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November 14, 2021 Alzheimer's What it Is and What it Looks Like (Mini-Series Part 1)

Today’s episode will be the first in a series on the seven stages of Alzheimer’s. For the first episode, we are going to be discussing what Alzheimer’s is and what the common signs and symptoms are, and how it is being treated today. Then, we’ll move on to a brief overview of the seven stages before taking an in-depth look at stages one and two. Now let’s move on to the rest of the show.

According to the Alzheimer’s Association, Alzheimer's is a type of dementia that affects memory, thinking, and behavior. Symptoms eventually grow severe enough to interfere with daily tasks. Alzheimer's is the most common cause of dementia, a general term for memory loss and other cognitive abilities serious enough to interfere with daily life. Alzheimer's disease accounts for somewhere between 60 and 80 percent of dementia cases.

Alzheimer’s is a progressive disease. In most cases, symptoms worsen gradually over several years. After being diagnosed with Alzheimer’s disease, a person usually lives anywhere from four to eight years, but in some cases, individuals have lived for over 20 years with Alzheimer’s.

Everyone experiences Alzheimer’s differently. There are many different signs and symptoms of Alzheimer’s that you should be aware of, especially if you are concerned that you or a loved one may be experiencing any of the symptoms.

The Alzheimer’s Association lists 10 early signs and symptoms of Alzheimer’s that you should be on the lookout for. The first sign they suggest is memory loss that disrupts daily life. As we age, we may begin to forget things and not be able to easily recall information, like names or specific memories, but we may be able to recall the information later. Not being able to recall the information at all is an early sign of Alzheimer’s. One example of this is your loved one asking the same question repeatedly because they don’t remember asking it or hearing your answer.

The second sign to look for is challenges in planning or problem solving. Trouble keeping track of finances or making a recipe they have made numerous times can both be examples of trouble planning or problem solving. Making the occasional mistake paying bills, however, is not an example of this. Mistakes happen but having an issue figuring out how to pay their bills or adding numbers may be a sign your loved one has Alzheimer’s.

Having difficulty completing familiar tasks is the third sign you should be looking for. Not remembering how to drive to a place your loved one has been to many times or not remembering how to write or organize their grocery list how they normally do can be an early sign of Alzheimer’s.

Another sign is being confused with times or places. Not knowing what day of the week it is can be an indicator that your loved one is confusing times or places, but it can also just be a normal sign of aging. Not knowing what season it is or not knowing where they are is mainly what we are referring to with this sign.

Trouble understanding visual images and spatial relationships is the fifth sign that the Alzheimer’s Association lists. Vision problems unrelated to cataracts can be a sign of Alzheimer’s. Having trouble judging distance or being unable to differentiate colors are both examples of this sign. These things can also make driving difficult and possibly unsafe for your loved one as well.

Another early sign to look for is new problems with words in speaking or writing. Someone with Alzheimer’s may have trouble following or continuing a conversation. They may forget words or the entire rest of their train of thought. Forgetting a word on its own may not be an early sign of Alzheimer’s, but constantly forgetting words or using the wrong word may be a sign your loved one has Alzheimer’s.

The seventh sign is misplacing things and losing the ability to retrace steps. For this sign, your loved one will lose things and not be able to figure out how to work backwards to find them. Many people with Alzheimer’s also tend to put items in unusual places, such as putting their keys in the freezer. As the disease progresses, they may even accuse others of stealing their things.

Decreased or poor judgement is another early sign of Alzheimer’s. Your loved one may begin to make poor decisions frequently, like not bathing regularly or taking care of themselves as well as they should and normally would do. Making one bad decision occasionally, like skipping a shower occasionally, or not filling up their car with gas when they should may not be an early sign of Alzheimer’s, but repeated decisions like these can be.

Another early sign of Alzheimer’s is withdrawal from work or social activities. This sign goes along with forgetting words and having trouble with conversations. Having difficulties following a conversation may lead to having difficulties in social settings and your loved one may withdrawal from activities they once loved. Occasionally being disinterested in hobbies or visiting with friends or family is not a sign that you loved one is withdrawing from their social life. There are times when you yourself don’t feel like being social and your loved one experiences times like those, as well. Continuously withdrawing from social situations is the sign you should be looking for in your loved one.

