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Alzheimer’s disease is commonly described in three stages- early, middle, and late. The symptoms vary depending on the stage, and not everyone experiences the same symptoms or progresses through the stages in the same way. Each stage includes a range of possible characteristics.

The Stages of Alzheimer’s and How to Handle Them

Normal Thinking – No Symptoms:

The term “Normal Thinking” is used to describe individuals who do not have Alzheimer’s disease or another form of dementia. These individuals are capable of living independently and managing their own care. It is normal for people to forget things occasionally and then recall them later, as this is a natural part of aging. Similarly, changes in physical abilities are also a normal aspect of getting older. In general, someone with normal thinking does not exhibit consistent signs or symptoms of dementia. It is important to note that Alzheimer’s disease is not a typical part of the aging process, and unlike the Stages of Alzheimer’s, which represent a gradual decline in cognitive function, normal aging does not lead to such significant memory loss or impairment.

Early Stage – Mild Symptoms

People in the early stage of Alzheimer can usually live independently and handle most daily activities. However, in the beginning stages of Alzheimer, they may need help to stay safe and maintain independence. They might struggle with remembering names, finding words, managing money, paying bills, and learning new things. Offering support can assist them in completing tasks, maintaining routines, and staying organized.

In the early stage of Alzheimer’s disease symptoms are mild. The key for you is to provide support in the person’s daily routine. Written notes can be useful.

Middle Stage – moderate symptoms

The middle stage of Alzheimer’s is the longest Alzheimer stage, often lasting for several years and requiring more care as it progresses. It often becomes unsafe for the person to drive. Behavioral and communication changes occur, with difficulty expressing needs, emotions, and completing complex tasks. Confusion about time and place becomes more frequent during this stage.

During the middle stage, it’s important to be patient as the person’s thinking changes. They may mix up identities, repeat stories, struggle with tasks, or need help choosing clothing. Behavioral changes, like fidgeting or kicking, may occur. They might nap often, wake up at night, or have trouble with bladder control.

Late Stage – Severe symptoms

In the late stage of Alzheimer’s disease, most individuals require full-time, around-the-clock assistance with daily personal care. Their physical abilities decline significantly, including walking, sitting, and eventually swallowing. At this stage, they are unable to understand goals, maintain focus, or complete tasks involving multiple steps on their own. Nonverbal communication becomes particularly important during this time.

In the late stage of Alzheimer’s, symptoms are severe. It’s important to reduce chaos by being mindful of noise and activity levels. Even if the person no longer understands words, they will still respond to your tone and body language. Ensure they feel safe and comfortable. You may notice that the person:

• Does not recognize themselves or close family

• Refuses to eat, chokes, or forgets to swallow

• Loses control of bowel and bladder

• Appears uncomfortable or cries out when moved or touched

• Sleeps more

• Needs full assistance with daily activities

Tests and Evaluations for Dementia

There are many medical tests to see if you have conditions like strep throat or the flu. Similarly, there are also many tests to help diagnose dementia. These tests include:

Cognitive Tests: These tests evaluate things like memory, language, special skills, and math skills.

Laboratory Tests: These tests evaluate things like blood levels, vitamin levels, and hormones.

Brain Scans: These tests evaluate things like previous strokes, tumors, and brain activity.

Psychiatric Tests: These tests evaluate things like depression or serious mental illnesses.

Genetic Tests: These tests evaluate whether a person is at risk for dementia because of family history.

The most common form of dementia is Alzheimer’s disease. But, a full medical and cognitive evaluation can help rule out other forms of dementia, conditions, and factors.

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Dementia affects different parts of the brain in different ways, and symptoms don’t follow a set order. Understanding these thinking skills can help you notice the changes and support them better.

If the person you’re caring for can’t put on their sweater without help, it might be because-

• There’s damage to the part of their brain that controls motor skills (for example, they can’t lift their arm into the sleeve).

• They have trouble with perception (for example, they see the sweater as a blanket instead of clothing).

• They have difficulty with judgment (for example, they don’t realize it’s cold and they need a sweater).

What can you do? Sometimes all it takes are some short reminders: “You look cold. This is your sweater. Let’s put it on this arm first.”

Key Functions Affected by Dementia

1. Motor skill:

in dementia some people have problems with coordination, balance, and fine movements, making everyday tasks like walking, dressing, or eating more difficult.

These challenges can lead to clumsiness, instability, and trouble with swallowing or chewing, increasing the risk of falls and making daily routines harder to manage.

2. Perception:

Perception issues in dementia involve difficulty recognizing familiar objects, not due to vision problems, but because of brain impairment in interpreting what is seen. And sometimes they may misinterpret common objects, like mistaking a black carpet for a hole or a glossy floor for water. Naming objects in their environment can help them recognize and understand what they are seeing.

3. Language:

This problem mostly starts with subtle word-finding difficulties, similar to the common ‘tip-of-the-tongue’ feeling. These dementia speech problems become more frequent as dementia progresses. While word usage becomes harder, the emotional meaning behind what is said remains intact. Focus on their emotions—whether they feel pain, insecurity, or discomfort—using tone and body language to understand their message.

4. Attention:

Attention issues in dementia make it difficult to focus on a task or conversation, as distractions pull attention away easily. And they experience “tunnel vision,” focusing on one thing at a time while everything else fades. To help you can minimize distractions and guide them back to the task or conversation.

5. Memory:

Like it sounds. Dementia memory problems affect the person’s ability to recall personal experiences, details, and past routines. To support them, you should focus on asking about familiar topics like past work or where they went to school. This helps them feel secure and maintain a sense of identity.

6. Judgment:

Judgment difficulties in dementia occur due to issues with memory, language, and reasoning, making it harder for individuals to make decisions or understand situations. To provide clear and simple choices to help with decision-making, such as “bath in the morning or evening,” avoiding broad or open-ended questions.

7. Abstract thinking:

makes it difficult to grasp concepts like time, sarcasm, or figurative expressions that require interpretation beyond their literal meaning. With this problem communication should be straightforward, avoiding sarcasm, slang, and abstract expressions to ensure clarity.

CARES Tip

Dementia affects each person differently, leading to varying levels of memory, thinking, and behavior changes. Alongside cognitive decline, physical and social abilities may also be impacted. However, it’s important to remember that these changes are only part of the person. Focus on their remaining strengths rather than what has been lost to support their dignity and well-being.

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