The 7 Stages of The Alzheimer's

Understanding Alzheimer's Progression

Alzheimer's disease is a progressive condition, meaning it worsens over time. The progression of Alzheimer's can be divided into seven stages, each characterized by various changes in the individual's cognition and behavior. Understanding these stages can be beneficial for both individuals with Alzheimer's and their caregivers, as it can provide insights into what to expect and how to best manage the condition.

Normal Outward Behavior Stage

The first stage of Alzheimer's is referred to as the Normal Outward Behavior stage. During this stage, individuals usually do not exhibit any noticeable symptoms of Alzheimer's disease. In fact, only a PET scan can detect brain changes associated with the condition at this stage [1]. People in this stage can function independently, carry out their daily activities without assistance, and maintain social and work skills.

Very Mild Changes Stage

The second stage, Very Mild Changes, may involve subtle symptoms that are often overlooked because they don't significantly interfere with a person's ability to work or live independently. Such symptoms may include forgetting words or misplacing objects.

One of the early signs of Alzheimer's disease observed in this stage is forgetting recently learned information, important dates, or events. It's also common for individuals to ask the same questions repeatedly. They may increasingly rely on memory aids or family members for tasks they used to handle independently.

Early signs of Alzheimer's disease at this stage include mild memory loss, which can progress to the loss of the ability to carry on a conversation and respond to the environment.

As we delve deeper, it's important to note that the progression of Alzheimer's disease can vary from person to person. The symptoms and their severity can differ significantly, making each person's journey with this condition unique. Understanding these initial stages is crucial for early detection and intervention, which can significantly impact the individual's quality of life and disease progression.

Mild to Moderate Decline

As Alzheimer's disease progresses, individuals typically move into the stages of mild to moderate cognitive decline. These stages, often referred to as Stage 3 (Mild Decline) and Stage 4 (Moderate Decline), are characterized by more noticeable changes in thinking, reasoning, and memory.

Mild Decline Stage

In this third stage of the disease, changes in thinking and reasoning become more noticeable. Individuals may find it increasingly difficult to perform routine tasks like managing finances and keeping track of appointments. These issues often lead to increased stress and anxiety for the individual.

Caregivers play a crucial role at this stage by stepping in to assist with these tasks. Their support can help to reduce stress and maintain a sense of normalcy for the person experiencing these cognitive changes. The importance of caregiver support in this stage is highlighted by multiple sources including WebMD, Alzheimer's Association, and CDC.

Moderate Decline Stage

The fourth stage, or Moderate Decline, is marked by increased memory loss and confusion. Tasks that were once routine, like handling finances and planning, may become increasingly challenging. This can lead to frustration and a sense of loss as the individual struggles to maintain their independence.

At this point, caregivers often need to take a more active role in assisting with daily tasks. Their guidance and support can help to navigate the increasing challenges that come with this stage of the disease. The role of caregivers in providing this support is underscored by resources such as WebMD, Alzheimer's Association, and CDC.

Understanding these stages is a key part of managing Alzheimer's disease. It helps caregivers and loved ones to anticipate the challenges that may arise, and to provide the necessary support to maintain the highest possible quality of life for those affected by this condition.

Facing Severe Symptoms

As Alzheimer's disease progresses, individuals may begin to face more severe symptoms that can significantly impact their daily lives. This progression is often categorized into three stages: Moderately Severe Decline, Severe Decline, and Very Severe Decline.

Moderately Severe Decline Stage

In the fifth stage of Alzheimer's, known as Moderately Severe Decline, individuals may struggle with orientation and forget personal details like their address or phone number. They may also face challenges in carrying out daily tasks. For example, they might have trouble remembering what type of clothing is appropriate for the weather or occasion.

During this stage, caregivers can provide much-needed support by assisting with these daily tasks. For instance, laying out clothing in the morning can help reduce confusion and stress. Additionally, when individuals repeat questions or become fixated on specific topics, caregivers can provide reassurance and patience [1].

Severe Decline Stage

The sixth stage of Alzheimer's, the Severe Decline Stage, isn't yet defined. More research is needed to fully understand the symptoms and progression of this stage. However, it's well-established that the challenges and symptoms become more pronounced during this stage. It's recommended for families to continue monitoring their loved one's condition and seek professional medical advice as needed.

Very Severe Decline Stage

The final stage of Alzheimer's, the Very Severe Decline Stage, is marked by a significant loss of basic abilities. This can include challenges with eating, walking, and sitting up. At this point, individuals may require substantial help from caregivers.

Given the intensive care required during this stage, families may need to consider professional care facilities such as nursing homes. It's also a time when many families begin to consider hospice care, as the disease advances towards the end of life [1].

Caring for someone in the severe stages of Alzheimer's can be challenging, but it's important to remember that support is available. By understanding the progression of the disease, families and caregivers can better prepare and provide the necessary care.

Treatment Options for Alzheimer's Disease

While currently there is no cure for Alzheimer's disease, a range of treatments are available that can help manage symptoms and potentially slow the progression of the disease in some cases. These include symptomatic treatments and disease-modifying drugs.

Symptomatic Treatments

Symptomatic treatments are designed to alleviate the cognitive and noncognitive symptoms of Alzheimer's disease. These drugs can help to lessen or stabilize symptoms for a limited time, but they do not stop the damage Alzheimer's causes to brain cells. The effectiveness of these medications often depends on the stage of the disease, emphasizing the importance of early diagnosis to have more treatment options available.

Examples of symptomatic treatments include:

Cholinesterase inhibitors: These drugs increase levels of a chemical messenger involved in memory and judgment.
Memantine: This drug works in the brain's chemical messaging system and is used for moderate to severe Alzheimer's.
Antidepressants, anti-anxiety medications, antipsychotics: These medications can help manage the behavioral symptoms of Alzheimer's.