The tenth and last sign that the Alzheimer’s Association mentions is changes in mood and personality. Your loved one may experience moods more strongly than they once did. They may become easily upset when they are uncomfortable and lash out at their friends and loved ones.

If you notice any of these signs or symptoms in your loved one, schedule an appointment with their doctor. They may be experiencing normal age-related symptoms and not symptoms of Alzheimer’s or another dementia, but their doctor will be able to determine whether they are showing signs of Alzheimer’s. Early detection and diagnosis of Alzheimer’s can help their doctor develop a treatment plan that will allow your loved one to maintain their independence longer and help control some of the symptoms right away, making their day-to-day life easier.

Some symptoms of Alzheimer’s disease may seem like they are just signs of the normal aging process, but they are not. Increasing age is a risk factor of Alzheimer’s, but age itself is not a cause of Alzheimer’s. Most cases of Alzheimer’s happen after age 65, but some happen before that age. Alzheimer’s that happens before age 65 is called younger-onset or early-onset Alzheimer’s. Individuals diagnosed with early-onset Alzheimer’s can be in any of the seven stages of Alzheimer’s at the time of their diagnosis.

As we said previously, early detection of Alzheimer’s is crucial. The earlier someone is diagnosed, the faster they can start treatment and get back to enjoying their lives and time with their loved ones. Currently, there is no cure for Alzheimer’s, but there are a few ways that doctors can treat the symptoms.

A new drug called aducanumab has recently been approved by the FDA to be used to address the underlying biology of Alzheimer’s disease. This drug is a treatment and not a cure. According to the Alzheimer’s Association, it is the first therapy to demonstrate that removing amyloid, one of the hallmarks of Alzheimer’s disease, from the brain is reasonably likely to reduce cognitive and functional decline in people living with early Alzheimer’s.

Approval of this therapy underscores the importance of early detection and accurate diagnosis. Treatment with aducanumab should be initiated in patients with mild cognitive impairment or mild dementia stage of disease, the population in which treatment was initiated in clinical trials.

Aducanumab was studied in people living with early Alzheimer’s disease and mild cognitive impairment due to Alzheimer’s who showed evidence of a buildup of amyloid plaques in the brain. Because of this, this treatment has not yet been recommended for individuals with middle or end stage Alzheimer’s.

Other medications treat the symptoms of Alzheimer’s, but not the underlying biology, like aducanumab does. There are medications that help treat cognitive issues, like memory problems, and there are medications that help with behavioral and psychological problems. There are also several clinical trials going on to help improve both memory problems and behavioral and psychological problems due to Alzheimer’s.

There are also alternative treatment plans that don’t require medication. Some supplements and foods may help improve the symptoms of Alzheimer’s. A fairly new idea that we recently talked about in a Quick Tips episode is a Dementia Friendly Community. These communities make it safer for those living with dementia to maintain their independence and help them be a part of society after they have been diagnosed with Alzheimer’s. To learn more about treatments for Alzheimer’s, talk to your doctor today. They can go over treatment options and recommend a best course of action.

You can also call the Alzheimer’s Association 24/7 helpline for any questions you may have regarding Alzheimer’s disease. They can be reached at 1-800-272-3900.

Now that we’ve discussed what Alzheimer’s is, what some of the signs and symptoms to look for are, and how it is currently being treated, let’s move on to a brief overview of the seven stages of Alzheimer’s.

You may be familiar with the three most commonly referred to stages of Alzheimer’s, the beginning, middle, and end stages, but today we are going to be expanding upon those and talking about all seven stages of Alzheimer’s.

The Global Deterioration Scale for Assessment of Primary Degenerative Dementia, which is what we are referring to as the seven-stage model of Alzheimer’s disease progression, was created by Dr. Barry Reisberg to provide caregivers an overview of the stages of cognitive function for those suffering from a primary degenerative dementia such as Alzheimer's disease.

