- Stage 1: Normal Outward Behavior.
- Stage 2: Very Mild Changes.
- Stage 3: Mild Decline.
- Stage 4: Moderate Decline.
- Stage 5: Moderately Severe Decline.
- Stage 6: Severe Decline.
- Stage 7: Very Severe Decline.
Combining the results of 11 studies shows that regular exercise can significantly reduce the risk of developing dementia by about 30 percent. For Alzheimer’s disease specifically, the risk was reduced by 45 percent.
There are several benefits massage therapy offers people with Alzheimer’s disease, including increased body awareness and alertness, as well as a reduction in the feelings of confusion and anxiety. “You also build reassurance and trust,” says Catlin, “and help calm agitation.”
The Phases of Alzheimer’s Disease
What is Alzheimer’s disease? According to Robert Butler, in his Merck Manual of Geriatrics contribution (“Alzheimer’s Disease – Senile Dementia of the Alzheimer Type”)1, it is “a progressive neuropsychiatric disease of aging found in middle-aged and, particularly, in older adults affecting brain matter and characterized by the inexorable loss of cognitive function, as well as effective and behavioral disturbances. It is a major public health issue. Treatment costs now exceed well over $40 billion/year.”
This tells us that the disease is progressive and that it destroys parts of the brain and hence is incurable. From Butler’s definition, we can also deduce that there must be several forms of the disease, because of the use of the term “Alzheimer’s Type.” His definition also implies that there are other kinds of dementia. But, according to the Merck Manual of Geriatrics, Senile Dementia of the Alzheimer Type (SDAT) accounts for over half of all dementia cases. We also come to this important sentence in the Merck Manual of Geriatrics chapter on symptoms and signs: “SDAT can be subdivided according to clinical stage, but there is great variability and the progression of stages often is not as orderly as the following description implies.”
In other words, it is difficult to even for a physician to determine if the patient really suffers from SDAT, much less what symptoms to expect or what stage he or she is in. Later on in the Merck Manual, Butler touches on the difficulties of proper diagnosis by admitting that “prior to the imposition of stricter diagnostic criteria, SDAT was misdiagnosed up to 50 percent of the time.”
The Merck Manual of Geriatrics goes on to describe the three stages of the disease as follows:
“The early stage of SDAT is characterized by recent memory loss, inability to learn and retain new information, language problems, mood lability, and changes in personality. Patients may have difficulty performing activities of daily living (e.g. balancing their checkbook, finding their way around, or remembering where they put things). They may be unable to think in the abstract and use proper judgment. Irritability, hostility, and agitation may occur in response to the loss of control and memory. Other patients may present with isolated aphasia or with visuospatial difficulties. The early-stage may not, however, compromise sociability. Patients may be alert, making it difficult for the practitioner to uncover problems with cognition. However, families may be reporting strange behavior (e.g. the patient’s getting lost on the way to the store or forgetting who a recent dinner guest was). This may be accompanied by the onset of emotional lability.
“The intermediate stage of SDAT finds the patient completely unable to learn and recall new information. Patients frequently get lost, often to the point of being unable to find their own bedroom and bathroom. Although they remain ambulatory, they are at significant risk for falls or accidents secondary to confusion. Memory of remote events is affected, but not totally lost. The patient may require assistance with activities of daily living (e.g. bathing, eating, dressing, toileting). Behavioral disorientation occurs in the form of wandering, agitation, hostility, uncooperativeness or physical aggressiveness. At this stage, the patient has completely lost his sense of time and place, since normal environmental and social cues are ineffectively utilized. Neuroleptic agents or antianxiety drugs may be required to stabilize the patient.
“The severe or terminal stage of SDAT finds the patient unable to walk, totally incontinent, and unable to perform any activity of daily living. Patients may be unable to swallow and require nasogastric feeding. They are at risk for pneumonia, malnutrition, and pressure necrosis of the skin. They are totally dependent on their family caregiver, or a long-term care facility. Eventually, they become mute. Recent and remote memory are completely lost. The patient cannot relate any symptoms to the physician. In addition, since there may be no febrile or leukocytic response to infection, the clinician must rely on experience and acumen when the patient looks ill.
“The progress of the disease is gradual, not rapid or fulminating; there is a steady decline, although some patients’ symptoms seem to plateau for a time. No motor or other focal neurologic features occur until very late in the disease. The end-stage of SDAT is coma and death.”2
Looking at this bleak scenario makes it obvious the disease is not just a catastrophe for the patient, but for their family. Since the course of the disease extends over many years, it is especially hard on the spouse who often becomes the caretaker of the patient at home, especially if the patient is a man. Convalescent hospital care is frequently beyond the financial capacity for the whole time-span. Sometimes grown children can make themselves available, but there is a heavy emotional price to pay when a child sees the respected head of the family slowly becoming an incontinent, incoherent stranger.
Understanding Alzheimer’s and dementia
Alzheimer’s is the most common cause of dementia, a general term for memory loss and other cognitive abilities serious enough to interfere with daily life. Alzheimer’s disease accounts for 60-80% of dementia cases.
Alzheimer’s is not a normal part of aging. The greatest known risk factor is increasing age, and the majority of people with Alzheimer’s are 65 and older. But Alzheimer’s is not just a disease of old age. Approximately 200,000 Americans under the age of 65 have younger-onset Alzheimer’s disease (also known as early-onset Alzheimer’s).
Alzheimer’s worsens over time. Alzheimer’s is a progressive disease, where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer’s, individuals lose the ability to carry on a conversation and respond to their environment. Alzheimer’s is the sixth-leading cause of death in the United States. On average, a person with Alzheimer’s lives four to eight years after diagnosis but can live as long as 20 years, depending on other factors.
Alzheimer’s has no current cure, but treatments for symptoms are available and research continues. Although current Alzheimer’s treatments cannot stop Alzheimer’s from progressing, they can temporarily slow the worsening of dementia symptoms and improve quality of life for those with Alzheimer’s and their caregivers. Today, there is a worldwide effort underway to find better ways to treat the disease, delay its onset, and prevent it from developing.
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