It's important to work closely with a healthcare provider to choose the most effective treatments based on the individual's symptoms and stage of Alzheimer's.

Disease-Modifying Drugs

Disease-modifying drugs aim to influence the underlying disease process. They target the brain changes associated with Alzheimer's disease and could delay or slow the progression of the disease. These drugs work by reducing the accumulation of beta-amyloid plaques, a primary marker of Alzheimer's disease, in the brain.

Two such drugs, Aducanumab (Aduhelm®) and Lecanemab (Leqembi®), have received FDA approval for treating early Alzheimer's disease. They have shown efficacy in reducing cognitive and functional decline in people living with early Alzheimer's disease [4].

However, insurance coverage for these treatments can be an evolving issue due to the novelty of drugs that treat the progression of the disease. The Centers for Medicare & Medicaid Services (CMS) have announced coverage for Lecanemab (Leqembi) for patients enrolled in a CMS-run registry.

While these treatments offer hope, it's important to remember that they are not a cure for Alzheimer's disease. Treatment plans should be individualized and discussed with a healthcare provider, considering factors such as the person's overall health, the severity of their symptoms, and their personal wishes.

Lifestyle Factors and Alzheimer's Risk

Understanding the lifestyle factors linked to Alzheimer's risk is a crucial step when discussing the 7 stages of Alzheimer's. Some risk factors are modifiable, allowing individuals to take preventive measures to potentially reduce the likelihood of developing this disease.

Risk Factors for Alzheimer's

A CDC study identified eight risk factors for Alzheimer's disease among adults aged 45 and older. These include high blood pressure, physical inactivity, obesity, diabetes, depression, smoking, hearing loss, and binge drinking. Furthermore, a University of Minnesota study attributed 41% of dementia cases to 12 modifiable lifestyle factors, with obesity, high blood pressure, and lack of exercise posing the highest risks for dementia.

Risk Factor	Impact
High Blood Pressure	High
Physical Inactivity	High
Obesity	High
Diabetes	Medium
Depression	Medium
Smoking	Medium
Hearing Loss	Medium
Binge Drinking	Medium

Preventive Measures

While some risk factors like age and genetics cannot be changed, many lifestyle factors can be adjusted to reduce the risk of Alzheimer's. Making healthy choices such as increasing physical activity, eating a healthy diet, and quitting smoking and excessive drinking can help [3].

Regular physical exercise can reduce the risk of developing Alzheimer's disease by up to 50 percent and can also slow further deterioration in those who have already developed cognitive problems. Aim for at least 150 minutes of moderate-intensity exercise each week [5].

Staying socially engaged may protect against symptoms of Alzheimer's disease and dementia in later life. Make developing and maintaining a strong network of friends a priority.

Adjusting your eating habits can help reduce inflammation and protect your brain. Manage your weight, cut down on sugar, enjoy a Mediterranean diet, get plenty of omega-3 fats, stock up on fruits and vegetables, and cook at home often.

Continuing to learn new things and challenge your brain throughout life can prevent the onset of dementia or delay its progression. Engage in activities involving multiple tasks, communication, interaction, and organization. Learn something new, raise the bar for an existing activity, practice memorization techniques, and enjoy strategy games, puzzles, and riddles [5].

Quality sleep is important for brain health. Establish a regular sleep schedule, reserve your bed for sleep and sex, create a relaxing bedtime ritual, quiet your inner chatter, and get screened for sleep apnea [5].

Chronic or persistent stress can increase the risk of Alzheimer's disease and dementia. Practice deep, abdominal breathing, schedule daily relaxation activities, nourish inner peace, make fun a priority, and keep your sense of humor.

Maintaining cardiovascular health can protect your brain and lower your risk for different types of dementia, including Alzheimer's disease. Control your blood pressure, watch your cholesterol levels, stop smoking, and make healthy diet and lifestyle changes.

Supporting Individuals with Alzheimer's

Providing support for individuals going through the 7 stages of Alzheimer's disease is essential yet challenging. It involves understanding their needs, managing symptoms, and assisting with daily tasks as their abilities decline. Particularly during the later stages, caregivers often face a myriad of challenges and must make important end-of-life considerations.

Caregiving Challenges

As Alzheimer's disease progresses, individuals may require significant help from caregivers. By Stage 7, known as the Very Severe Decline, individuals may lose basic abilities like eating, walking, and sitting up. Caregivers, therefore, play a crucial role in providing assistance with these tasks.

Caregiving at this stage may involve:

Helping with personal care tasks, such as bathing, dressing, and toileting.
Assisting with feeding and drinking.
Providing comfort and reassurance.
Monitoring and managing symptoms.
Communicating with healthcare providers about changes in the individual's condition.

However, caregiving can be physically and emotionally demanding, leading to fatigue and burnout. It's important for caregivers to take care of their own health and well-being and seek support when necessary. This can include joining support groups, seeking respite care, or consulting with a mental health professional.

End-of-Life Considerations

As the disease advances towards the end of life, families may need to consider professional care facilities such as nursing homes. These facilities are equipped to provide round-the-clock care and handle the unique challenges posed by late-stage Alzheimer's.

In addition to considering care facilities, families may also need to think about hospice care. Hospice care focuses on providing comfort and quality of life to individuals in the final stages of a terminal illness. It involves a team of healthcare professionals who provide medical care, pain management, emotional support, and spiritual guidance.

Finally, it's essential for families to discuss advance directives and end-of-life wishes with the individual, if possible, and with their healthcare providers. This might include preferences for medical interventions, comfort measures, and funeral arrangements. These conversations can be difficult, but they are important in ensuring that the individual's wishes are respected and that their final days are as comfortable as possible.