The first stage is referred to as no impairment or before symptoms appear. Changes in the brain are happening during this stage, but no noticeable signs or symptoms will be seen. Because there are no signs or symptoms during this stage, people are not normally diagnosed during stage one.

Dr. Wolk, co-director of the Penn Memory Center states that “this time period — often called ‘pre-clinical Alzheimer’s disease’ — likely begins 10 or 15 years before people have symptoms. Currently, there is no treatment for this pre-clinical stage, but we hope in the future that we will have medicines that can halt the progress before people have symptoms and prevent the disease.”

The second stage of Alzheimer’s tends to show up as a very mild decline in cognitive health. According to Senior Link, in this stage, a person with Alzheimer’s disease begins to experience the typical forgetfulness associated with aging. They may forget where they left their car keys or their purse. These symptoms are typically not yet noticed by the individual’s family members or physician.

The third stage of dementia shows noticeable memory difficulties and is sometimes referred to as a mild decline. Dr. Wolk explains that “for many, this stage brings noticeable changes, and it will become harder to blame age. It’s common to be diagnosed in this stage, because this is when a person’s daily routine becomes more disrupted.” These first three stages usually occur prior to a diagnosis. An early diagnosis is usually made in stage three, with early-stage dementia being stage four.

Stage four is known as moderate cognitive decline and, as we just said, is what is usually referred to as early-stage dementia. According to Dr. Wolk, in this stage, damage to the brain often involves other aspects of cognition outside of memory, including some difficulty with language, organization, and calculations. These problems can make it more challenging for your loved one to perform daily tasks. Because of the damage to the brain cells, your loved one may also experience other personality changes, such as feeling suspicious of others, having less interest in things, or feeling depressed. These kinds of symptoms can often be improved with medications.

Stages five and six make up mid-stage dementia. Stage five is known as moderately severe cognitive decline or decreased independence. According to the Premiere Neurology Center, from stages one through four, most people will continue to maintain their independence with only minor challenges. However, during stage 5, independence becomes harder since they begin to forget close friends and family, struggle to learn new skills, and may forget to perform basic tasks, like getting dressed. Additionally, emotional changes are also frequently seen during this stage. This can cause hallucinations, delusions, and/or paranoia.

With stage six comes severe symptoms or severe cognitive decline. Dr. Wolk says that living on your own requires you to be able to respond to your environment, like knowing what to do if the fire alarm goes off or the phone rings. During stage six, this becomes difficult for people with Alzheimer’s. Your loved one will be experiencing more significant symptoms at this time, which will impact their ability to manage their own care and they will be more dependent on others.

Late or end stage dementia is also known as stage seven - very severe cognitive decline or a lack of physical control. The Premiere Neurology Center says that the final stage of Alzheimer’s disease is when the brain has sustained so much damage that it fails to communicate with other parts of the body, causing mental and physical impairment. During this final stage, people require around the clock care and assistance for even the most basic parts of their daily routine.

Now that you know what the seven stages of Alzheimer’s are, let’s take a closer look at stages one and two.

Stage one is the preclinical Alzheimer’s stage or the no impairment stage. Most people are not diagnosed during this stage, but it isn’t impossible to be diagnosed during stage one. According to Healthline, you may only know about your risk for Alzheimer’s disease due to family history or your doctor may identify biomarkers that indicate your risk.

Your doctor will interview you about memory problems if you’re at risk for Alzheimer’s, but there will be no noticeable symptoms during the first stage, which can last for years or decades. Changes in the brain can happen up to fifteen years before any signs or symptoms of Alzheimer’s even develop.

While Alzheimer’s may be undetectable in stage one, knowing the risk factors of Alzheimer’s can help you spot signs and symptoms as soon as they appear, and as we have said a few times today, the earlier you can diagnosis Alzheimer’s, the better.

Age, gender, genetics, family history, head trauma, brain abnormalities, smoking, high blood pressure, obesity, limited physical activity, lack of mental activity, and a poor diet are all risk factors for Alzheimer’s disease.

According to Healthline, Alzheimer’s is not a normal part of growing older. However, age is a risk factor for developing this condition. One in nine people over age 65 and one in three people over 85 have Alzheimer’s.

