Everyone has heard of Alzheimer’s disease, but despite its rising popularity in the vocabulary of the general public, most people do not actually comprehend what it means to suffer from this terminal illness.
Often used interchangeably with dementia, Alzheimer’s disease is one of the most common brain disorders in adults over 60 for which there is no cure. In simple terms:
It is a progressive brain disorder that slowly causes the brain to shrink as cells die-resulting in cognitive decline and decreased brain function, which affects a person’s ability to interpret reality and function independently.
In other words, Alzheimer’s disease is a pandora’s box of monsters that feast on a healthy person’s brain; and once unleashed, the damage cannot be reversed.
Dementia vs Alzheimer’s
Although the exact cause of Alzheimer’s is not perfectly understood, its symptoms are well known- dementia being the most prominent. Most people usually confuse the two, so here is a little crash lesson distinguishing them:
Alzheimer’s disease is a specific illness that refers to brain degeneration caused by extensive cell damage, while dementia is an umbrella term to describe the various symptoms associated with memory decline. Alzheimer’s disease is the leading cause of dementia worldwide- but not the only one.
The daily reality of this illness involves symptoms ranging from confusion to trouble speaking, walking, and even swallowing. Symptoms vary per individual and get more severe as the disease progresses in the following stages:
The Stages of Alzheimer’s Disease
Stage 1: Pre-symptomatic
Similar to other diseases, changes in the brain occur long before an individual shows any symptoms. Often labelled “pre-clinical”, it can take over a decade until more symptoms are noticeable. During this phase, the brain begins accumulating protein clumps (amyloid plaques) and tangling bundles of protein fibers (tau tangles) but remains otherwise functional.
What it looks like: An aging individual (we’ll call her Nancy) leads an independent life. She dives, shops, bakes, volunteers on Fridays, and loves gathering with her family to socialize and reminisce.
Stage 2: Subjective cognitive decline
Everyone is forgetful to some extent. This is also something commonly amplified with age. At this stage, forgetfulness starts to show, but it appears normal. The affected individual may feel a layer of fog infiltrating their brain but nothing will raise a flag- even memory tests can yield normal or ‘good’ results.
What it looks like: Nancy lives her life normally, but can sometimes forget people’s names, or where she left her keys. Like Nancy, elders at this stage will notice their forgetfulness and blame ‘age’ since they can still remember important information, are social, can work, drive, etc.
Stage 3: Noticeable memory impairment
Cognitive problems are out of the norm and will begin to disrupt the daily life of the affected individual. Feelings of anxiety or denial are common among seniors with Alzheimer’s or their families at this stage.
Forgetfulness will begin to disrupt daily life and it will become harder to blame age. These early signs of dementia now show on memory tests, which is why diagnosis at this stage is common.
What it looks like: Nancy keeps losing her keys and often misplaces her phone- once she had even placed it in the fridge by accident! Nancy also has trouble remembering unfamiliar names of celebrities her granddaughter shares and all the new people her son introduced her to. In conversation, Nancy struggles to find the right words, reiterate topics discussed, or recall conversations from the previous weekend.
Stage 4: Moderate cognitive decline
This stage is usually the longest and can last decades. This is usually when a physician will prescribe the use of medication to help with symptoms like dementia and behavior changes. By now, cognitive impairment affects cognition beyond memory and involves aspects such as language, organization, planning, and the ability to perform simple math.
Daily tasks also become more difficult, so the affected individual may get frustrated often, feel withdrawn, and could even fall into depression.
What it looks like: Nancy is still cognizant of important aspects of life like her husband, her children, her address, and her home. She has a hard time remembering day-to-day occurrences, but can easily recall memories of her childhood in Prague. Sometimes, this leads to confusion regarding dates and the weather.
As per extensive cognitive damage, changes in behavior, sleep patterns, and personality are also common at this stage, which is especially challenging for caregivers and loved ones.
Stage 5: Significant cognitive decline
People in stage five need help to perform certain tasks like organizing finances, shopping, and even dressing (depending on the severity). Most individuals will still recognize the closest members of their family and will be capable of completing basic functional tasks independently, like bathing, feeding, and going to the bathroom. However, they will find it difficult to learn anything new, recall details about themselves and remember people outside their inner circle.
What it looks like: Nancy can do basic functional tasks on her own but relies on others and assistive technology for cooking, cleaning, getting dressed, and most other daily tasks. She also needs somebody to set medication alarms for her and jot down her details like full name, phone number, and other reminders.
Individuals at this stage should not be left unsupervised for prolonged periods of time, since they are likely to get lost and wander without recognizing people or places nearby. Extensive brain damage may even cause unprecedented emotional changes that can cause significant confusion, paranoia, delusions, and even hallucinations.
Stage 6: Severe cognitive decline
Severe symptoms will affect the elder’s ability to care for themselves, so they will rely on others for most daily tasks. At this stage, most families seek professional care for frequent help and supervision.
Although the person with Alzheimer’s will still have the ability to speak, communicating specific ideas, worries or symptoms becomes a deeply frustrating challenge.
What it looks like: Nancy is no longer like her old self. She often hums an old nursery rhyme and mumbles when communicating- requiring a trained ear to understand her. She also needs help from her husband and her nurse with activities like toileting, bathing, remembering details about her family, taking her medication, and understanding her surroundings.
Personality changes from stage six continue to occur, which may bring about more intense symptoms of confusion and anxiety.
Stage 7: Terminal decline and severe dementia
Unfortunately, Alzheimer’s disease ends in a place most people are not prepared to go. Brain damage has been so extensive that it causes severe mental and physical impairment. Without the ability to communicate or properly respond to their environment, constant supervision is extremely important.
Coupled with decreased mobility, everyday objects and situations can be hazardous. Thus, this stage of the disease can easily bring other morbidities like pneumonia, ulcers, falls, etc.
What it looks like: Nancy can no longer recognize the faces of her son or grandchildren. She keeps uttering the same words repeatedly and is growing weaker.
Reduced mobility also means affected individuals will need help walking, sitting, and feeding until eventually, they may lose their ability to swallow, hold themselves up, and smile.
We all know how Alzheimer’s disease ends after years of hardship and emotional turmoil.
Recently, there have been advances in the pharmaceutical sector for the development of a new drug for Alzheimer’s, but the controversies surrounding the situation suggest this may just be another empty promise.
Medical and nutritional intervention early on is important, to supply the body with the power to slow down the illness as caregivers and care receivers prepare for the reality they are about to face.
Alzheimer’s is more than just a disease. It is a challenge in patience, love, and mental health. Life at this point is taking a dramatic turn for everyone, and the best thing to do is to learn from it and enjoy each moment.
Alzheimer’s Facts and figures. Alzheimer’s Disease and Dementia. (n.d.). https://www.alz.org/alzheimers-dementia/facts-figures.
Mayo Foundation for Medical Education and Research. (2021, June 26). Alzheimer’s disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447.
The 7 stages of alzheimer’s disease. Penn Medicine. (n.d.). https://www.pennmedicine.org/updates/blogs/neuroscience-blog/2019/november/stages-of-alzheimers.
World Health Organization. (n.d.). Dementia. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/dementia.
