The Three Stages of Alzheimer's Disease

Many experts agree that Alzheimer's Disease follows a recognizable pattern as it progresses in most people. In each stage of the disease, there are specific symptoms and behaviors that are expected. Knowing what is considered "normal" for the disease progression can sometimes help caregivers prepare themselves for what lies ahead. Caregivers can now make sound decisions regarding the level of assistance their family member will need and the amount of care they are able to give. The following lists the three stages of Alzheiemr's Disease, the common symptoms and some general approaches that may assist caregivers. Please note that any changes in your family members behavior should be discussed with their physician to rule out any other causes.

> STAGE 1 - Mild - Can last 2-4 years

Over-reaction, hysteria, rage, short tempered. : Keep to routines so your family member will know what to expect. Do not respond to the words they are saying. Understand that this is the "disease talking" - not your family member. Try and keep your responses calm and reassuring.

Memory Loss for recent events. : Use an orientation board that shows the date, day of the week - keep keys, glasses... in this same area. Post notes on the board that remind of upcoming appointments.

Disorientation to Time or Place. : Do not argue and avoid correcting them all the time. Gently begin talking about where you are, what you will be doing and who you will be doing things with.

Lack of spontaneity / Lack of energy. : Allow and encourage short naps as

appropriate.

Depression. : Over 75% of persons with a diagnosis of dementia suffer severe depression. Discuss your family members behavior with their physician. The use of anti-depressant medication is often helpful.

Trouble concentrating. : Mark photos with names of persons in the pictures. Break tasks into simple, short activities. Plan on keeping their attention on one thing no longer than 15-20 minutes.

Feeling of "going crazy". : Use humor as appropriate. Empathize how you have had these feelings as well. (Share Senior Moments) Begin to use validation rather than reality orientation. Avoid the need to correct them all the time. Don't sweat the small stuff.

> STAGE 2 - Moderate - Can last 2-10 years (average is 4 years)

Sundowner's Syndrome (behavior problems in the late afternoon or early evening.) : Keep a structured routine whenever possible. Keep the environment calm and quiet. Encourage quiet activities in the late afternoon and through bedtime such as setting the table, washing dishes, folding towels, listening to music...

Eating and Sleeping Disorders. : Offer snacks often. Offer finger foods (food that can be eaten with hands such as sandwiches, fresh fruit cut up, cookies, tater tots, raw vegitables cut up, enriched drinks...) Keep to a structured bedtime routine to signal that rest time is anticipated - Lower lights, turn on soft music, wash face & hands, get comfortable in nightwear, have a snack...

Incontinence. : Keep to a 2 hour toileting schedule. Use disposable adult incontinence products. Be sure you and they are using good hand washing technqiues. Keep them hydrated. Offer water, juice and non-caffinated beverages throughout the day. (Avoid beverages after 6pm)

Hostile, agressive, angry and argumentative. : Back off! Use a gentle approach. Never argue or scold. Do not attempt to reason. Use distraction to change their focus. Remove them from the area of high stimulation.

Loss of the power of expression by speech, writing or sign. They may use word salad (disorderly arrangement of the spoken word)or repetitive speech (speaking the same word or words over and over again). : Listen for key words that may describe what they are trying to say. Offer correct words if you see they are struggeling, use hand gesture and simple phrases, be sure your body language and facial expression are calm and friendly. Show them by gesture what you want them to do.

Difficulty with simple daily activities such as dressing. : Offer simple one step instructions. Hand them one item at a time and allow them to do as much for themselves as they are able. Use mirroring techniques to demonstrate what you want them to do. (You brush your teeth when they do so you can show them what they should do.) Do not argue or attempt to reason. Keep choices to a minimum. Do not offer choices unless "No" is an acceptable response - simply state what is required without sounding "bossy" -ie: "Mom - here is your clean shirt. I'll help you and then we'll have lunch."

High risk for wandering or becomming lost. : Keep environment secure. Add slip locks to the top or bottom of exit doors. Use motion sensors with sounders to notifiy you if they have opened exit doors without supervision. Notify neighbors of the risk factor and instruct them what you would like them to do if they find your family member wandering unsupervised. Register for Safe Return - a National registry through the Alzheimer's Association. Notify the local police department that you have a family member with Alzheimer's Disease and be sure they have proper phone numbers to reach you incase of an emergency.

Increased risk for falls and injury. : Review the environment. Look for trip hazards such as short magazine racks, throw rugs, foot stools. Avoid crowding rooms with furniture. Add grab bars in bathrooms near toilets and in showers. Be sure stairs in the home are well lit and have no obstructions on them (such as shoes...). Keep halls and rooms lit at night to avoid falls - the use of nightlights are helpful.

> STAGE 3 - Severe - 1-3 years

Anorexia - Loss of the will/desire to eat. : Offer nutritionally enhanced meal replacement drinks. Fortify them with icecream, fresh fruit or flavored syrups.

Choking. : Discuss a thickening agent with their physician or pharmacist. This non-flavored powder can be added to liquids to make them easier to swallow. Try griding meat in blender - add mashed potato and seasoning to create a smooth, easy to swallow consistency.

Inability to speak. : Always explain what you are doing for them. Continue to talk to them as if they could respond to you.

Tendency to put non-food items in the mouth. : Keep their environment free from hazards such as toxic plants, small decorative items...

Excessive movement. : Use activities that will help involve their movements in meaningful behaviors (rocking dolls, wiping tables, rubbing soft material...)

Less than normal movement. : Assist them by gently lifting arms, bending elbows... Offer lotion rubs...

Emotional Flatness. : Offer sensory stimulation. Singing familiar tunes or reciting prayers or poetry. Look for eye movement. Touch frequently - brush their hair, offer lotion on hands and arms...

Seizures : Discuss this with their physician. Use of anti-seizure medication may be advised.

Susceptible to illness and infection. : Use good hand washing techniques. (Vigorously rub hands together using soap - while alternately running them under warm water for 30 seconds - HINT: 30 seconds is approximately the amount of time it takes to sing the Jeopardy theme song. Remove rings & pay attention to nail beds.) Ask family members with colds or fevers to postpone visits until they are well. Use anti-bacterial wipes on commonly touched areas (counters, doorknobs, faucets...)

Non-ambulatory or bed bound. : The family may need to consider comfort care at this time. Hospice can provide a free screen to help the family determine if their loved one is preparing for death. Use soft music from their era in their room. Keep one side of the bed against a wall and consider an "under the mattress" guardrail for the other side to help avoid falls out of bed. Be sure they are moving and shifting their weight every hour or so to avoid sores from the pressure and deminished circulation. Check hands and feet for tempurature. Layer soft blankets as needed if skin is cool to the touch. Keep lips moist with lip balm.

As with any disease, Alzheimer's Disease progresses differently in different people. It is important to have good communication with your family members physician so you can discuss changes in their behavior and physical needs.

For more caregiver tips or information on the Safe Return program, please contact the Alzheimer's Association at (716) 626-0600.

If you would like information about the programs and services offered through ElderWood Senior Care, please contact us at (716) 633-3900.