The Stages Of Alzheimer’s Disease — And How Families Can Prepare

{By: Dr. Nasli R Ichaporia}

Alzheimer's disease is a kind of brain disease that progressively impairs thinking, behaviour, and memory. It is most prevalent in older adults, and people find it more difficult to carry out daily tasks as the illness worsens. Alzheimer's affects not just the individual with the disease but also their loved ones and carers. Families can better prepare for each stage of Alzheimer's disease by being aware of its various stages. Alzheimer's disease typically advances through three main stages: early, middle, and late, though each person's experience is unique.

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Stage 1 - Preclinical Alzheimer’ Disease (No Symptoms)

In this early stage, changes are happening in the brain, but there are no noticeable symptoms. This stage can last for many years. During this time, harmful changes in the brain, like the build-up of amyloid plaques (clumps of protein) and tau tangles (twisted protein strands), begin to occur. However, the person doesn’t show any clear signs of memory loss or confusion. Family members won’t notice anything different at this stage. Though there are no symptoms, medical tests, like brain scans or cognitive tests, may detect early brain changes that could later lead to Alzheimer’s.

Stage 2 - Mild Cognitive Impairment (MCI)

In the second stage, people may begin to notice problems with memory or thinking, but these changes are still mild and don't significantly interfere with daily life. This stage is called Mild Cognitive Impairment (MCI). People may forget recent events, names, or appointments. They may also find it hard to concentrate or solve problems. These problems are more than just normal age-related forgetfulness, but not severe enough to be considered Alzheimer’s. Family members may notice that the person needs reminders more often or is repeating themselves in conversations. 

In this stage, it’s important for families to help their loved ones maintain a healthy lifestyle, including regular exercise, a balanced diet, and staying mentally active. Doctors may also recommend starting treatments or changes to delay further memory decline.

Stage 3 - Mild Alzheimer’s Disease (Early Stage)

In the early stage of Alzheimer’s, memory problems become more noticeable, and it begins to affect daily life. People may have trouble remembering familiar names, faces, or important dates. They may also get lost in places they know well or forget things they’ve just learned. Their ability to manage tasks like planning meals, paying bills, or organizing their schedule becomes more difficult. Although the person may still be able to live independently at this stage, they will need help with some tasks.

Families should be prepared to assist with daily tasks and provide a routine that helps the person feel more secure. It’s also important to be patient and understanding as the person may feel frustrated with their memory lapses. Using calendars, reminders, and checklists can help the person maintain some level of independence.

Stage 4 - Moderate Alzheimer ’s Disease (Middle Stage)

As Alzheimer’s disease progresses to the moderate stage, memory loss becomes more severe, and the person may have trouble recognizing close family members. Their ability to speak clearly and understand conversations decreases, and they may struggle with tasks such as dressing themselves or maintaining personal hygiene. Mood swings, anxiety, and depression are common in this stage. The person may also experience confusion and difficulty in making decisions.

At this stage, the person will need more help with everyday activities. Families should be prepared for more intensive caregiving, and it may no longer be safe for the person to live alone. Family members should consider professional care options, such as a caregiver or adult day care, to provide support. It’s also helpful to offer emotional support, as the person may feel scared or upset by their growing difficulties.

Stage 5 - Severe Alzheimer’s Disease (Late Stage)

In the late stage of Alzheimer’s, the person’s memory and cognitive abilities are severely affected. They may no longer recognize family members or friends, and their ability to speak or understand language is greatly diminished. The person may be unable to perform any daily activities on their own, including eating, bathing, or dressing. Incontinence (the inability to control urination and bowel movements) is common, and the person may become bedridden.

During this stage, the person needs around-the-clock care and supervision. Families should focus on making the person as comfortable as possible. This may include managing pain, making sure they are clean and comfortable, and offering emotional support through touch or familiar music. It can be emotionally difficult for family members, so it’s important to seek support, such as through caregiver groups or hospice services.

Stage 6 - End-Stage Alzheimer’s Disease (Final Stage)

End-stage Alzheimer’s is the final and most severe stage of the disease. At this point, the person may have lost the ability to speak or respond to others. They may not be able to move or even control their muscles, becoming completely dependent on others for care. Health complications, like infections, are common in this stage, and the person may experience significant physical decline.

Families should focus on providing comfort, offering emotional support, and making sure their loved one is pain-free. End-of-life care options, like hospice care, are important at this stage. Hospice care helps ensure that the person is kept comfortable, with pain management and support for the family. It’s important to continue showing love and care, even if the person can no longer communicate.

Preparing For The Journey

Alzheimer's is a long-term and difficult illness. Families should plan for caregiving needs, seek medical assistance, and understand what to anticipate at each stage. In order to manage the illness and enhance the patient's quality of life, early diagnosis and treatment are crucial. Because caring for someone with Alzheimer's can be highly demanding, caretakers also require assistance. Families must take breaks, go to support groups, and get professional assistance when necessary. It's critical to strike a balance between providing care and taking care of oneself because Alzheimer's affects the patient as well as their loved ones.

The author, Dr. Nasli R Ichaporia, is the Director - Neurology, at Sahyadri Super Speciality Hospital, Nagar Road, Pune.

[Disclaimer: The information provided in the article, including treatment suggestions shared by doctors, is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.]

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