A symptom is something you tell the doctor that you have or that you are feeling. A sign is something the doctor uncovers through observation or by examining you. The signs and symptoms of Alzheimer’s frequently defy the norms, for they are the individualized manifestations of the genetic factor, lifestyle, and other environmental and health susceptibilities of each patient. In other words, each patient’s progression with the disease will differ from the norm, at times in a dramatic fashion.
For example, take patients A and B, both 80 years old, and both with first stage Alzheimer’s. Patient A lives with her family and is accorded a lot of affection, and the presence of children in the household. Patient B lives in a home where the staff may be underpaid and overworked. I don’t need to tell you that patient A will remain in stage one for a long time, while patient B will slip into the other stages more rapidly.
Affectionate, loving care, a good nutritious diet, and a daily walk in the outdoors will do wonders for someone who is dementia-impaired. Children are also known to add a positive influence, being not intimidating in appearance and behavior.
In addition, we shouldn’t be surprised to find patients going from third stage on one day and then behaving in a less rigid manner that can be described as first stage. Many patients do that, particularly when they are in the early stages, and they do it in reaction to fears, confusion, and other psychological and environmental factors.
Experts use two models for classifying the stages of dementia. In the first, they use medical or anatomical models based on the disruption the disease is causing in the brain. In the second, they use socio-psychological standards which set out these stages:
- In the first stage, patients try to fend for themselves as best they can. Their memory starts acting up, and they can frequently get stuck on a word, raking their minds to retrieve it, and ending up with a lot of frustration and embarrassment. They try to hide what goes on, using pretenses and creating stories and fables about what they’re up to. “Confabulation” is the clinical term that describes patients filling gaps in their memory with made up stories that they end up believing. They get highly irritated if anyone challenges the stories.
- In a second stage, patients “let go” of all the fabrications, and they let go of the control they wanted to have in the earlier stage. They are more relaxed as a result, and they start to withdraw and live in the past, conjuring up the “happy times”. Many patients will start living entirely in the past in that stage, frequently also confusing people. A devoted daughter may suddenly be called by another daughter’s name, an unnerving circumstance to say the least.In the second stage, patients may also start doing something and forget what they’re up to, so they would embark on another course of action altogether. They get distracted in mid-course and make frequent changes in their activities. They also start using phrases that are not clear. They suddenly let go of thoughts and speech when it all gets muddled. They may thus end up talking in gibberish. Finally, they may stand up and then freeze, not knowing what to do. Their mind gets riddled with confusion in this stage.
- In the third stage, patients will withdraw further and deeper. Communication becomes a “yes” and “no”, or some meaningful word from the past. They would get totally engrossed in memories of activities in the past, and they might live wholly in that time frame. Wandering is common in that phase. They wander because they would be trying to overcome boredom, or looking for something or someone. They will also start desiring things and expressing those desires through actions and gestures. For example, they might start wringing their hands or working on a small piece of paper or clothing with total focus. Experts think that they are thus regressing into a time period when they were central to what went on around them. Finally, many patients become incontinent in this third stage.
- In the fourth stage, it’s the complete shut-out of the outside world. They would be found staring at nothing in particular and may not react to someone talking to them. The body gets rigid, and the eyes glare at the emptiness on the wall or ceiling.
There are more stages of Alzheimer’s, three more to be precise. The Global Deterioration Scale (GDS), the Resiberg Scale, as it is also known, goes on to describe those. In the next stage, stage five, which typically lasts for a year and a half, there is almost a complete wipe-out of the memory, and patients lose any ability they may have retained to take care of activities of daily living.
Stage six typically lasts for 2.5 years and is characterized by agitation, repetitive behavior and compulsive activity. Patients may become combative in this stage, and they will need assistance with all facets of daily living. By then most patients would have become incontinent, incapable of talking coherently, and they may have lost all their motor skills and become non-ambulatory, i.e. wheelchair and bed-bound. In addition, they may become at times delusional and prone to forgetting the names of close family members.
In the final stage (seven), patients will make unintelligible utterances, but for all practical purposes, all verbal abilities are lost. Patients will by then require assistance with all activities, including feeding. The brain seems to have disconnected from the body which experiences general rigidity. This stage may last from a few months to two years or more.
The Global Deterioration Scale, developed by Dr. Barry Reisberg, provides caregivers of patients with Alzheimer’s with an overview of the deterioration of cognitive function they can expect in the patients they care for. It is to be noted, once again, that the affectionate care and lifestyle accorded to each patient will determine how well they do in each of those stages.
About Mike Takieddine, the author:
Mine has been a privileged life, first for having traveled all over as son of a diplomatic family, then for having had the opportunity to study at Oxford, and finally for a gratifying career in geriatric home care where I had the opportunity to restore sanity and optimism to many family caregivers. I look forward to using this wonderful medium to discuss the various ailments that afflict the elderly.