Don’t focus on what’s slipping away; instead, focus on what’s still possible
You can help support your loved one with Alzheimer’s by learning more about how the condition unfolds. Remember, your older parent is not asking you to take charge; they are simply asking for a helping hand.
The stages don’t always fall into neat boxes, and the symptoms might vary, even from day-to-day or during the same day. But they can be a guide and help you plan for your friend or relative’s care.
Stage 1: Normal Outward Behavior
When your loved one is in this early phase, he won’t have any symptoms that you can spot. Only a PET scan, an imaging test that shows how the brain is working, can reveal whether he’s got Alzheimer’s.
As he moves through the next 6 stages, your friend or relative will see more and more changes in his thinking and reasoning.
Stage 2: Very Mild Changes
You still might not notice anything amiss in your loved one’s behavior, but he may be picking up on small differences, things that even a doctor doesn’t catch. This could include forgetting a word or misplacing objects.
At this stage, subtle symptoms of Alzheimer’s don’t interfere with his ability to work or live independently.
Stage 3: Mild Decline
It’s at this point that you start to notice changes in your loved one’s thinking and reasoning, such as:
- Finding the right word during conversations
- Forgetting something he just read
- Asking the same question over and over
- Having more and more trouble making plans or organizing
- Can’t remember names when meeting new people
- Frequently losing personal possessions, including valuables
Keep in mind that these symptoms might not be Alzheimer’s at all. Instead, they could simply be normal changes from aging or, perhaps, another medical problem that can be corrected. So, before making any drastic lifestyle changes, check with his personal physician or a neurologist who specializes in dementias.
If his changes are indeed due to Alzheimer’s or another dementia, you can help by being your loved one’s “memory.” Make sure he pays bills and gets to appointments on time. You can also suggest he ease stress by retiring from work and putting his legal and financial affairs in order.
As a general rule, don’t argue with your loved one. While you may try one time to correct a misstatement or misunderstanding, drop it if you meet with resistance. As your loved one moves from one stage to another, he will increasingly be living in his own world — one created by his disease — and increasingly unlike the one we live in.
Finally, always ask, don’t assume — even if you’re in a hurry. Help them, but only to extent they need it. For example: “Would you like some help with that?”
Stage 4: Moderate Decline
The problems in thinking and reasoning you noticed in stage 3 get more obvious, and new issues appear. For example, instead of just losing his keys, he may forget what keys are for. Other symptoms include:
- Having difficulty with simple arithmetic
- Forgetting details about his personal history
- Having trouble putting the right date and amount on a check
- Forgetting what month or season it is
- Having trouble cooking meals or ordering from a menu
- Having poor short-term memory (may not recall what he ate for breakfast, for example)
You can help with everyday chores and his safety. Work with him to stop driving and to assure him that someone isn’t trying to take advantage of him financially.
Stage 5: Moderately Severe Decline
During this period, the problems in thinking and reasoning you noticed in stage 4 get more obvious, and new issues appear. Your friend or family member might:
- Have significant confusion
- Lose track of where he is and what time it is
- Be unable to recall simple details about himself such as his own phone number, address or where he went to school
- Have difficulty dressing appropriately
You can help by laying out his clothing in the morning. It can help him dress by himself and keep a sense of independence.
If he repeats the same question, answer with an even, reassuring voice. He might be asking the question less to get an answer and more to just know you’re there.
Even if your loved one can’t remember facts and details, he might still be able to tell a story. Invite him to use his imagination at those times.
Stage 6: Severe Decline
As Alzheimer’s progresses, your loved one might recognize faces but forget names. He might also mistake a person for someone else, for instance, thinking his wife is his mother. Delusions might set in, such as thinking he needs to go to work even though he no longer has a job. He might:
- Be confused or unaware of environment and surroundings
- Have major personality changes and potential behavior problems
- Need assistance with activities of daily living such as toileting and bathing
- Be unable to recognize faces except closest friends and relatives
- Be unable to remember most details of personal history
- Lose bowel and bladder control
It might be hard to talk, but you can still connect with him through the senses, including touch. Many people with Alzheimer’s love hearing music, especially popular music from their youth, being read to, or looking over old photos and movies.
You can find more tips in our article How to Communicate Effectively with Your Elderly Parent.
Stage 7: Very Severe Decline
Many basic abilities in a person with Alzheimer’s, such as eating, walking, and sitting up, fade during this period. You can stay involved by feeding your loved one with soft, easy-to-swallow food, helping him use a spoon, and making sure he drinks. This is important, as many people at this stage can no longer tell when they’re thirsty.
While he may still be able to utter words and phrases, he may have no insight into his condition and need assistance with all activities of daily living. In the final stages of the illness, he may also lose his ability to swallow, ultimately leading to aspiration pneumonia and death.
For a list of just a few of the activities that can bring him a better quality of life, check out our article, What Could Be … Imagine The Possibilities.