Your loved one now needs help in initiating most activities, needs someone to help him 'think', needs 'hand's-on' care as his dependencies increase and needs help in expressing his needs.
He can and should no longer drive. Family members must take it upon themselves to ensure that he does not drive. Memory gaps trigger insecurity and defensive behavior as he continues to deny and shield his mistakes. He may fabricate information in conversation that may seem irrelevant or absurd, but in truth, he is valiantly trying to fill in information gaps created by his memory loss. He may be pulling together pieces of his own reality in order to maintain a meaningful life.
As his memory deteriorates, an increased sense of insecurity can develop into suspicion and paranoia. Judgment and reasoning further deteriorate and suspiciousness may be accompanied by anger at family members when they try to prove the accusations or suspicions false. Soothing and calming support and understanding are good responses from the caregiver during this phase.
Fluctuations in memory happen on an almost moment-to-moment basis. Caregivers need to realize that these fluctuations are a normal part of the disease and make the best of the days that are better and avoid despondency when the days are bad.
Logical, sequential reasoning and actions diminish and your loved one's ability to recall correct sequences of behavior and tasks are now seriously impaired. This impairment may show up in areas such as dressing or grooming where he may complete only one part of the task. It is important for the caregiver to encourage independence as much as possible. Don't assume he needs total help with dressing, he may still be able to dress himself, but will just need help in selecting properly matched and appropriate clothing. It's common for Alzheimer's patients to want to wear the same clothes every day without changing or washing them. The caregiver may want to take over the entire task, but the patient should be encouraged to care for himself as long as possible.
Simple decisions now become overwhelming. During early dementia he will have difficulty making even simple decisions concerning things like eating or dressing but the caregiver still can offer simple suggestions and alternatives that require just a yes or no answer. It's helpful to offer a choice of two necessary alternatives. This increases the chances of him undertaking at least one of the suggestions.
Social withdrawal accompanied by impaired thinking capacity happens. You can expect him to withdraw from social and task-oriented activities. He will be less able to adjust to stressful situations. It he is pushed, he'll become overly anxious and angry. If pushed too often, he will refuse to do even necessary stressful activities. He may still enjoy some social situations like going to church or to the movies which are not too demanding, while visiting with an old friend may be overwhelming to him
At this point you, as the caregiver, need considerable emotional support and relief. This is a very hard phase. Family, friends, neighbors or paid caregivers can give support and relief. Caregivers must monitor their own ability to handle the demands placed upon them and not hesitate to ask for help. Remember, you MUST take care of yourself before you can care for anyone else.
Stage IV. Middle Dementia
Your loved one now reacts more severely to loss of abilities. Major changes occur as Alzheimer's disease progresses from early dementia to middle dementia. The involvement of caregivers increases considerably. At this stage, denial is becoming a less effective protector for the person with Alzheimer's. Withdrawal is now being replaced by agitation, paranoia and delusions. This is a very hard period for the caregiver. The environment for your loved one must meet his need through structure, routine and caring. Delusions reflects fears of loss and imagined threats in the outside world. Many times, spouses may be accused of being unfaithful. Once-trusted neighbors and friends may be blamed for unbelievable things.
There may be sleep disturbances and hallucinations. His sleep is often disrupted and erratic. He may be awakened by hallucinations or delusional fears that make it almost impossible for him to sleep and he may begin to wander at night. Safety measures must be implemented so he does not wander outside or get to cooking facilities where he might be harmed. Emotional changes appear as well as repetitive behavior. They may include compulsions such as pulling clothes out of drawers and replacing them over and over. Also, he may tear his bed apart, making it over and over again. He may not be able to hold onto thoughts long enough to complete an action. Obsessive thoughts or repetitive ideas and concerns may become evident.
He may have movement and coordination difficulties. He will develop problems with walking and with purposeful, coordinated movements required for dressing, eating, brushing his teeth etc. He may have eating difficulties that contribute to weight loss. Sometimes excessive eating becomes a problem.
