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The Stages of Alzheimer's Dementia

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The symptoms of dementia worsen over time, although how fast the disease progresses is different for everyone. On average, a person with Alzheimer's lives four to eight years after they have been diagnosed, but this can vary widely, depending on how early or late the diagnosis was made, and whether they have any additional types of dementia or other medical issues. Changes in the brain related to Alzheimer's begin years before any signs of the disease. As dementia progresses, the person with the disease will have more caregiving needs over time, and their needs will continually change. Usually, the stages of dementia are divided into different categories: mild, moderate and severe Alzheimer’s disease. This is helpful for you to think about the caregiving needs the person has at any particular time. But it may be difficult to place a person with Alzheimer's in a specific stage as symptoms from different stages may overlap.


Mild Cognitive Decline (MCI) & Early Alzheimer's Dementia

What is MCI? Some people have memory problems that are not severe enough to be called dementia. In normal memory, there is mild slowing of memory that occurs after age 40 for everyone, and all of us forget names or have memory lapses here and there, but with time we are usually able to recall the information.


But Mild Cognitive Decline (or MCI for short) is different. You may notice one or more of the following in the older adult:

  • New or worsening word or name finding problems
  • New or worsening ability to remember names when introduced to new people
  • Difficulty managing in social situations
  • Reading something, then not being able to remember much of it
  • Losing or misplacing something of importance to them
  • Worsening in the ability to plan or organize

MCI describes problems in one or more brain functions, for example memory, planning, language, attention or visuospatial skills. Sometimes, the older adult may complain that they are having memory problems, but no one else notices. Other times, these problems may be noticeable only to you as the caregiver.

The difference between MCI and full blown dementia is that in MCI, the problems don’t significantly interfere with everyday living. Having MCI doesn’t necessarily mean the person will get dementia. Some people get better, some stay the same and some get worse and develop dementia.

In the early stages of Alzheimer's, the affected person may function independently even if they feel like they are having trouble doing so. They may still drive, work and be part of social. The difficulties are similar to those that occur during mild cognitive impairment, but the difference is that you as the caregiver, as well as friends and family, are more likely to notice the difficulties. You may also notice that the older adult may be subdued and withdrawn, especially in socially or mentally challenging situations.

If the person you care for begins to forgets information that he or she would previously have eventually recalled, complains of new or worsening memory problems, or something just seems a little "off" to you, encourage them to see a doctor. If they have a family member that is involved, tell the family member your concerns. It is important that the older adult see a doctor - there may be something easily treatable going on.


Caregiving In MCI & Early Alzheimer's Dementia 

It is a good idea to encourage the older adult with MCI or early Alzheimer’s dementia to:

  1. Exercise regularly. This will help their heart and blood vessels, including those that go to the brain. Tai Chi, an activity frequently available at community centers and senior centers, may improve brain function. Exercise can also be a simple as gardening or going for a walk together.
  2. Eat healthy, manage any diabetes, and quit smoking. Again, these will all help to protect their heart and blood vessels, including those that protect the brain.
  3. Perform mentally stimulating activities. If the older adult is able to and interested, encourage them to take a course learning new skills, such as computer skills or photography. If that is not possible, lower challenge activities such as previously enjoyed activities like reading, crafts or cooking are also a great idea.
  4. Participate in socially engaging activities: this might include meeting up with friends, going to religious services, or a seniors’ center. Even sitting with them and talking, perhaps for a meal, can be very good for them emotionally and mentally.
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Madhuri Reddy

Dr. Reddy is a specialist in Internal Medicine & Geriatric Medicine, and holds appointments at Harvard Medical School & Hebrew SeniorLife in Boston, MA. For years she has seen first hand the struggles that families and caregivers go through while caring for older adults.

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