The rate of progressive deterioration varies greatly between patients. With Alzheimer's Disease, there is no recovery and the slow, progressive course leads to more and more deterioration in abilities and behavior.
Watching this is heartbreaking for family and friends, and naturally, everyone wants to know what to expect as the condition progresses. Knowing this allows you to prepare for future stages, ease the adjustment of the patient and help everyone adjust and to gradually accept the disease's effect on the whole family.
For some patients, especially those who are under 60, the stages move rapidly and the illness results in death within 3 to 5 years. When the disease begins at a later age, after 65, it may progress slowly for 10 or more years.
Stage I. Forgetfulness
You will notice your loved one seems forgetful. As his memory worsens, his social and occupational skills will begin to noticeable diminish. He may deny his memory problems and compensate at times, but he will not be able to catch all of his mistakes. It may become harder for him to deal with changes and new things. He may get lost in unfamiliar areas. Names of new people will not be remembered and he may not be able to remember television shows or what he has read in books or magazines.
You may notice personality changes in your loved one. He may lose his spontaneity and sparkle. He will be less careful in what he says and does. He may lose initiative and drive and have low energy. He will get more easily upset, angry, and anxious. He will start to avoid social and work situations and anything that is unfamiliar or difficult. He may have trouble finding the right words. His confusion and slowing responses may affect his driving.
His denial may conceal recognition of some early symptoms and family members can easily discount the severity of his problems. He seems distressed and the reasons are often a mystery to those close to him. Because many of these symptoms seem more emotional than physical, psychiatrists and mental health professionals are the ones family most likely calls for a diagnosis and treatment. Medications may be given to manage the emotional symptoms, but a diagnosis needs to be made by a neurologist as the behaviors will soon dramatically change and treatment for the just the symptoms will soon be unrealistic.
You must understand that Alzheimer's problems are not caused by laziness, carelessness or momentary irrational behavior. It is the disease. Family and friends must begin to prepare for the worsening of problems as the loved one declines.
Stage II. Late Confusional Phase
Now, the memory problems your loved one has are much more evident. His retention for current evens declines, and he'll lose the thread of a story and have noticeable difficulties following conversations. He may respond in ways that fail to match the situation. His memory of personal history may become foggy.
Making plans and decisions becomes very difficult and you may feel the need to help him with finances and other important responsibilities as it becomes clear he is not handling them well. Your loved one may not welcome this assistance as he is still denying his problems and sees assistance as interference. You, as the caregiver, may see his refusal for help and his refusal to admit his problems as impaired judgment. This is when many family conflictions may begin. Also, he may avoid social situations altogether when they begin to be too difficult to handle.
Driving becomes riskier and it may become a source of concern. At this stage, Alzheimer's patients can probably follow familiar routes with reasonable safety, but he is vulnerable to mistakes and improper or slow responses to unforeseen circumstances and may overreact or not react at all to potential dangerous situations and traffic conditions. Now is the time for the family to curtail or eliminate driving opportunities.
Orientation to time and place starts to be infected and difficulties in concentrating makes it hard to recall events of the last few minutes, days or weeks. Memories of the distant can be surprisingly clear and accurate. He may begin to speak more about the past and avoid current events and conversations about them.
Your loved one will need some supervision and daily support now. He is not disabled in all aspects of life, he will need help in complex areas such as finances and paying bills, income tax reports, and balancing his checkbook as the stress and detailed organization necessary for these tasks will be more than he can handle.
Stage III. Early Dementia
Dependency is now increasing your job as caregiver. By this time, your loved one has become quite dependent on you for his care. Your sense of responsibility for caring for all his needs and keeping him safe may be overwhelming. Other family members may not be supporting you because they can't envision how strenuous the mental and physical demand of daily care giving really are.
