Joseph R. Anticaglia MD
Medical Advisory Board
Far more than a senior moment, Alzheimer’s disease (AD) is the “Long Goodbye.” The disease is not a part of normal aging. It is a gradual, deadly assault on memory, reasoning and behavior. It cripples a person’s emotional and physical health.
More Americans than ever fear Alzheimer’s disease and for good reason. Once a person is in the grasp of this disease, it relentlessly proceeds towards a mindless, incapacitating ending. There is no cure for it at present and no one is spared the trauma of this disease.
It affects 10% of Americans over the age of 65 and 65% of the cases are women. About 5.5 million Americas in 2017 suffered from Alzheimer’s and numbers are growing at an alarming pace. It’s on a course to bankrupt Medicare and crush families…
Consider the situation of Helen, a 73 y/o lady and former business executive with a university degree in accounting.
Throughout her business career she was praised as being logical, astute and a whiz at mathematics. She was the one who presented the annual business report to the board of directors, outlined the budget for the next fiscal year and was in charge of the accounting department.
About ten years ago she noticed that she was becoming forgetful, but paid little attention to it. It didn’t seem to interfere with her job performance. However, at home, her husband became concerned because she wasn’t sleeping well, misplaced keys in unusual places and over time, began repeating the same stories and accused him of wrongdoing.
At work, she gradually had difficulty communicating with fellow workers and became combative with the staff. Uncharacteristically, she had difficulties with numbers and the quality of her work noticeably declined. Helen was politely urged to retire and thereafter her condition went from bad to worse. Eventually she was totally dependent on others to care for her basic needs.
More than 90% of the cases of AD are late onset, meaning, they occur after the age of 65. Five to ten percent of the cases occurs before 65 years of age and is called early onset Alzheimer’s. For example, people with Down’s syndrome are prone to early onset AD.
It is thought that people with AD have two proteins that pile up in the brain (amyloid plaques and tau tangles) which eventually damage and kill brain cells. Damaged brain cells cause problems with:
- Memory
- Speech
- Thinking — reasoning
- Solving problems
- Focusing on a task
- Judgment
- Emotions and Moods
- Movement
These problems appear at different times and in different combinations. Alzheimer’s disease first attacks the region of the brain where new memories are formed, the hippocampus — temporal lobe. Next the plaques and tangles ruin the speech and language center. After this, damaged brain cells target the frontal part of the brain, the executive center, where thinking and problem solving take place. The disease continues its deadly march of destruction by crippling a person’s emotions, movements and orientation as to time, place and events…
To assist with the understanding and diagnosis of AD, doctors categorize the progression, the spread of this disease into different stages. Classifying Alzheimer’s is arbitrary since the stages can overlap and patients with AD have their own time line as to how the disease progresses
The Long Goodbye Typical Progression of Alzheimer’s disease
| Stage | Average Time Frame |
|---|---|
| Mild | 3 years |
| Moderate | 6 years |
| Severe | 1-2 years |
Five Stages of Alzheimer’s disease
1. Pre-clinical
No behavorial impairment. You are symptom free although image studies, genetic tests and biomarkers may indicate you are at risk for Alzheimer’s. This stage may last for many years, perhaps decades.
2. Mild Cognitive Impairment (MCI)
You continue to have rather normal family and social relationships. You can drive to work and your work performance does not decline in a significant way. But memory lapses come into the picture.
You might occasionally forget what you had for lunch, not remember recent conversations or miss a doctor’s appointment. It’s usually shrugged off as, “This stuff happens. It’s nothing to worry about.” But when other people notice this behavior, many will find it troublesome.
3. Mild Dementia
Here, family and friends are concerned that their loved one is showing signs of serious difficulties with memory, judgment and behavior. It’s in this stage that AD is most commonly diagnosed and the disease interferes with daily activities at home or in work.
People may have trouble planning a family vacation, remembering recent events or have trouble cooking meals. They may make uncharacteristically foolish financial decisions.
Friend’s eyes roll when they hear the same story or the same question repeated again and again. Misplacing valuable objects or not knowing how to return home after shopping become worrisome.
4. Moderate Dementia
In this stage memory, thinking and judgment continue to deteriorate. They need more help with daily activities and self-care. The unfavorable characteristics in stage 3 become more pronounced with worsening confusion and disorientation.
They gradually become more reticent, lose the ability to converse and not understand what is going on around them. They may wander from home and not know how to return. They start to become suspicious and belligerent.
5. Severe Dementia
In this late stage, the individual is a hollow replica of the person she or he once was. They may scream and yell throughout the night and at times become violent.
Incapable of speaking coherently, unable to comprehend conversation, no longer capable of recognizing friends or family members; at this point, people with Alzheimer’s are separated from the real world and sealed off from the heartache experienced by family.
People in this stage of AD revert to the diaper days of infancy. They are totally dependent on others for eating, dressing and other daily necessities, such as showering and washing their genitals. They go back to using adult diapers…
After years of family and friends visiting the loved one suffering from late stage Alzheimer’s, pictures return of the once jovial grandfather, grandmother’s love of reading, the athletic father or delicious holiday dinners prepared by mom.
The pre-clinical and MCI stages of this disease do not always progress to late stage Alzheimer’s. Intense research is on-going to find a cure and prevent AD from moving beyond these early stages. In the meantime, AD families suffer years of anguish and grief trying to navigate through the “Long Goodbye.”
References
Reisberg, B., Ferris, S.H., de Leon, M.J., and Crook, T. The global deterioration scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 1982, 139: 1136-1139.
The Global Deterioration Scale for Assessment of Primary Degenerative Dementia
Stages of Alzheimer’s; Alzheimer’s Association
Mayo Clinic; Alzheimer’s Stages How the Disease Progresses
Anticaglia, Joseph R; Alzheimer’s Disease A Healthcare Tsunami; HC Smart, 2018
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.