Trying to maneuver through the maze of Alzheimer’s disease is confusing and frustrating for the family members and caretakers of those who have the disease. Over the past seven years that we have operated a memory care day center, we have spoken to many families who are confused and feeling a great deal of stress about this.
While the study material outlines seven distinct stages, the truth is, especially in the beginning stages, each guest may exhibit a little of each stage at any given day or at any time. This is confusing and frightening for the caregiver who may think that their loved one has moved to another stage, when in fact, they are still in their current stage, but may be having a bad day, or even a bad moment, or they may have a symptom of a later stage while still in an early stage.
Another frustrating thing about this disease is the fact that each person is an individual, and each disease process is also individual. While some people may stay in one stage for many years, others will move through the stages more rapidly.
In the first two stages, there are hardly any symptoms, and the disease goes unnoticed by most. It is not until stage three that there are any real noticeable signs of the disease. People in stage three may have difficulty finding the right word when trying to describe something. They also tend to lose things, even valuables. Their ability to plan and organize are beginning to become impaired. This is the first stage where impairment is beginning to be seen on a memory test. For the most part, though, most people in stage three are still able to function well.
Stage four is more apparent. The people in this stage are beginning to experience short term memory loss. They may forget what they had for lunch, or if they even ate lunch. Many can “fake it” in this stage. They may tell their loved ones that they didn’t eat lunch because they don’t remember that they did. Many in this stage can no longer do simple math like balancing their checkbooks and paying bills. They may forget details of their own lives. Many will compensate for the lapse by creating details that did not actually happen.
You will see a more noticeable decline in stage five. People experiencing this stage will have significant confusion and may have difficulty remembering their own phone number or address. Or they may remember an address where they lived many years ago, and think that they currently live at that address. They will typically have difficulty picking out the correct clothing to wear. They may wish to wear heavy winter clothing in the summer, or their Hawaiian shirt and shorts in the winter. These individuals are generally still able to toilet themselves, and even if they do not wish to bathe themselves, are still able to. They can still remember many details about their lives and their childhoods.
In stage six you may see behavioral problems. Also, people in stage six will need help to get dressed, toileting, and bathing. Many will wander. They can no longer recognize people except their closest friends and relatives. They may lose bladder and bowel control.
Stage seven is the final stage, and people in this stage are near death. They may lose their ability to swallow. They can no longer communicate other than a few words and phrases. They may not recognize family and friends. Many can no longer walk and will need assistance with all activities of daily living. They will have no bowel or bladder control.
Please keep in mind that these are general guidelines. You may have a loved one in stage four who begins to wander. This happens. It does not mean that they have jumped to stage six. It means that they are in stage four but they wander. Each person’s disease process is individual, and each person’s journey is different from the next. I have known people who can walk, toilet themselves completely, carry on a nice conversation, but be unable to figure out how to put on a t-shirt without assistance. This person is not in a later stage of the disease. He just has that later symptom, while still in an earlier stage.
It is all very confusing and individual. At Encore, we get to know each guest personally, and can help the caregiver at home with their loved one to maneuver through the process in ways that work for that particular individual. In most cases, this makes it easier at home. Our goal is to facilitate more independence for each guest who comes to our center, and to keep them active and engaged so that they can sleep better at night.
