Alzheimer's disease is a degenerative condition marked by a progressive decline in cognitive functioning. This decline, often coupled with emotional apathy, affects the individual's behavior and mood. People sometimes mistake forgetfulness or absentmindedness in seniors for early signs of Alzheimer's, but some memory loss is actually considered a normal effect of aging.
You may have heard the terms early, mid- and late-stage Alzheimer's. These are general terms that were used until the development of a more detailed framework with seven separate stages which measure the disease progression. The system is known as the Functional Staging Assessment or FAST scale, developed by Barry Reisberg, MD, Clinical Director of New York University's Aging and Dementia Research Center. This article will examine the seven stages of Alzheimer's disease, distinguishing between the normal aging process and the signs and symptoms of Alzheimer's.
What is normal during the aging process?
As we age, some memory loss is considered normal, especially if it is not progressive. Following are some examples. An aging senior who does not have Alzheimer's may:
- Be concerned about memory loss but be able to provide significant detail regarding specific incidents of forgetfulness.
- Have trouble finding the right word, but remember it later.
- Forget the day of the week or where he or she is going, usually remembering later.
- Need to pause to remember his or her way, even in familiar territory.
- Misplace keys or a wallet temporarily.
- Feel sad or moody occasionally, but be able to recover from it.
- Avoid work or social obligations, but show no decline in interpersonal skills.
The 7 Stages of Alzheimer's Disease
The FAST scale measures the decline of people with Alzheimer's. Although each stage is distinct, because there is a steady decline in cognitive function, there is some overlap. It is useful to view the scale as a spectrum, where the condition progresses as the patient's symptoms gradually increase and worsen.
Stage 1: Normal Adult
In this first stage, there is no obvious memory impairment. Clinical tests also show no measurable deficit.
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Stage 2: Normal Older Adult
A person in stage two shows very mild cognitive decline, usually showing some personal awareness of the change. This may include the person worrying that he or she is becoming more forgetful, although it is not obvious to a health care professional, family or friends. The individual may forget names and temporarily misplace commonly used objects like keys or a wallet.
Stage 3: Early Alzheimer's Disease
During this stage, the individual may have difficulty concentrating on certain tasks and may falter during a conversation. The individual may also have difficulty retaining information that he or she has just read or heard. Forgetting names and words becomes more frequent. Misplacing objects of value may occur. Some degree of confusion is common.
Stage 4: Mild Alzheimer's Disease
By stage four, friends and family members will have begun to notice changes in the senior, in addition to the symptoms mentioned above. These observations could include the person:
- Forgetting people he or she has met recently.
- Losing interest in social or work situations.
- Being uncharacteristically disorganized.
- Showing a decreased ability to perform common tasks such as planning dinner, paying bills or managing finances.
Stage 5: Moderate Alzheimer's Disease
At stage five, the senior is no longer able to function independently. Typically, the senior will remember his or her own name as well as the names of a spouse and children, but may be unable to recall a home address or phone number. Forgetfulness increases, and disorientation is common, with seniors in this stage often being confused about time, place, date, day of the week and season. Other signifiers may include the senior:
- Being unable to make proper clothing choices (e.g., selecting a sundress during the winter).
- Forgetting personal history, such as where he or she went to school.
- Withdrawing from social or challenging situations.
Stage 6: Moderately Severe Alzheimer's Disease
By this time, the senior will exhibit major gaps in memory and significant decline in cognitive function. Personality changes may begin to emerge as well. A person in stage six may be unable to distinguish familiar people, including a spouse or children, from those he or she doesn't know. The individual may require assistance with daily activities such as eating and toileting. Incontinence is common. In addition, the senior may:
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- Forget the name of his or her spouse, even if that person is the primary caregiver.
- Wander and become lost.
- Experience hallucinations, interacting with people or things that are not there.
- Exhibit delusional and/or paranoid behavior.
Stage 7: Severe Alzheimer's Disease
In the final stage of Alzheimer's disease, most individuals have lost the ability to communicate verbally, although some may retain a few words. A severe physical decline is apparent. The individual will experience a progressive loss of basic physical abilities, including sitting, walking and even swallowing. Muscles become rigid from lack of use, and reflexes are abnormal. There is a disruption in the senior's diurnal cycle, which can upset sleeping patterns and contribute to disorientation and fatigue.
Although the cause of Alzheimer's remains unknown, research shows that many factors can play a part in the development of the disease. Understanding normal aging patterns will help you distinguish them from the warning signs of Alzheimer's. If you are uncertain, talk to the senior's doctor about getting a definitive diagnosis.