At the core of how we relate to our loved ones, there are three stages of Alzheimer’s disease. (note that some researchers/websites break these down into more steps making finer distinctions between them. From my experience, these three work nicely for those of us struggling with understanding the nature of this problem.
- Early stage or mild Alzheimer’s disease.
- Middle stage or moderate Alzheimer’s disease.
- Late stage or severe Alzheimer’s disease.
In the early stage, those with Alzheimer’s can function quite normally. However, they may start to forget things such as the right word to fit the sentence. They may forget where they put things. They may have increasing difficulty with planning and organizing their personal and family life.
This is a difficult stage, because many of these forgetful episodes resemble what we all do on a normal, daily basis. It’s extremely difficult to identify a person with Alzheimer’s during the early stages.
The Middle Stage.
This stage is when personal behaviors begin to change. The person is aware they are forgetting, and they respond to this. They may be moody, withdrawn, confused, and in some cases, quite angry. Those emotions are broadcast clearly to the people around them. It’s very much like the internal editor we normally use to “not say what we’re thinking” – disappears and what’s on the top of the mind rolls out.
Like a lot of things, this doesn’t happen overnight. It slowly but surely develops over months or years. This stage is typically one of the longer stages, so while the early stage is often difficult to clearly see, the middle stage slowly but surely illuminates the disease.
This is when family and friends begin to notice the change in behavior. At the earlier stages of this middle ground, a person continues to function in the community but often you’ll see a withdrawal because of the internal confusion they feel.
Personal note. My mother was an extremely sociable person. She was involved in the community and had a significant number of friends. Many of these friends did not recognize that she had entered the middle of Alzheimer’s because she can carry on conversations with them without exhibiting any problems. She simply asked them questions rather than answering them. I remember one day when we stopped at a park to chat with an old and dear friend. The conversation progressed normally, and even I was wondering where the Alzheimer’s went. But after the conversation, my mother turned to me in and asked, “Who was that?”
Losing A Sense of Time And More
Somewhere along the line in this middle stage, a patient begins to lose what I would call artificial concepts. The easiest example of this, is”time”. Because time is something humans have invented, it operates in a part of our brain devoted to higher associations. This is one of the first parts of the brain to be lost.
So when you notice your loved one can’t tell the time, you know they’re firmly entrenched in the middle stages of Alzheimer’s disease.
The Late Stage.
In this last and final stage, our family members lose the ability to respond to those around them and to the environment in which they find themselves.
This is a difficult stage because it marks the disappearance of the personality we loved. Memory and thinking skills continue to deteriorate and slowly but surely the walls closing in around the person. In this stage, a person with Alzheimer’s will require personal care and they will lose awareness of current activities. There is no short-term memory left. Higher functions of the brain, including speech, begin to deteriorate and will eventually disappear.
Towards the end of this late stage, the continuing shutdown in the brain will begin to have an impact on bodily functions. At some point a critical organ will shut down and the patient will begin to die.
Different researchers break these three steps down into finer differentiations. But for the most part, these work for the family involved.
Early-stage one patients continue to live in their home with support. It is only when we get to the middle stages, and the later stage the patient will require outside assistance. It is clear by the end of the second middle stage, and certainly the latter stages specialized nursing care is required.
How Much Time In Each Stage?
This is a variable that defies a time frame. I remember a physician telling me that my mother’s life expectancy with this disease was eight years. As I write, it’s 13 years and counting. She has been in the late stages for almost half of that time as I write this.