Alzheimer’s disease is a brain disorder that slowly destroys memory and thinking skills, and, eventually, the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear later in life.
Alzheimer’s Disease is progressive. The course of the disease varies in individual cases. Some people have the disease only for the last five years of life, while others may have it for as many as twenty years. The most common cause of death in AD patients is infection, for example pneumonia. Changes in the brain related to Alzheimer’s begin years before any signs of the disease. This time period, which can last for years, is referred to as preclinical Alzheimer’s disease.
Some of the features of Alzheimer’s disease are commonly classified
into three stages or phases. It is important to remember that not all of
these features will be present in every person, and that they might
occur at different stages for some people. However, it remains a useful
description of the general progression of dementia caused by
Alzheimer’s disease.
The stages are separated into three categories: mild Alzheimer’s disease, moderate Alzheimer’s disease and severe Alzheimer’s disease.
Mild Alzheimer’s disease
Sometimes this stage is only apparent in hindsight. The onset of
Alzheimer’s disease is usually very gradual, and it is often impossible
to identify the exact time it began.
The person might:
• Appear more apathetic
• Lose interest in hobbies and activities
• Be less willing to try new things
• Be less able to adapt to change
• Be slower to grasp complex ideas and take longer with routine jobs
• Become more forgetful of recent events
• Become confused or disoriented to time and place
• Become lost if away from familiar surroundings
• Be more likely to repeat him/herself or lose the thread
of their conversation
• Be more irritable or upset if a mistake is made
• Have difficulty managing finances
• Have difficulty shopping or preparing meals
Moderate Alzheimer’s disease
At this stage the person’s difficulties are more apparent and pervasive.
A person with moderate Alzheimer’s may experience significant
challenges to their independence and may require significant
day-to-day support.
The person might:
• Be very forgetful of current and recent events. Memory for the
distant past is generally OK, but some details may be forgotten
or confused.
• Be often confused regarding time and place
• Become lost more easily
• Forget names of family or friends, or confuse one family member
with another
• Forget saucepans and kettles on the stove or leave gas lit
• Be less able to perform simple calculations
• Show poor judgement and make poor decisions
• See or hear things that are not there or become suspicious of others
• Become very repetitive
• Be neglectful of hygiene or eating
• Be unable to choose appropriate clothing for the weather, occasion
or time of day
• Become angry, upset or distressed through frustration
Advanced Alzheimer’s disease
At this stage, the person is severely impacted by dementia and needs
continuous care for all daily activities.
The person might:
• Be unable to remember current or recent events, for instance
forgetting that they have just had a meal or being unable to recall
where they live
• Be unable to recall important events or facts from their early life
• Show confused recognition of friends and family
• Fail to recognise everyday objects or understand their purpose
• Lose their ability to understand or use speech
• Need help with eating, washing, bathing, brushing teeth, toileting
and dressing
• Become incontinent
• Experience disturbed sleep
• Be restless or fidgety
• Call out frequently or have aggressive outbursts
• Have difficulty walking and other movement problems
including rigidity
There is no cure for Alzheimer’s Disease and no way to slow its progression. For some people in the early or middle stages of the disease, medication such as tacrine may alleviate some cognitive symptoms. Aricept (donepezil) and Exelon (rivastigmine) are reversible acetylcholinesterase inhibitors that are indicated for the treatment of mild to moderate dementia of the Alzheimer’s type. These drugs (called cholinesterase inhibitors) work by increasing the brain’s levels of the neurotransmitter acetylcholine, helping to restore communication between brain cells. Some medications may help control behavioural symptoms such as sleeplessness, agitation, wandering, anxiety, and depression. These treatments are aimed at making the patient more comfortable.
As much as possible the patient should follow a safe, regular exercise routine, maintain normal social contacts with family and friends and continue intellectual activities. Safety concerns, especially driving safety, should be discussed with the doctor.
Although no medication is available to cure Alzheimer’s Disease, the cholinesterase inhibitors may improve performance of daily activities, or lessen behavioural problems.
Medications for the treatment of Alzheimer’s Disease currently being tested.
Alzheimer’s Disease is a form of dementia — a neurodegenerative disease that damages the brain’s intellectual functions (memory, orientation, calculation, etc.), but usually preserves its motor functions.
Although usually a disease of later life (generally after the age of 60), it may rarely affect persons as young as age 30. There appear also to be genetic factors that increase the risk of Alzheimer’s Disease. Other people possibly at risk of developing Alzheimer’s Disease are those with a history of head injury, of the female sex and those of a lower educational level. Although these risk factors often make headlines in the popular press, the possible additional risk is not high, and the evidence not very strong.
