DMT04: The Stages of Alzheimer’s

Alzheimer’s Stage 1

The early stage of Alzheimer’s Disease usually lasts two to four years. It is characterized by forgetfulness, increasing difficulty with problem-solving and withdrawing from activities. If these symptoms are recognized and diagnosed at an early stage, it can save both the individual and their families time and hardship.

During this stage you can expect the person with Alzheimer’s to forget experiences, rather than details (like names). The person may need minor assistance or reminders, but may be able to live alone competently. Efforts to hide confusion from others (the person usually knows something is not right) are sometimes successful at this early stage. 

Alzheimer’s Stage 2

The middle stage of Alzheimer’s Disease is characterized by an increase in memory loss and confusion, shorter attention span, increase in language difficulties and repetitiveness. The middle stage lasts for two to ten years. 

In the middle stage, the confusion is apparent to caregivers. The person may be aware of his/her impairment, but lacks the ability to hide it from others. There is full loss of executive function (i.e. reasoning/problem solving) and difficulty taking care of oneself. The person may need help with activities of daily living (ADLs), such as dressing and bathing. 

As tasks become more challenging, both physically and cognitively, the person may become delusional, paranoid and develop associated behavioral changes. Optimizing physical, mental and social stimulation is key to slowing the rate of decline into the next stage. Constant supervision is needed. The person shows poor judgment and cannot live alone for safety reasons. At this time, patients are often placed in adult day care programs and/or assisted living. Toward the end of the middle stage, the person loses the ability to control bladder and/or bowel function.

Alzheimer’s Stage 3

The late stage of Alzheimer’s Disease is a time of severe confusion and loss of all functional skills. The person has no awareness of his/her condition.

During the late stage of Alzheimer’s the person has: loss of self-care ability; loss of language, is incontinent; is unable to recognize self or others; requires more sleep. Other signs include: weight loss despite a good diet and difficulty swallowing.

The individual responds best to sensory activities and cannot tolerate crowded or noisy environments. Typical of this stage is care in dementia care units/nursing homes with 24-hour supervision and assistance. The final stage lasts for one to three years and ultimately ends in death. Severe Alzheimer’s can be quite distressing to witness.

---

The Condition Of Alzheimer’s Disease Behaviours

When you work with a client who has been diagnosed with Alzheimer’s Disease (at any stage), it is important to know that their behaviour can be unpredictable.

This is often a response to discomfort, an unmet need, and increasing confusion. Patients also develop an increase in difficulty communicating, progressive loss of independence and poor insight and judgment.

Key to reducing behavioural disturbances is to identify triggers. These include: pain; fatigue; acute illness; sensory deficits; hallucinations and/or delusions.

Behaviour’s may be psychomotor (pacing, wandering, repeatedly crying out, etc.); verbal (belligerence, nastiness towards others, repetitiveness) and/or physical (combativeness, inappropriate touching). Care-worker’s need to be aware of these types of behaviour’s which can be expected from their clients.

Emotions

Alzheimer’s patients often experience a strong sense of depression. This may be reflected as irritability, fearfulness, tearfulness, hopelessness, somatic complaints (i.e. feeling ill physically), lack of energy/interest, changes in appetite.

They also may experience feelings of anxiety. This includes feelings of nervousness, worry and apprehension. This is more common in early stage dementia, when the client is acutely aware of their deficits.

Alzheimer’s patients also experience apathy, or flatness of mood, which manifests as an inability to interact appropriately with one’s environment.

Sleep / Delirium

Sleep disturbance occurs in 50% of Alzheimer’s patients living in a community setting. It is one of the most disturbing behaviour’s for caregivers and can cause exhaustion and despair in caregivers.

Patients may have trouble falling or staying asleep, or with resuming sleep. They may wander, may reverse night and day, appear more confused and/or may have exacerbation of anxiety, physical or verbal outbursts.

Alzheimer’s patients can also experience delirium – a sudden increase in mental confusion, accompanied by hallucinations. Alzheimer’s patients often need medication to help them sleep.

Conclusion’s

• When treating an Alzheimer’s patient with medication, remember that it is administered for the benefit of the patient and not for staff convenience. The administration of medication should be tailored to the individual. 
• Carers should constantly be aiming to identify links between certain behaviour’s and medications. Carers should employ strategies that do not require medications. Medications can and should be considered when such strategies are ineffective or not effective enough. 

RISKS & BENEFITS

• Carers need to remember the importance of limiting the number of medications administered to patients and monitor which medications patients react well to and which ones they react poorly to. 
• It is important to provide medication in a slow and infrequent manner, because elderly people do not tolerate medications as well as younger people.
• Avoid medications with undesirable side effects, those which can cause more confusion or sedation, or worsen a patient’s condition.

Treatments

BEHAVIOUR

Atypical antipsychotics (such as Seroquel, Zyprexa, Risperdal) can be helpful, but they carry a concern for side effects. These can include: movement disorders, increased confusion, and the potential for increased cardiac complications. Seizure medications (e.g., Depakote) may be given. However, blood serum levels need to be closely monitored.

PAIN

It is important to recognise and treat pain. This may require careful attention to body language and behaviour. Avoid medications such as Darvon, Percocet and Opioids. Tylenol, regularly dosed, is a very effective analgesic (pain medication). Consider non-pharma options such as: moist heat, massage, and re-positioning.