other activities of daily living. Individuals may also become increasingly restless and agitated due to a lack of understanding or an inability to communicate their needs. As the disease progresses, individuals may experience difficulty swallowing and develop bedsores due to limited mobility.

Due to the progressive nature of Alzheimer's at this stage, individuals may require 24-hour care in a supervised facility or long-term care unit. Family members and loved ones may need to advocate for the individual, ensuring they receive proper medical attention and the highest level of care.

Find out what treatments may be available for people living with Alzheimer's

Treatments for individuals living with Alzheimer's disease vary depending on the stage of the disease. The primary goals of treatment are to manage behavioral issues, delay the disease's course, lessen symptoms, including disorientation and memory loss, and maintain quality of life. Treatment approaches may include medications that can improve cognitive function, behavior management techniques, and psychosocial interventions such as reminiscence therapy.

Confusion, agitation, and memory loss are signs of Alzheimer's disease that can be treated with medication. Examples of drugs that may be used include cholinesterase inhibitors, memantine, and NMDA receptor agonists. Cholinesterase inhibitors act to preserve levels of the neurotransmitter acetylcholine, which is vital for memory and learning. Memantine helps reduce glutamate activity in the brain, reducing excitatory transmission and helping with cognitive functioning. NMDA receptor agonists help stimulate plasticity in neurons, aiding in learning and memory formation.

Behavioral management techniques are often utilized by memory care facilities for Alzheimer’s patients and can be used to reduce agitation and other disruptive behaviors. Examples of behavior management techniques include reality orientation, distraction techniques, and positive reinforcement. Reality orientation involves reminding individuals of the date, time, or their current location to orient them to the present moment. Distraction techniques can help redirect individuals who become agitated or confused. Positive reinforcement is an effective technique for encouraging desired behaviors through rewards or praise.

Psychosocial interventions such as reminiscence therapy can provide comfort and reduce distress in individuals living with Alzheimer's disease. Reminiscence therapy involves discussing fond memories and past experiences with the individual, helping them recall positive and meaningful moments. This can provide a sense of comfort and security to patients who may be struggling with confusion or memory loss. Other techniques, such as music therapy, art therapy, and aromatherapy, may be used to provide comfort and relaxation.

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