When Alzheimer's disease begins to destroy brain cells, no outward symptoms are evident.  After a while, small memory lapses appear and grow more serious.  The afflicted individual may:

• Forget the names of familiar people or places
• Forget the words to express what they want to say
• Forget the location of everyday objects

While some of us experience mild memory losses with aging, people with Alzheimer’s have a more noticeable and rapid decline in memory and other cognitive skills.  If you become concerned about such mental changes in yourself or a loved one, it may be time to consult a physician.

Are people with Alzheimer's aware of their signs and symptoms?

People with Alzheimer's show a range of responses to their own behavior and condition:

• Denial (in the early stages)
• Blames others for making them “look ridiculous”
• Complete self-awareness (“I’m sorry, I have Alzheimer's”)
• Frustration, agitation, rage
• Vacant despair, with no apparent recognition that they were once a different person

By the middle stage of Alzheimer's, most victims no longer are aware that they don’t remember things or aren’t communicating coherently. This is fortunate for them.  In a safe environment with good care and social contact, most Alzheimer’s patients seem relatively free of suffering.  For their friends and relatives it’s a different story: the long steady decline of their loved one is painful to watch.  The demands of Alzheimer’s care also take a toll, over the many years before inevitable death. Depression is more common among the caregivers of Alzheimer's patients than it is among the patients themselves. For a discussion of how caregivers can take care of themselves, see Helpguide’s Support for Caregivers of People with Alzheimer's Disease or Other Dementias.

What are the symptoms of Alzheimer's disease as it progresses?

As the memory lapses of early Alzheimer’s become more serious, other cognitive deficits and behavior problems develop:

• General confusion, disorientation to date, time or place
• Apathy, irritability, depression, anxiety
• Problems with language, math, abstract thinking, and judgment
• Personality changes with strange quirks or inappropriate behaviors
• Wandering, hiding objects, problems with eating and sleeping
• Late in the disease, paranoia and delusions may occur
• Toward the end, total loss of self, and inability to control bodily functions

This list is a summary of major symptoms.  Not all patients have all these symptoms, but it is important to recognize problems early, and get help for them.  The importance of early diagnosis is discussed in Helpguide’s Alzheimer’s: Diagnosis and Risk Factors.

What are the stages of Alzheimer’s disease?

If you or a loved one has received a diagnosis of Alzheimer’s disease, you may be wondering what to expect with the disease as it takes its course.  From the time of diagnosis, a person usually lives from three to twenty years, with an average of eight years.  Various authors have identified anywhere from 3 to 16 stages of the disease, with sub-stages.

It’s helpful when planning for Alzheimer’s care to consider the three main stages.

People vary in the length of time spent in each stage and in which symptoms appear. Because the stages overlap, it is difficult to definitely place a person in a particular stage. However, the progression is always toward a worsening of symptoms.  The stages identify groups of symptoms that reflect more and more brain decay and increasing dependence on caregivers. The end result of Alzheimer's is death, whether caused by the inability of the brain to keep the body going, or by another disease or injury along the way.

What personality changes and cognitive deficits occur?

The focus of early-stage Alzheimer's is cognitive decline. The Alzheimer's sufferer, as well as family, friends, co-workers, and medical practitioners start to notice the changes. Memory and concentration problems are evident and measurable by cognitive tests. Communication issues surface. Changes in personality and a few idiosyncratic behaviors begin to appear. As a result, the person’s performance suffers both at home and at work. The apathy and lack of engagement that is characteristic of all three stages begins here.

Early signs and symptoms could include any of the following.

When Alzheimer’s has been diagnosed early, the loss of abilities is often mild, and with a little help, the individual can continue living independently much as they did before.  In this early stage, some people experience minor physical compensations, such as falling asleep easily, or immunity to colds, but these positive aspects of Alzheimer's are short-lived.  In fact, by the time this condition is diagnosed, some of the problems described above may have already progressed to the point where the individual is already in the middle stage of the disease, needing considerable caregiver support.

No matter what stage the individual is in at the time of diagnosis, apathy is a major problem from the beginning to the very end. More than forty per cent of people in early-stage Alzheimer's show a lack of interest, initiative, and emotional involvement. In the last stage of Alzheimer's, more than ninety per cent of people are apathetic.

What are the behavior problems and physical limitations?

The focus of mid-stage Alzheimer's is a decline in functioning of many body systems at once and steadily increasing dependence on caregivers.  In mid-stage Alzheimer's disease, the cognitive problems of early Alzheimer’s get worse and new ones develop:

• Memory and cognition problems become severe
• Communication becomes warped
• The personality is transformed

The person has a marked change in appearance and hygiene as they become less and less able to take care of themselves:

• Physical problems increase, including problems with voluntary control of the body
• Health declines
• Wandering, aggressiveness, hallucinations, and paranoia appear

This stage is the longest. Those sufferers who are able to recognize their own decline may become suicidal.

The range of problems that may occur include the following.

What further changes lead to the total dependence on others in late-stage Alzheimer's?

The focus of late-stage Alzheimer's is the complete deterioration of the personality.  Cognitive symptoms worsen, and physical symptoms become profound. The loss of brain cells in all parts of the brain leads to lack of functioning in all systems of the body. The wild behaviors of earlier stages disappear, replaced by a dulling of the mind and body.

As the end of life approaches, the Alzheimer’s patient may require around-the-clock care.  It will be necessary for loved ones to decide whether that care can occur at home or in a facility. The guidance of a physician or a hospice team will be needed.

(Information obtained from: http://www.helpguide.org)