Levels of Impairment of Dementia and Alzheimer’s
Early Mild Stage:
* The area of memory lapse varies from moment to moment. Family members frequently call this being “good one day and bad the next”.
* Individuals at this stage can no longer survive alone in a community; memory loss is more evident. At times they can recall their address, the year, or other major information about their life. However, they may not remember what day it is or may get days and nights mixed up. Resident/patient and /or family will report an increase in forgetting things, and a decrease inability to recall words.
* There is often notable trouble with calculation and /or completing tasks or following directions.
* Frequently the individual will lose or misplaces objects and they will handle personal finances less.
* Individuals will experience difficulty and anxiety when traveling in unfamiliar locations.
* There is generally a decrease in social skills, and marked inability to function independently in community activities. The individual will more often forget names, important events and appointments.
* Individuals also will display poor judgment and /or impulse control.
* This stage is recognized by the person’s impaired functional level such as difficult choosing appropriate clothing, self-care, and driving a car.
* Individuals will show signs of difficulty following conversations, movies or television plots.
* Anger, suspicion, and transient crying episodes occur. Care and supervision of such individuals now becomes a full time responsibility.
* Often the person will be good at compensating for memory loss and denies the problem, but experiences increased anxiety.
* Individuals may be experiencing uncontrolled searching and/or wandering behaviors.
* Sometimes individuals may talk constantly of events and appointments that have already happened from past events that they look as to a present events, which may cause arguments if you tackle the situation. This will cause frustration for them and may become defensive.
* It is known that in some early stages, some will shut totally down themselves and become depressed cause they can’t do the things they were able to do at one time or another, it has been known for them to totally stop eating, if not approached correctly or with the right caregiver or care.
* In some cases, placing in a closed unit is helpful and sometimes it can cause even more hostility.
* In some cases individuals will begin to follow you around constantly and sometimes develop patterns of repeating sentences over and over again. Looking for their parents or family members already deceased such as their husbands/wives or children. Hiding wet under garments to save for a later time, collecting others clothes and items, trying to get outside, putting on extra clothes or undressing constantly, unable to rest, can be verbally abusive and sometimes physical towards themselves and family members as well. The list can go on in these early stages.
* Some days are wonderful and they can rest really well, some days can turn into 3 to 4 days with out any sleep or rest for any one
Middle Moderate Stage:
* Individuals at this level begin to require assistance with basic activities of daily living such as bathing and toileting.
* Memory deteriorates to a fragmentary knowledge of address and whereabouts. The person frequently cannot identify the spouses upon whom they depend for survival.
* The individual may have difficulty counting backwards from 10 in clinical testing.
* Person’s with Alzheimer’s disease, early in this stage develop a fear of bathing. They forget how to adjust the water for the temperature and may become frightened, particularly of the shower. At times towel washing is all they will tolerate.
* Later in this stage, the person may begin to forget the mechanics of toileting and must be given step-by-step instructions for wiping and washing themselves.
* Decreased cognitive capacity eventually results in urinary and fecal incontinence. The lack of control is not caused by infection or physiological change, but simply by lack of memory about toileting.
* Individuals are prone to agitation, violence, paranoia and delusions in place of withdrawal. They may experience delusions or hallucinations.
* Emotional changes in this stage are variable and can include obsessive symptoms such as repeating a simple cleaning activity. Individuals can show loss of will because they cannot carry through a thought long enough to determine an action.
* Language and communication become more impaired. The individual may be able to describe an unnamed object, but is unable to write intelligently or follow verbal instructions.
* Individuals may exhibit poor impulse control, and may behave inappropriately, for example in a sexual or aggressive manner.
* The person with dementia is unable to discern dangerous situations and may begin to wander. They are often fearful and anxious.
* Resident/patient will most often have dysphasia/feeding problems.
* Residents/patients may be found on the floor because they “forget” they are walking and collapse.
* The crisis that leads to institutionalization is usually violence and incontinence.
* In this stage as well verbal and physical abuse can almost become unbearable to family members. Outburst of constant cries and yelling, caused by the lack of their ability to do for themselves is unacceptable, yet it is not easy for them to comprehend and express the fear of loosing that independence. This sometimes comes in the form of rage.
Late Stages:
* Individuals at this stage first lose the ability to speak and then to walk.
* Vocalizations may be reduced to grunts and screams.
* Resident/patient’s screams and emotional outbursts should be interpreted carefully.
They maybe attempts at communicating needs, not just expressions of distress.
* Persons at this stage are unaware of surroundings and require extensive watch and care or assistance.
* Residents/patients often will not recognize caregivers, family members or their own image in the mirror.
* The end stages are stupor and coma if the resident has not succumbed to aspiration, infection or other illness.
* Medical problems increase and the body is more susceptible to infections.
* The body begins to shut down, as the brain is no longer able to tell the organs how to function.
* In some cases some individuals are in such denial of having to let go, they scream or pray until the last of their breath, from the fear of having to let go of what they don’t’ remember but have some recall of.
* Comfort is provided and in some cases being at home is more relaxed for them, even if they are not conscious, they are still aware that family members are near and they are safe as they make their exit. We hate to say this, but this is what it is.
In any case, as to my personal experience and work with dementia/Alzheimer’s, many individuals live many years in this state of consciousness. It can very hard and stressful to and for family members to see and experience them slowly slipping away, for years this can go on, but I in my own experience found that the longer they can be at home in familiar surroundings and with people they can somewhat relate to, make the process a lot easier. With a proper diet, exericise, daily activities along with rest, the battle may not be a streeful on everyone as a whole. I have experienced family members literally beating themselves up and feeling guilty cause they don’t know how to handle it, or what to do, and this is ok, we all are learning the signs and the behavior of this disease.
Now statistics have shown that there is no age limit as to this disease, sometimes it can start in the early 40’s and they can live for 40 more years afterwards.
I at present work with dementia/Alzheimer patients, and I deal with many in different stages, I help family members deal, react, care for their loved ones, for those that wish for them to be home. I would say at some point it is considered for an individual to be institutionalized id the combativeness iss too dangerous to you and to themselves, they would need constant around the clock watch. Private home care is a very much needed thought and consideration. to try.
I personally am available to assist as well. I have over 25 years of on hands experience in this area. Please continue to read the information I put here on my site. The main thing is to be strong enough to make decisions or at least to try them and see what will work in the best interest of you and your loved one. There is no need to beat yourself up, and there is nothing that you did to cause this. You handle dementia/Alzheimer’s one day at a time. Technology is coming out with more and more ways to maybe stop or to at least help educate people as to slowing the process down, but in the interim, it is good that you learn all that you can and be able to handle on coming situations.
