Alzheimer’s is a progressive, fatal disease that eventually affects most if not all of the brain’s functions. It is this progression through the brain, following virtually the same path in everyone afflicted, that causes the stages of Alzheimer’s disease. The disease kills brain cells, beginning in the hippocampus and steadily advancing into other areas of the brain. As different areas of the brain are affected, different brain functions are lost or impaired. Alzheimer’s may be present in the brain years before it is diagnosed. The time frame, from earliest recognition of symptoms to ultimate death, can range from three to ten or even twenty years. Not all of the symptoms are present in every case, and there are individual differences in the speed that the disease advances from early to later stages.
The Stages of Alzheimer’s—Two Models
There are two recognized models of the stages of Alzheimer’s disease. The two most prevalent models use three and seven divisions respectively to describe the progression of the disease. The easiest one to understand is the three-stage model; early-stage, middle-stage and late-stage or end stage Alzheimer’s disease. We are accustomed to thinking of things happening in threes, or being divided into three parts.
The Stages of Alzheimer’s Disease—Three Stage Model
Easier to understand than the seven stages of Alzheimer’s, the three stage model divides the progression into early, middle, and late stage Alzheimer’s, or mild, moderate, and severe Alzheimer’s disease.
Stage One Alzheimer’s – Mild Alzheimer’s Disease
Not to be confused with younger onset Alzheimer’s or early onset Alzheimer’s, mild Alzheimer’s disease is characterized by some memory loss, especially memory of more recent events. A person in the early stages of Alzheimer’s will likely be able to carry out the daily activities of living, but may begin to forget familiar words and names when speaking, and have trouble finding things like keys. Judgment and attention span will become impaired. (more….)
*Early Alzheimer’s disease, the first stage, should not be confused with early onset Alzheimer’s. “Early onset” or “younger onset Alzheimer’s disease” is a variant of the disease that can affect people more than a decade earlier than Alzheimer’s generally strikes.
Stage Two Alzheimer’s – Moderate Alzheimer’s Disease
The symptoms of moderate Alzheimer’s disease are in large part an increase in the severity of the symptoms of the first stage. Professional and social functioning continue to deteriorate because of increasing problems with memory, logic, speech, and initiative. (more….)
Stage Three Alzheimer’s – Severe Alzheimer’s Disease
Severe Alzheimer’s disease is characterized by almost total memory loss. The person in this last stage of Alzheimer’s usually needs help with all of the basic activities of daily living. She will lose the ability to walk unassisted, and, in time, even to sit up by herself. The body eventually forgets how to carry out the normal biological functions necessary to sustain life. (more….)
The Stages of Alzheimer’s Disease—Seven Stage Model
An alternative model that differentiates seven Alzheimer’s stages, the one promoted by the Alzheimer’s Association, more accurately reflects the step-by-step progression of damage as Alzheimer’s disease travels through the brain. The disease first affects the area of the brain in which new memories are formed. It then moves to other areas affecting different functions, like reasoning or emotions, as it travels. The cerebellum and the brain stem, the last (approximately seventh) areas of the brain to be affected, control basic bodily functions, including breathing, heart-rate, and blood pressure.
Stage One Alzheimer’s
Normal mental Functioning (more….)
Stage Two Alzheimer’s
The beginning of early Alzheimer’s disease or early stage Alzheimer’s – The person may feel that he or she is getting forgetful or losing things, but it is not apparent to others. (more….)
Stage Three Alzheimer’s
Mild symptoms – Friends and family begin to notice that memory and functioning are declining. (more….)
Stage Four Alzheimer’s
Symptoms become more evident – To memory problems are added problems involving reasoning and planning. (more….)
Stage Five Alzheimer’s
Activities of Daily Living begin to be more difficult – Memory problems become more pronounced. The individual may begin to forget personal history. (more….)
Stage Six Alzheimer’s
Personality changes and behavioral disorders become evident – This is the stage that is most associated with Alzheimer’s disease, the stage in which the individual might forget family members, wander, and may start to dress and behave inappropriately. (more….)
Stage Seven Alzheimer’s
Late or final stage Alzheimer’s – The person loses the ability to function in the environment, communication becomes very limited, and finally the organs of the body start shutting down. (more….)
Very often during her progression through the stages of Alzheimer’s disease a person will experience what has been called a “moment of clarity.” For a brief period, she will sound and act as though the disease has gone into remission. She may relate a memory that was previously lost, or recognize someone she did not know minutes before, or hasn’t recognized for years. She may even say something truly touching or profound.
It is not the case that the disease has gone into remission. Alzheimer’s disease is not reversible, and there is no cure, but you can still take comfort in these moments. They are evidence that the person you have always known is still there. Person-hood survives the physical and neurological effects of the disease. Mind and spirit endure. A simple YouTube video recently went viral. Taken by Kelly Gunerson as she talked with her mother, the video demonstrates this moment of clarity and how memories that seemed to be lost are again accessible. You can watch that video here.
After Bernice moved to an assisted living facility, Holly and friend, Kate, took on the responsibility of cleaning out her apartment. Several years before, Bernice had two closets built into her living room. Holly had always assumed that the closets were to house keepsakes, photographs, and other mementos she had collected from a life as a professional woman. She was in for a surprise!
Among the piles of flattened cardboard boxes (tied together with string or ribbon and labeled with dimensions and dates, then wrapped in paper and tied again), thousands of plastic grocery bags neatly folded consuming one closet from floor to ceiling, Styrofoam packaging material in all imaginable sizes, shapes, and forms (taking up 40 – 50 cubic feet of space in her living room), and much more – among all this they found newspaper articles and books on brain function and memory loss. Each was, of course, dated at the time she read them. Bernice knew something was happening.
Bernice dated just about everything. She stored samples of fabric, that she would someday “make something with,” in six large suitcases. Periodically she would take this fabric out to air and freshen, and Holly knew exactly when she had done this as all the airing dates were clearly marked on each suitcase. Her hearing aid batteries had the purchase date marked clearly on the package. Purchase dates were attached to medications as well, and the times and dates the medications were taken were listed. Some of these behaviors were probably part of her obsessive/compulsive disorder.
Bernice is also a “hider”. This behavior both results from and feeds her paranoia. She hides things so that they won’t get stolen: toothbrushes, bandages, combs, then of course she doesn’t remember that she has hidden them. When she can’t find them, it is undeniable proof that they were indeed stolen…. She has even written notes to the “thieves” and left them inside drawers, telling them to stay out, that they should stop stealing her things; the police will be called.
These are by no means the only symptoms that Bernice suffered from. Her severe reaction to auditory hallucinations was one of the things that made Holly realize that Bernice needed help. She was unable to stay on top of finances, even to reconcile her checkbook, though this was something about which she had always been fastidious . She got lost several times while driving in her own neighborhood and had to wait for someone to come along and help her find her way home. She was adept at concealing her failing abilities, covering up her mistakes, but it was becoming clear to Holly that Bernice would not be able to care for herself much longer. She was still in the early stages of Alzheimer’s disease.