Women are one and half to three times more likely to develop Alzheimer’s than men. Healthline also states that Researchers have found two classes of genes related to Alzheimer’s. Deterministic genes guarantee that people will develop the disease if they live long enough. Usually, people with deterministic genes will develop Alzheimer’s in their 30s, 40s, or 50s. The Mayo Clinic estimates that these genes caused the condition in about five percent of people with Alzheimer’s.

People with risk genes may or may not develop the disease. However, they are more likely to develop Alzheimer’s than people without risk genes.

If your family has a history of Alzheimer’s, you are also at a higher risk. The more family members you have had that had Alzheimer’s disease, the higher your risk will be, as well.

Researchers have found that if you have had serious head injuries you are also at a higher risk for Alzheimer’s disease. Healthline states that the risk increases if the injury involves losing consciousness or happens repeatedly, such as in contact sports. Along with head trauma, scientists have identified brain abnormalities in people who are likely to later develop Alzheimer’s. One is the presence of tiny clumps of protein, also known as plaques. The other is twisted protein strands, or tangles. Inflammation, tissue shrinkage, and loss of connection between brain cells are other clues that Alzheimer’s may develop.

Smoking can also increase your risk of developing Alzheimer’s, as well as numerous other health problems. High blood pressure is another risk factor tied to Alzheimer’s. Researchers have found an especially strong correlation between high blood pressure at middle age and the chances of later developing the disease.

Both obesity and limited physical activity increase your risk of Alzheimer’s. Being overweight can double your risk. An article published in Maturitas, an international journal of midlife health and beyond found that exercising twice a week during midlife may lower your risk of developing Alzheimer’s.

Lack of mental activity is another risk factor for Alzheimer’s. When we challenge our mental capabilities by trying new things and learning new things, playing an instrument, or doing other activities that use our minds, we create internal connections that can help protect against dementia.

Lastly, a poor diet can be a risk factor of Alzheimer’s. Eating plenty of fruits and vegetables and other healthy foods can help lower your risk of developing Alzheimer’s later in life. Developing healthy habits early on can help you live a longer and healthier life overall.

Now that we’ve taken a closer look at stage one and some things to look out for while you’re younger, let’s move on to stage two.

With stage two comes some signs and symptoms that were not visible during stage one. According to Alzheimer’s dot net, the senior may notice minor memory problems or lose things around the house, although not to the point where the memory loss can easily be distinguished from normal age-related memory loss. The person will still do well on memory tests and the disease is unlikely to be detected by loved ones or physicians.

Healthline says that Alzheimer’s disease affects mainly older adults, over the age of 65 years. At this age, it’s common to have slight functional difficulties like forgetfulness. But for stage 2 Alzheimer’s, the decline will happen at a greater rate than similarly aged people without Alzheimer’s. For example, they may forget familiar words, a family member’s name, or where they placed something. During this stage, a loved one may notice symptoms, but not usually the person with Alzheimer’s. If you recognize any cognitive decline in your loved one, talk to them about scheduling an appointment with their doctor.

In the next episode in our series we will dive into the next stage of Alzheimer’s, which is stage three, noticeable memory difficulties. If you are interested in learning more about Alzheimer’s before the next episode airs, visit our YouTube channel where you can find an entire playlist dedicated Alzheimer’s and dementia. You can also check out the show notes for this episode for resources we used during this episode.

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Sources:

https://www.alz.org/alzheimers-dementia/stages

https://www.alz.org/alzheimers-dementia/10_signs

https://www.alz.org/alzheimers-dementia/what-is-alzheimers

https://www.nia.nih.gov/health/what-are-signs-alzheimers-disease

https://www.pennmedicine.org/updates/blogs/neuroscience-blog/2019/november/stages-of-alzheimers

https://www.alzheimers.net/stages-of-alzheimers-disease

https://www.seniorlink.com/blog/the-7-stages-of-alzheimers

https://premierneurologycenter.com/blog/the-7-stages-of-alzheimers-disease/

https://www.alz.org/alzheimers-dementia/treatments/aducanumab

https://www.alz.org/alzheimers-dementia/treatments

https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory