By Dr. Raymond Vickers M.D.
Probably the most remarkable thing about the very early stages of Alzheimer's disease is its unremarkableness. Signs and symptoms seem to creep up and take us unaware, surprising both us and our loved one. With the passage of time, the mental and physical deterioration of Alzheimer's becomes more and more pronounced.
While no two people progress at the same rate or according to the same exact pattern, there are some characteristic behavior and personality changes peculiar to each stage of the illness. Knowing what these changes are can help promote a better quality of life for yourself and your loved one. Understanding the signs and symptoms of Alzheimer's is crucial to the care Alzheimer's victims need.
Two to four years is the average length of the first stage of Alzheimer's. The initial symptoms of Alzheimer's may include any or all of the following:
Memory loss: Recent events are forgotten. The ability to concentrate, learn new things and process new information is progressively lost. Bills go unpaid or are paid several times. Checking accounts are overdrawn when the person has trouble adding, subtracting and balancing the checkbook. The names of known and loved persons may also be forgotten. People with Alzheimer's usually compensate, initially, by writing notes to themselves. But as the disease progresses, they no longer remember the notes. People frequently deny experiencing these symptoms as they struggle to preserve their self-esteem and identity.
Confusion and disorientation: Confusion is often related to place and time. People with Alzheimer's sometimes gets lost on their way somewhere, or they will arrive at a place and not know where they are or how to get home. The day and month are forgotten as well.
Speech and language disturbances: There may be a progressive inability to name objects or to end sentences. The person searches for words and phrases. Wrong words and phrases are substituted for the forgotten right ones.
Impaired judgment: There's a lack of insight and a growing inability to discriminate, understand and follow directions. Driving is progressively impaired; the person may go through stop signs or wind up going the wrong way on a one-way street. The ability to read is retained but not the ability to remember what is read. Difficulty completing familiar tasks: It becomes increasingly difficult to cook, clean, engage in familiar hobbies, hold down a job. Routine activities of daily living go through a process of "unlearning". For example, the ability to tie shoes, button a blouse or shirt, or make a cup of coffee is impaired.
Personality and mood changes: Depression frequently accompanies the early stages of Alzheimer's. There may be listlessness, apathy, suspiciousness, paranoia, social withdrawal, and episodes of crying. Conversely, there may be restlessness, anxiety, agitation and feelings of "going crazy". On the other hand, they recognize that something is going wrong.
Carelessness and neglect: Personal hygiene can become a problem, and people may appear careless and unkempt. They may neglect to bathe, brush their teeth, change or wash their clothes. They simple may have forgotten how. The time from the onset of Alzheimer's to the person's death varies greatly. It may be a few years or over twenty, depending on any number of other health-related factors. Generally speaking, the younger the person is, the faster the rate of progression and deterioration.
Facing the Second Stage
As the disease progresses, stage one symptoms intensify. Memory loss becomes more profound. Behavior becomes more disturbing, bizarre and unpredictable. This second stage of Alzheimer's may last for two to ten years.
Continued and progressive memory loss: Past events as well as recent ones may no longer be remembered. The ability to engage in familiar activities or carry out the routines of daily living, such as bathing, dressing and toileting, is impaired.
Progressive to complete disorientation and confusion: Our loved ones may lose their ability to recognize people, including family members. They may no longer recognize their own reflection in the mirror. They may forget the names and uses of familiar objects. They may wander off and get lost, or they may even get lost in their own homes.
Speech, communication and language disorders: People with second-stage Alzheimer's are progressively unable to express themselves and to complete sentences. The repetition of words, questions and phrases is common. Speech may become garbled or very slow. Catastrophic reactions: They may include pronounced mood swings or personality changes including outbursts or anger, increased suspiciousness or paranoia and even episodes of physical violence, usually short-lived.
Wandering, restlessness and pacing: Restless wandering often occurs at night or in the late afternoon, around sundown. Repetitious movements, such as finger or foot tapping, lip smacking and constant chewing motions, may increase.
Various behavior problems: There may be hallucinations or delusions of being persecuted. People with Alzheimer's frequently hide and hoard things and may tear the house apart looking for "lost" items. There may be inappropriate sexual and social behavior with marked social withdrawal.
Physical signs: Motor activities may be affected; many people in the second stage progressively lose their ability to engage in activities requiring hand and finger coordination. Opening a can with a can opener, buttoning a shirt, tying a shoelace, hammering a nail---all could be affected.
Occasionally there is muscle twitching or jerking. People may tend to lose their balance and fall as coordination becomes impaired. Eating and elimination problems manifest themselves
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