Alzheimer's disease is a long journey. Patients move at different speeds and take different routes, but they're all headed in the same direction. Over time, their disease will worsen, their memory will fade, and they will have more and more trouble taking care of themselves or completing basic tasks.

The Alzheimer's Association recognizes seven different stages that patients pass through, starting with good health and ending at severe dementia. If you or a loved one has been recently diagnosed with the disease, it can help to know what lies ahead. Here's a look at the seven stages of Alzheimer's.

Before Alzheimer's starts to take its toll, a person still has a sharp mind. The disease may have already killed some of his brain cells, but he hasn't noticed any problems with thinking or memory.

As people get older, their ability to remember things is likely to slip a little. They may lose their car keys more often or have trouble remembering the names of people they just met. These memory glitches are completely normal and are no cause for concern. But some people with very mild cognitive decline will go on to develop Alzheimer's.

Also called mild cognitive impairment, this is the stage where red flags start appearing. Friends, family, or coworkers will begin to notice changes in a person. He may struggle to remember words or names, have trouble finishing tasks, lose important or valuable things, or become disorganized. Sometimes family members get frustrated at this early stage: they may notice subtle personality changes but not connect them to a memory problem. They may not realize, for example, that their loved one is trying to cover up his forgetfulness by sticking stubbornly to certain routines, or becoming more short-tempered as a result of fear and confusion over his failing memory.

A person in this stage should see a doctor promptly. A doctor may be able to find a physical cause for the symptoms, such as high blood pressure, poorly controlled diabetes, or side effects from medications. If there's no clear explanation for the fading memory, the patient may be referred to a neurologist. With careful testing, including interviews and, perhaps, high-tech brain scans, neurologists can sometimes see signs of approaching Alzheimer's. For most patients, however, the future will be uncertain.

By this point, a person's thinking and memory have clearly gone downhill. A person in this stage may forget about things that happened earlier in the day. He may put the iron in the refrigerator, have trouble remembering words ("gloves" may become "those things for my hands"), or need help with basic tasks such as handling finances; he may also seem withdrawn. A neurologist can now diagnose Alzheimer's disease with confidence. Once the diagnosis has been made, a doctor may prescribe a drug that can help boost the patient's memory or even slow the course of the disease. Razadyne (galantamine) – formerly known as Reminyl -- or a similar drug, along with vitamin E, are common options. Depression is also common in patients with Alzheimer's, and treating it with medication can often improve functioning.

At this stage, independent living is no longer an option. The person can usually no longer manage basic tasks such as cooking, and he can no longer go out in public alone due to the danger of getting lost. He may not be able to recall basic details of his life, such as his current address or phone number, but he may enjoy talking, dancing, walking with a friend or family member, and other favorite activities. Patients usually need supervision to get safely through the day. This is a time when the strain on family caregivers can peak because they may attempt to do all the caregiving themselves. Hiring a home health aide or taking a loved one to adult day care is often a lifesaver. That way, family members can get some relief while their loved one remains at home. Physicians will continue to recommend drugs like Razadyne and donepezil (Aricept) in this stage.

Until this stage, most patients have kept their basic personality. But as the disease worsens, a different person may emerge. A patient may become paranoid and accuse loved ones of being kidnappers. As more memory and reasoning powers are lost, confusion takes over. He will need help using the toilet and may have frequent episodes of urinary and fecal incontinence. If not carefully supervised, he can wander away and become lost.

Until very recently, there was no treatment for people in the advanced stages of Alzheimer's disease. There is, however, some cause for hope. A new drug, Namenda (memantine), approved by the Food and Drug Administration in 2003, has been shown to slow the advance of severe Alzheimer's

In the end, Alzheimer's disease robs a person of the ability to speak. The patient won't be able to walk without help, and even sitting up may be a struggle. Before long, he won't even be able to hold up his head. He will become bedridden, and death won't be far away. Every now and then, however, he may still surprise you with a smile.

Every stage of Alzheimer's disease presents new hardships and challenges for caregivers and patients alike. If you're ready for those challenges, you can make the journey as smooth as possible. The final destination never changes, but there are many different ways to get there.

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. His reporting on occupational health earned him an award from the Northern California Society of Professional Journalists.

References

alzheimersupport.com New Findings Show Reminyl Slows Cognitive Decline by 60% in Alzheimer’s. May 23, 2003 http://www.alzheimersupport.com/library/showarticle.cfm/ID/1931/

First published September 25, 2003
Last updated January 10, 2007
Copyright © 2003 Consumer Health Interactive

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