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The Stages of Alzheimer's Disease

 

All forms of Alzheimer’s / Progressive Dementia follow a pattern that is broken into three major stages of deterioration.

Whether The stages of Alzheimer's/dementia are referred to as The Early, The Mid, and The Late Stage, or The First, Second and Third Stage, each stage is unique and demonstrates noticeably different changes in function.   This has to affect how caregivers approach their people and this includes the professional caregiver as well as the family caregiver.  The duration of each stage and the manner in which each stage progresses remains fairly consistent and predictable and that does provide the caregiver with some guidelines as to what to expect as the various phases of this disease unfolds.    I know there are those out there who have a problem with categorizing Alzheimer's into stages but from the vantage point of a caregiver who has been through the entire process of this disease, the categories do hold some relevance in helping to define the tasks, measure the distance traveled and anticipate what is yet to come.   I found that helpful.     

Of all the reams of material I amassed on this disease over the 10 years I cared for my husband, the following charts compiled by Dr. Barry Reisberg and Ms. Lisa P. Gwyther, ASCW, were the materials I most frequently referred to when I needed a quick fix on where we were in the scheme of things.  I offer copies of these charts to you for your reference material and suggest that you keep them available for your future reference.   

The only problem I have with these scales and others that exist is that the list, while accurate as only an overview.   They exists for a quick fix, they don't give the caregiver much insight into how these symptoms translate into caregiver tasks.  For example:   6a on the Reisberg FAST scale states; "Difficulty putting clothing on properly without assistance."

When I read that I integrated some vague idea that I would just have to help Tom dress.  I had no way of knowing that loss of dexterity, touch, motor control, rote memory, ability to prioritize action and organize steps would leave the both of us literally flapping in the wind.   Just dealing with his zipper became a full time job.

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Tom discovered he couldn't tell if his zipper was up or down.  He would zip it up and down a few times hoping it would end up in the proper position but he could never really be sure and most of the time it was left in down position.  He was walking around town with his fly open, his shirt tail caught in it with people staring and laughing.  No amount of practice allowed him to figure out this one stupid act in dressing.  

He was constantly embarrassed by having me hover and check him out when he came out of public restroom and in the homes of friends and the two of us trotting off to the bathroom, always, together, had to have raised eyebrows amongst those friends and relatives.  In fact I was told I shouldn't hover so much, as if they had any idea why I was hovering.   I suspect a few even laughed at us at times.  He couldn't leave home alone without my checking him and the few friends who were privy to this problem had the added joy of entering his space to tell him is fly was open or the extra added joy of cleaning up after he missed the toilet, another aspect to this phase in this illness the list just can't encompass.   That zipper constituted just one tiny aspect of the whole process of losing the ability to dress himself and yet it's affect was far reaching on so many levels.

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Throughout this section I will be referring to these lists as Figure I, Figure II and Figure III.    Figure IV, the Lisa Gwyther list is provided for your enhanced view of this disease and although I don't make reference to it specifically in this section it nevertheless stands as a valuable tool and I recommend you refer to it and keep it available for information.   

Dr. Barry Reisberg is the Director of the Zachary and Elizabeth M. Fisher Alzheimer’s Disease Education and Resources Program, New York University Medical Center; and professor, Psychiatry, New York University of Medicine, New York.  His material first became available to me at a seminar I attended at the International Center for the Disabled, in New York City in 1986.

 

Figure I, "The Functional Assessment Staging of Alzheimer’s Disease, (FAST)."  © Seven major areas of functioning are delineated with accompanying sub areas.

Figure II, "The Stages of Deterioration," © delineates the three major stages of degenerative dementia and categorizes them into the following:

Stage 1 - Forgetfulness

Stage 2 - Confusional Stage

Stage 3 - Demential Stage

Figure III"The Functional Stages in Normal Human Development and Alzheimer’s Disease," © compares ages 1 month through 12 years in childhood development with the last 5 stages on the FAST scale, which is in essence the last 12 years of life for someone with this disease.

Lisa P. Gwyther, ACSW, is the Director, Duke Family support program, Center for Aging, Duke University Medical Center.   She also delineates three stages to this disease and provides a list of symptoms and examples to help caregivers assess where on the scale their people reside.  Her, "Stages of Symptom Progression in Alzheimer's Disease," first appeared in, "Care of Alzheimer’s Patients: A Manual for Nursing Home Staff." Pages25-27, 1985. Published by The Alzheimer’s Association and the American health Care Association.  

Figure IV, "The Stages of Symptom Progression In Alzheimer’s Disease," ©

The First Stage - (2-4 years leading up to and including diagnosis).

The Second Stage - (2-10 years after diagnosis).

The Third/Terminal Stage - (1-3 years).

 

 

 

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