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Stages of Alzheimer’s

One of the most frequent questions that professionals who work with Alzheimer's disease receive is about its evolution.

How long it lasts? how do you know what phase I am in?... these are not easy-to-answer questions. There is not two equal Alzheimer’s, neither two dementias.

To launch the Fundació ACE blog, I will try to summarize what we know, putting Alzheimer's disease and dementia in context.

Based on what we know so far, Alzheimer's disease is the most common type of dementia. It is an evolutionary disease and currently has no cure.

The functional and cognitive impairment of each patients depends on many factors, such as the treatment and lifestyle followed by the affected person.

Currently, Alzheimer's disease is considered a continuum from the appearance of the first changes in the brain until symptoms manifest and the disease develops. These changes in the brain can appear up to one or two decades before the onset of symptoms (“preclinical” phase).

Later, the first symptoms begin in the form, for example, of forgetting new information, names or appointments, or slight difficulties in finding words, but all this does not initially interfere with day-to-day activities. That is, the person continues to carry out their activities, with more effort, but satisfactorily and autonomously (phase called "mild cognitive impairment").

At the moment in which the cognitive symptoms affect the activities of daily life, needing the help of a third person to carry them out, the patient enters the phase known as dementia. Within it, we can differentiate three stages.

Mild stage

Things that we used to do well begin to turn out not so well.

During this phase will cost an extraordinary effort to learn new things such as how to operate a new mobile phone or a television remote control. It will also be difficult to remember the names of some acquaintances.

During the mild phase, the functional loss of the more elaborate activities of daily living occurs, that is, the affectation in the so-called complex instrumental activities. These are the ones that in order to carry them out, it is necessary to mentally process an idea or action, program it and execute it, such as, for example, making financial arrangements (paying bills, etc ...) or controlling medication.

Moderate stage

In the moderate phase, specific operations that have been acquired between 7 and 12 years begin to be lost.

The second phase of the disease begins when the simplest instrumental capacities of daily life begin to break down, that is, when the ability to develop situations that allow survival and self-care is lost.

The person with Alzheimer's in moderate phase loses skills to make purchases, use money or follow a diet or proper hygiene. The loss of interaction with the environment begins, the previous egocentricity appears or worsens and the inability to adapt to routine changes and focus on stimuli.

Severe stage

In this phase, the sensory and motor capacity, which originate with birth and up to 2 years, ends up being destructured.

The third and final phase of Alzheimer's is characterized by the progressive loss of the most basic abilities of daily life, such as food, hygiene and control of the urinary and faecal sphincters.

At this time, people with dementia need help to carry out their basic care because they can no longer understand the information that their senses perceive, and they are unable to interact with the environment. Furthermore, they have already lost the ability to manipulate objects and, once these disappear from their sight, they cannot understand that they still exist.

The loss of functional capacities follows the reverse order of how they have been acquired and, in its last stage, people with Alzheimer's only have emotional memory (a smile, a hug or a kiss), but without understanding when, who and why.

DRA. MERCÈ BOADA

@MerceBoadaR

Founding member and medical director of Fundació ACE

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