Alzheimer's is divided into four stages which progress from one into the next. They are classified as Pre-Dementia, Early Dementia, Moderate Dementia and Advanced Dementia.
The first symptoms are sometimes mistaken for ageing or stress. Detailed neuro-psychological testing can reveal mild cognitive difficulties as early as eight years before a person is officially diagnosed with Alzheimer's.
The most noticeable early symptom is memory loss, which usually shows up as trouble remembering recently learned facts or an inability to remember new information. Subtle problems with attentiveness, planning, flexibility, and abstract thinking, or impairments in semantic memory (memory of meanings, and concept relationships), can also be signs of the early stages. Apathy is sometimes seen at this stage and it remains throughout the next three phases. This early stage of the Alzheimer's is also called "mild cognitive impairment."
The increasing challenges of learning and memory eventually leads to a doctor's diagnosis of Alzheimer's. In a few people, difficulties with language, executive functions, perception/understanding, or movements are more prominent than their memory problems.
Alzheimer's does not affect all types of memories the same. Older memories of the person's life, facts learned, and implicit memory tend to be affected less than are newer facts or memories. Language problems are mainly characterised by a shrinking vocabulary and decreased word fluency, which eventually interfere with one's writing and speaking skills. In this stage of Alzheimer's, the affected person is slowly reduced to communicating only basic ideas.
While performing fine motor tasks (finger control) such as writing, drawing or dressing, one's movements that require planning and coordination are difficult, making sufferers appear clumsy. As the disease progresses, people can often continue to perform many tasks independently, but might need help or supervision with the more mentally demanding activities.
During this third stage, one starts losing their ability to be independent. Conversation becomes difficult, due to an inability to remember words. Sometimes wrong words are substituted. Reading and writing skills also decline. Complex movements that require coordination are more challenging, causing the ability to normal daily living activities to be difficult. During this phase, memory problems worsen, and the person may fail to recognise close relatives.
Long-term memory becomes impaired and behavioral changes become more noticeable. Common neuro-psychiatric manifestations are wandering, sundowning, irritability and labile affect can lead to crying, outbursts of aggression and/or resistance to caregiving. About a third of patients also develop illusionary misidentifications and other delusional symptoms. Urinary incontinence can develop.
During this stage of Alzheimer's, the patient's symptoms create increasing stress for their relatives and caretakers. It's at this point most loved ones must consider moving the patient into long-term care facilities that specialize in caring for Alzheimer's patients.
During this last stage, the patient has become completely dependent upon others for care. Speaking with simple phrases or single words eventually turns to a complete loss of speech. Despite this, patients can often understand and return emotional signals. Aggressiveness might still be present but extreme apathy and exhaustion are more common.
Patients will eventually become unable to do most simple tasks without assistance. Muscle mass shrinks and mobility deteriorates to the point where they are bedridden. The Alzheimer's patient will lose their ability to feed themselves.
Finally comes death, usually caused directly by something external such as pressure ulcers or from a cold turning into pneumonia.
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