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Although the two terms are often used interchangeably, Alzheimer's and dementia are actually two different terms. Dementia is an umbrella term used to describe several conditions, which includes Alzheimer’s, as well as other conditions with shared symptoms. More than mere forgetfulness, an individual must have trouble with at least two of the following cognitive areas to be diagnosed with dementia:
Memory
Communication and speech
Focus and concentration
Reasoning and judgment
Visual perception (including trouble detecting movement, differentiating colors, or experiencing hallucinations)
Although there are many people who suffer from dementia (approximately 14% of those aged 71 and older), no individual progresses the exact same way, but there is a natural course of the disease. And unfortunately, it can be guaranteed that with time, the ability to function will worsen. The progression of dementia disease is typically characterized into three levels (mild, moderate and severe) as typically used by the general public. Using these designations to identify the correct stage of your loved one can assist with determining the best treatment approaches. Read on to discover symptoms of each stage, where your loved one falls and how the progression of the disease often goes according to the symptoms they display.
Mild Dementia
In this earliest stage of dementia, individuals still function primarily on their own. They are able to travel to familiar places, recall familiar faces and are largely aware of time and place. Many of the symptoms seen in this early stage are typically connected to the normal aging process, with minor deficits in concentration and memory starting to surface. For instance, there may be slight memory lapses for recent events or word finding problems, but they are still able to maintain a social life. In this stage, difficulties may develop with higher functioning tasks like planning, organizing and concentrating which becomes particularly evident for someone who may still be in the workplace.
Difficulty performing instrumental activities of daily living (IADLs) such as cooking, cleaning grocery shopping and paying bills may become more challenging. Siple reminders along with written to-do lists and schedules can be often enough to compensate the deficits in the stage, although some may require mild assistance for some of the more complex tasks. Individuals may also experience changes in their emotions with decreased reaction to some scenarios in could start to withdraw from challenging situations. This is the time to ensure that all legal and financial matters are taken care of, should the need for more care arise in the future.
Moderate Dementia
The middle stage of dementia are characterized by enough brain damage that deficits become more obvious, even to the layperson. Someone at this stage can no longer function independently. Symptoms such as difficulty expressing their thoughts, performing daily tasks and short term memory impairments start to become more troublesome. Many people develop some type of aphasia (the loss of ability to express or understand speech) and use jumbled speech such as word substitutions ("book" for newspaper), object description in place of the word ("thing you sit on" for chair) or nonsense words ("thing-a-ma-gig" for watch or any other object). As a caregiver, it is helpful to use to a clear, slow rate, supplement speech with non-verbal communication and provide prompts or assistance to maximize understanding and maintain an individuals safety during day-to-day activities.
An individual in this stage demonstrates noticeable short-term memory deficits and might not remember their address, might be unable to recall their personal history, and may get confused as to their location. They retain some memory of their past, but it is spotty and incomplete. They become disoriented with time and place and may not remember the name of their spouse, even though they see them daily. They are typically unable to count to backwards from 10 to 1, and sometimes not even forward from 1 to 10. They may also become incontinent at this stage and require assistance for toileting and hygeine. They are no longer able to complete IADLs. Other common symptoms of this middle dementia stage include mood and behavior changes. Delusional thoughts and/or paranoia may develop, such as accusations of spousal infidelity, that the spouse is an imposter, that the house is not one’s home, or that someone is stealing personal belongings. This may result in anxiety, agitation or aggression even towards family and loved ones. Behaviors such as wandering and rummaging may pose safety risks and require more supervision. At this stage, many will present with repetitive speech, gestures and mannerisms which can be difficult to redirect at times. Other symptoms such as difficulty sleeping or hoarding may also develop.
Severe Dementia
Someone in this last stage of dementia, also known as advanced dementia, will have significant issues with communication, often only using single words or short phrases when speaking, with an inclination toward parroting or repetitive speech. Towards the end of this stage, they may also become completely non-verbal. In this stage, both long term and short term memory often become affected and they may not be able to recall what they ate for lunch, who their family members are, or even what time period they are currently in, often times reverting back to childhood or another significant period in their life. Individuals may no longer be able to walk and will require extensive assistance with daily living activities, such as personal hygiene. They are incontinent of bowel and bladder.
Swallowing also becomes an issues in late stage dementia, and caregivers have to make adaptions, use strategies and alter food consistencies to keep their loved ones from potentially choking or acquiring aspiration pneumonia. Someone in this stage typically requires 24 hour care and will require physical assistance to complete most tasks, including transfers, eating, hygiene and grooming. Towards the end of this stage, most individuals are bed bound with the inability to roll or sit up in bed, making them bed-ridden at at high risk for bed sores. During this stage, caregivers will focus mostly on providing comfort and quality of life. According to the Alzheimer's Association (2018), there are 16.1 million unpaid caregivers of people with dementia in the United States. While many Americans are caregivers for loved ones, many people also hire someone to provide care or supplement the care they are already providing. There are many options for care, such as in-home care, adult day care, and nursing home care, and there is also financial assistance available. It’s important to remember, providing care for a loved one can be stressful, and self-care is a must. Click here to learn about ways to deal with stress, finding support, and more.
While the exact symptoms described in each stage can differ between individuals, this ca be used as a general outline to help families know what to expect and when to expect it. Is your loved one following this path? Share your experiences in our forum or leave your comment below.
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