DIMENSIONS Winter 1998


by Julie Cleveland

Alzheimer's Disease (AD) is a progressive, degenerative neurological disease which results in significant impairment of memory, thinking and behavior. The onset of the disease is gradual, and the course is irreversible. At this time there is no known cause or cure. Although there are individual differences in each person's reaction to the disease, there are general stages that may help people understand the course of the disease.

Stage 1: Early. The first stage of Alzheimer's begins gradually. One may never be able to place a specific date on the onset of AD. The first symptom noticed is usually forgetfulness. Other signs may include: vague complaints, disorientation of time and place, misplacing commonly used items, depression, difficulty finding words (dysnomia) or concentrating, difficulty understanding abstract concepts or mathematical equations, and anxiety or other mood and personality changes due to symptoms.

When caring for a person in the initial stage of Alzheimer's, try to understand the person's confusion and anger, as well as your own. Begin to organize and simplify daily routines, and design the home environment for safety. Become familiar with the community resources available, including referral lists, helplines, support groups and family education programs.

Stage 2: Middle. The second stage of Alzheimer's is marked by an advancing decline. There is noticeable deterioration of memory and functioning. Although memory from the distant past is often still clear (such as remembering stories on from young adulthood), the patient may forget more recent events, such as what they did earlier in the day or yesterday. A person in this stage must often give up complex activities such as driving, and needs help making decisions, performing tasks, or planning for the future. Other symptoms may include: an increase in forgetfulness and disorientation, restlessness, agitation, wandering, difficulty sleeping at night, and failure to recognize friends at times.

Caring for a person in the middle stages of AD may involve direct supervision and assistance with activities of daily living. Remember to provide help, but to treat the person as an adult. Set routines, limit choices, and give one step instructions. Allow enough time for communication--give the person plenty of time to listen and respond. Encourage the person's strengths and accept some withdrawal. People who have AD often pose severe behavior management problems for those who provide care. Changing behaviors involves the following steps: 1) Learning to observe and define problem behaviors 2) Developing a plan to change the behavior 3) Evaluating your plan's effectiveness in changing behaviors, 4) Changing your plan and reevaluating to make your plan more effective.

Stage 3: Advanced. The final stage of Alzheimer's is the shortest. A person in this stage may become uncomprehending and lose the ability to speak. They may become unable to recognize others, themselves, or their surroundings. They go through considerable weight loss and lose control of bodily functions. They may walk with a shuffle, and show minimal emotional response. In the latter phases, the patient is unable to eat or walk without assistance.

When caring for a person in the advanced stages of Alzheimer's, remember that the disease is affecting the person, and the person's behavior is not intentional. Relate to the person's feelings, not their words. Offer reassurance, and use touch to communicate. You may want to use visual cues and memory aids. Continue to use community resources, and ask for support in both emotional and practical matters. Care in a nursing home or other type of institution may be required for someone in the advanced stage of Alzheimer's.

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