A first cousin – just a few years older than myself. The husband of a lovely lady I have known since grammar school. The mother of a relative by marriage. It seems every week or so I hear of someone else beginning the Alzheimer’s journey. It is a long, difficult road. What a difference it makes to have a loved one travel with you.

Now the sixth leading cause of death in our nation, one in three seniors die with Alzheimer’s or another dementia. According to the Alzheimer’s Association, this devastating illness is “the only cause of death among the top 10 in America that cannot be prevented, cured or even slowed.”

Many of you who are reading this are caring for someone who has received this heart-breaking diagnosis. An important aspect of caregiving is learning all you can about the disease that affects your loved one. Numerous books have been written and an abundant amount of information is available online. I encourage you to take advantage of these. My goal today is to summarize the stages of Alzheimer’s, providing an overview that can help you as you prepare for the days ahead. Knowledge is power. 

Several models have been prepared, but I am using the Global Deterioration Scale, also known as the Reisberg Scale. Remember that these are general guidelines. Time spans for each stage are approximate. Every Alzheimer’s journey is unique.

Stage 1 – No impairment.

Stage 2 – Minimal impairment as memory lapses and cognitive changes go undetected by others, especially since almost half of all people over 65 begin noticing problems in concentration and word recall.

Stage 3 – Mild impairment (2 to 7 years) transpires as subtle difficulties influence cognitive function. Signs include difficulty retrieving words, misplacing objects, inability to plan and organize, and forgetting recent learning to the degree that life at home and work is impacted. Depression and other changes in mood may occur. Often, the person may try to cover up these problems. There is a window of time, usually in the early stages, when a person recognizes their deficits and, by “calling on” all the brain’s resources, can compensate for neurological limitations. Research has revealed that during the early stages of the disease, a person performing a memory test has increased activity in the front part of the brain – the prefrontal region. Many times, I have observed someone, who it seems, “musters every cell of his/her brain” to enable a proper response to a challenging situation. This ability has always amazed me, especially because it occurs independently of other, not-so-proper actions. In psychology this ability is referred to as “compensating” and defined as an attempt to conceal or offset a disability or frustration. Some people can do this so well that the caregiver may temporarily consider all is well with their loved one.

Stage 4 – Mild Alzheimer’s (about 2 years) includes the development of mathematical challenges such as the inability to handle finances; increasing forgetfulness of recent events; and problems performing chronological tasks such as cooking, driving and ordering from a menu. Self and familial recognition is usually intact at this stage, but withdrawal from social situations is common. The person may deny problems and become defensive. An accurate diagnosis of Alzheimer’s is possible at this stage.

Stage 5 – Moderate Alzheimer’s (average 1.5 years) includes severe decline in abilities, requiring increased supervision and assistance. Recall of personal history details is lost and there is frequent disorientation regarding time and place. Judgment skills deteriorate, making the person vulnerable to scams. Safety risks are an issue. 

Stage 6 – Moderately Severe Alzheimer’s (2.5 years) is marked by a total unawareness of present events and the inability to remember the past. The ability to perform any personal care (dressing, toileting, eating) is progressively lost. Response to nonverbal stimuli and the ability to communicate pleasure and pain by behavior are still possible. Dramatic changes – such as late afternoon agitation or hallucinations, wandering, or suspicion of family members – are common. This is the stage in which your loved one may no longer recognize you but may still know you are “familiar.”

Stage 7 – In the Final Stage (1 to 2.5 years) speech becomes severely limited, as does the ability to walk or sit. Total, around the clock care is required. “Duration is impacted by quality of care.” 

That last line is a direct quote from this disease model and may be the most important to remember. Even in a disease as grim as Alzheimer’s, you can find hope in knowing that as a caregiver, the quality of care you provide does make a difference.   

Caring definition: Impact – the effect or influence of one person, place or thing on another.