Stages of The Disease

Contact the Association for support throughout these stages

Stage 1 - Forgetfulness | Stage 2 - Confused | Stage 3 - Disorientation | Stage 4 - Dependency

Stage I - Forgetfulness Stage

Symptoms:

• Recent memory loss begins to affect job performance
• Vague complaints
• Less tolerant
• Angry
• Less energy
• No initiative
• Slow to react and learn
• Forgets what he/she was just told to do
• Loss of spontaneity, spark, or zest for life, less energy
• Loss of initiative - can't start anything
• Mood/personality changes - anxious about his symptoms - keeps to himself
• Poor judgement - makes bad decisions
• Takes longer with routine chores
• Trouble handling money, paying bills

Examples:

• Forgets which bills are paid
• Forgets which cards are played in bridge
• Forgets phone numbers and grocery lists
• Difficulty driving a car
• Difficulty cooking - following recipes
• Difficulty maintaining a checkbook
• Loses things
• Forgets grocery list
• Arrives at wrong time or place or constantly rechecks calendar

"Mother's not the same - she's withdrawn, disinterested"

• Appears less outgoing, hides things, gets upset easily
• Spends all day making dinner and forgets three courses
• Pays the bills three times over or doesn't pay for three months

Care:

• Try to understand the person's anger and confusion (and your own)
• Offer support in times of frustration
• Begin to organize and simplify daily routines, and to structure the home environment for safety

The Association and Community Resources:

• Helpline
• Community referral lists (day care, geriatric assessment, etc.)
• Project Esteem Group for early diagnosed persons
• Support groups
• Family Education Programs

Stage II - Confused

Symptoms:

• Needs assistance to manage
• Can't calculate, understand, concentrate, plan, or decide
• Slow to react or overreacts
• Can't cope with failure
• Self-absorbed
• Increasing memory loss and confusion
• Shorter attention span

Examples:

• Not performing activities of daily living such as bathing and cooking
• Giving money to strangers

Care:

• Be prepared to offer supervision
• Provide help but treat as an adult
• Give one-step directions
• Limit choices
• Set routines
• Remind and repeat gently
• Encourage strengths
• Accept some withdrawal

The Association and Community Services

• How to Cope classes
• Family Education Programs
• Family Care Planning
• "Ask the Attorney" Program
• Respite and time-out opportunities
• Community resources like adult daycare

Stage III - Disorientation

Symptoms:

• Obviously disabled
• Lethargic
• Disoriented to time and place
• Uncertain how to react
• Poor recent memory
• Inappropriate behavior problems
• Problems recognizing close friends and/or family
• Repetitive statements and/or movements
• Restless, especially in late afternoon and at night
• Occasional muscle twitches or jerking
• Perceptual-motor problems
• Problems organizing thoughts and/or thinking logically
• Can't find right words - makes up stories to fill in
• Problems with reading, writing, and numbers
• May be suspicious, irritable, fidgety, teary, or silly
• Loss of impulse control - sloppy - won't bathe or afraid to bathe - trouble dressing
• Gains and then loses weight, may see or hear things that are not there: "My daddy is waiting for me outside, I'm going home"
• May have fixed ideas that are not real (delusions)
• Needs full-time supervision

Examples:

• Can't remember visits immediately after you leave
• Repetitive movements, statements, tapping, or folding
• Sleeps often and awakens frequently at night and may try to jump up and "go to work"
• Perceptual-motor problems such as having difficulty getting into a chair or setting a table
• Can't find right words: "I used to be a boss big man and now I'm an old big dummy..."
• Problems with reading numbers - can't follow written signs, write names, add, or subtract
• Suspicious - may accuse spouse of hiding things or of infidelity - may act childish or finger clothes constantly
• Loss of impulse control, such as forgetting table manners
• May forget proper place to dress/undress
• High appetite for junk food or other people's food
• Forgets when last meal occurred, then gradually loses interest in food
• Sample of perceptual losses or hallucinations
  "there are babies in this house" "the police are after me"
  "I want to go home"

Care:

• Devise and use memory aids
• Offer reassurance
• Approach slowly
• Explain before doing a task
• Decipher meanings
• Relate to feelings, not to words
• Use touch to communicate

The Association and Community Services

• Family Care Planning
• Support Groups
• How to Cope classes
• Respite, in-home, special residential or nursing home care

Stage IV - Dependency

Symptoms:

• Can't recognize family or self in mirror
• Needs assistance with simple tasks
• Appears apathetic
• Perception is distorted
• Physical disabilities
• Loss of coordination
• Inability to feed himself or to swallow
• Greater immobility (may be unable to walk)
• Seizures
• Skin breakdown
• Infections
• Loss of bowel and bladder control
• Loses weight even with an adequate diet
• Little capacity for self care
• Can't communicate with words
• May put everything into mouth or touch everything

Examples:

• Looks in mirror and talks to own image
• Needs help with bathing, dressing, eating, or toileting
• May groan, scream, or make grunting sounds

Care:

• Assist with daily needs
• Remember that the behavior is not intentional
• Understand the disease is affecting the patient
• Ask for support in both practical and emotional matters
• Look to the community for resources/respite care
• Nursing home placement may need to be considered

The Association and Community Services

• Late-stage support groups
• How to Cope II programs
• Hospice and nursing home options, as appropriate