Alzheimer’s Progression: Is It Possible to Predict?

hands around glowing ballExperts estimate that specialized physicians now have the tools to diagnose Alzheimer’s disease with more than 90 percent accuracy. That fact sent me in search of data on symptoms, and when and in what order they are likely to occur after diagnosis. About 15 months ago, my husband was diagnosed with Alzheimer’s, and I continue to struggle with 1) what about his behavior is symptomatic of the disease, 2) if what I observe will be consistent behavior (Can I count on what he can and cannot do all the time), and 3) what might be just normal aging behavior for someone his age (78).
The short answer: Well….it appears that the short answer to all 3 of my dilemmas is “You can’t be sure.” Because Alzheimer’s affects people in different ways, each person will experience symptoms – or progress through Alzheimer’s stages – differently. Even the definition of “stages” seems a little vague. Some sources listed 3 stages of progression through the disease, while others came up with 7. And even then the reader is warned that symptoms might overlap or even not occur in that particular order. While designating Stages of Alzheimer’s can give a general forecast of what to expect, progression varies greatly from person to person and a division into Stages only provides a general guide.
Another challenge: People with possible warning signs of Alzheimer’s may find it hard to recognize they have a problem and may resist following up on their symptoms. Signs of dementia may be more obvious to family members or friends. And memory loss might not be the first symptom that shows up. My husband’s earliest and most consistent symptoms involve what some experts call “executive function,” or the lack of ability to process a string of instructions or to initiate and plan activities. The neurologist who evaluated his tests confirmed that my observations in these areas were correct.
Progression in 3 stages: The Alzheimer’s Association Website favors describing a 3-stage slow progression for the disease: mild (early-stage), moderate (middle-stage), and severe (late-stage). symptoms are listed. But what I found most helpful and descriptive of my own observations so far is their chart titled “10 Early Signs and Symptoms of Alzheimer’s.” Click on the link to find descriptions and “typical age-related changes” for each of these 10 symptoms:

  1. Memory loss that disrupts daily life
  2. Challenges in planning or solving problems
  3. Difficulty completing familiar tasks at home, at work or at leisure
  4. Confusion with time or place
  5. Trouble understanding visual images and spatial relationships
  6. New problems with words in speaking or writing
  7. Misplacing things and losing the ability to retrace steps
  8. Decreased or poor judgment
  9. Withdrawal from work or social activities
  10. Changes in mood and personality

Divided into the 3 stages, these are the common symptoms noted by the Alzheimer’s Association: 
1) Mild Alzheimer’s disease (early-stage) (Once source said that there is also a stage when Alzheimer’s is developing but no symptoms are yet manifested.)

  • Problems coming up with the right word or name
  • Trouble remembering names when introduced to new people
  • Challenges performing tasks in social or work settings.
  • Forgetting material that one has just read
  • Losing or misplacing a valuable object
  • Increasing trouble with planning or organizing

2) Moderate Alzheimer’s disease (middle-stage) (Typically the longest stage that can last for many years)

  • Forgetfulness of events or about one’s own personal history
  • Feeling moody or withdrawn, especially in socially or mentally challenging situations
  • Being unable to recall their own address or telephone number or the high school or college from which they graduated
  • Confusion about where they are or what day it is
  • The need for help choosing proper clothing for the season or the occasion
  • Trouble controlling bladder and bowels in some individuals
  • Changes in sleep patterns, such as sleeping during the day and becoming restless at night
  • An increased risk of wandering and becoming lost
  • Personality and behavioral changes, including suspiciousness and delusions or compulsive, repetitive behavior like hand-wringing or tissue shredding

3) Severe Alzheimer’s disease (late-stage)

  • Need round-the-clock assistance with daily activities and personal care
  • Lose awareness of recent experiences as well as of their surroundings
  • Experience changes in physical abilities, including the ability to walk, sit and, eventually, swallow
  • Have increasing difficulty communicating
  • Become vulnerable to infections, especially pneumonia

At least with an early diagnosis, my husband and I and our family can plan for the future, however uncertain its course may be. The day of his diagnosis, we met with a family counselor in the U. of U. Neurology Dept. She advised me that, “Even though it’s not fair, you are the only one who can change. Ultimately, it’s better to be happy together than to be right.” I took this to mean that whether his changing behavior is a symptom of Alzheimer’s or just part of normal aging, it will ultimately be better for both of us if I can react with patience and understanding…or not react at all.
by Marti Lythgoe, DTN Travel Nurse Editor/Writer

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