Figure 1 shows five stages of Alzheimer’s Disease (AD) that contains uncertain AD presymptomatic, symptomatic and dementia periods that begins with unaware biological anomalies as early as age 45.  This article provides some a little knowledge and insight for AD awareness and which stage to focus when dealing with Alzheimer’s Disease (AD) and these five stages.

Figure 1: Stages of Alzheimer’s Disease & Dementia

1.         Evidence indicates Alzheimer’s Disease (AD) is a result of amyloid plaque that aggregates to a level that triggers fibrils and tangles in the Tau protein, and without patient awareness, begins a neuron loss in the Entorhinal Cortex (EC) which years later shows as memory symptoms and cognitive impairment.  The disease progresses to cause loss of executive functions of thinking, learning, comprehension, reading, writing, decision making, and wandering.  As neurodegeneration progresses, patients evolve through severe AD into a dementia where they require caregiver support for Activities of Daily Living (ADL), as well as issues of anxiety, confusion, fear, worry, and depression that can become behavior problems.  

            Functional Assessment Staging Test (FAST) https://www.mccare.com/pdf/fast.pdf is an AD symptomatic tool that determines if change in a patient’s condition is due to Alzheimer’s Disease (AD) or another conditions.  If change is due to AD progression, then any changes on the FAST scale will be in sequence – AD related changes do not skip FAST stages.  The stages are: 1) normal aging, 2) possible cognitive impairment, 3) mild cognitive impairment (MCI), 4) mild AD, 5) moderate AD, 6a, b, c, d, e) Moderately severe AD/dementia, 7a, b, c, d, e, f) severe AD/dementia.  Ref. Reisberg B. – 1988

2.         There is a significant difference between Alzheimer’s Disease (AD) stages and AD Dementia.  When a patient reaches the stage where they no longer can independently perform normal “Activities of Daily Living (ADL), they have reached AD Dementia (Figure 1) and need constant attention and care.  Caregiving management is different during stages before and after ADL dependence.

3.         Behaviors and Symptoms differ between Alzheimer’s Disease (AD) patients who maintain independent Activities of Daily Living (ADL) compared to those patients who are demented and need caregiver support for AD dementia.  During independent ADL, AD behaviors and symptoms are inconveniences and differ from other mental disorders, such as Lewy Body Disease, Vascular Disease, Frontotemporal Dementia, and Parkinson’s disease. All mental disorders evolve into dependent ADL/Dementia where they develop many similarities.

4.         Behavior’s issues are mainly associated with the brain’s Limbic System and primarily with the amygdala, where emotions and fear, flight, or fight as well as depression occurs.  Impact to this area in AD normally begins in a late stage as indicted by “me and my shadow” where the patient is insecure or worried and seeks caregiver support and comfort.  Aggressive behavior may follow. 

5.         Accept the fact that cure, delay, and prevention for symptomatic Alzheimer’s Disease (AD) is currently not realistic and quality care is the best approach.

6.         Venting is good, but use it as a learning experience, especially from support group feedback, who have experienced many of your vents.  Accept the help, move-on, and grow from the help.

7.         Guilt is tough but normal.  Your emotions are telling you that you should or shouldn’t have done somethings that would have made the patient feel better.  This is your brain’s issue, and whatever it is, the demented patient has no memory of you or the issue after 10 seconds    of your absence. 

8 Caregiver Feelings – If you are doing your best, that is all you can do.  Play the cards that you are dealt.  As a family caregiver, avoid feeling guilty, being a hero, and ignore sibling’s inappropriate behavior (if possible).   As an institutional or in-home caregiver, be aware of the impact to you of becoming attached

9.         During presymptomatic stages, candidate patients should become aware of research activities, along with a pursuit of Social activities, continue Learning, develop Exercise routines, and establish a healthy Diet. (SLED), as well as controlling caloric intake.

Caregiver Tools

1..        Patience – always answer the question, no matter how often asked.  To the patient, it is the first time they are asking.      

2,         Redirection – Change the subject, offer a cookie, take a walk, change the patient’s current issue, then their concern will not recallable.  That is not to say it won’t happen again. 

3..        Never argue – whatever it is, agree.  The patient won’t remember.  Arguing is only satisfying your values or ego.  Remember that you are dealing with the disease.

4.         Attention – Most patients crave attention, the same as a small child does.  Recognize that the patient is in the opposite phase of life as a child and with Alzheimer’s Disease (AD) has behaviors similar to a child. Attention is their reward and stimulates their ego.  This is evident during the severe stage of AD and as dementia progress.  Tell them stories of their past.  They won’t remember but it is effective “at the moment”.

5.         Hugs and Kisses are usually well accepted.  However, depending on the patient mood, these could be viewed as threats which the patient might defend and become aggressive.  Be sensitive.

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