As we discussed last week, November is National Alzheimer’s Awareness Month. In our practice, we regularly come across clients or their loved ones who have Alzheimer’s disease with its related dementia symptoms. It is important that we as legal professionals understand Alzheimer’s disease and dementia, since it affects so many of our clients and how we advise them.
It is also important that you understand Alzheimer’s, since it is reported that over 5 million Americans have the disease. You will likely encounter someone with the disease or may even have it yourself.
The Alzheimer’s Association has developed a checklist of common symptoms of Alzheimer’s disease to assist you in recognizing the warning signs:
Memory changes that disrupt daily life.
Challenges in planning and solving problems.
Difficulty completing familiar tasks.
Confusion to time and place.
Trouble understanding visual images and spatial relationships.
New problems with words in speaking or writing.
Misplacing things and losing the ability to retrace steps.
Decreased or poor judgment.
Withdrawal from work or social activities.
Changes in mood or personality.
The progression of Alzheimer’s can vary from person to person. And not everyone will experience the same symptoms. Barry Reisberg, M.D., clinical director of the New York University School of Medicine’s Silberstein Aging and Dementia Research Center has developed a framework that is generally recognized as the seven stages of Alzheimer’s:
Stage 1: No impairment (normal function). The person does not experience any memory problems. An interview with a medical professional does not show any evidence of symptoms of dementia.
Stage 2: Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer’s disease). The person may feel as if he or she is having memory lapses — forgetting familiar words or the location of everyday objects. But no symptoms of dementia can be detected during a medical examination or by friends, family or co-workers.
Stage 3: Mild cognitive decline (early-stage Alzheimer’s can be diagnosed in some, but not all, individuals with these symptoms). Friends, family or co-workers begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration Common stage 3 difficulties include:
• Noticeable problems coming up with the right word or name.
• Trouble remembering names when introduced to new people.
• Having noticeably greater difficulty performing tasks in social or work settings.
• Forgetting material that one has just read.
• Losing or misplacing a valuable object.
• Increasing trouble with planning or organizing.
Stage 4: Moderate cognitive decline (Mild or early-stage Alzheimer’s disease). At this point, a careful medical interview should be able to detect clear-cut symptoms in several areas:
• Forgetfulness of recent events.
• Impaired ability to perform challenging mental arithmetic — for example, counting backward from 100 by 7s.
• Greater difficulty performing complex tasks, such as planning dinner for guests, paying bills or managing finances.
• Forgetfulness about one’s own personal history.
• Becoming moody or withdrawn, especially in socially or mentally challenging situations.
Stage 5: Moderately severe cognitive decline (Moderate or mid-stage Alzheimer’s disease). Gaps in memory and thinking are noticeable, and individuals begin to need help with day-to-day activities. At this stage, those with Alzheimer’s may:
• Be unable to recall their own address or telephone number or the high school or college from which they graduated.
• Become confused about where they are or what day it is.
• Have trouble with less challenging mental arithmetic, such as counting backward from 40 by subtracting 4s or from 20 by 2s.
• Need help choosing proper clothing for the season or the occasion.
• Still remember significant details about themselves and their family.
• Still require no assistance with eating or using the toilet.
Stage 6: Severe cognitive decline (Moderately severe or mid-stage Alzheimer’s disease). Memory continues to worsen, personality changes may take place and individuals need extensive help with daily activities. At this stage, individuals may:
• Lose awareness of recent experiences as well as of their surroundings.
• Remember their own name, but have difficulty with their personal history.
• Distinguish familiar and unfamiliar faces, but have trouble remembering the name of a spouse or caregiver.
• Need help dressing properly and may, without supervision, make mistakes such as putting pajamas over daytime clothes or shoes on the wrong feet.
• Experience major changes in sleep patterns — sleeping during the day and becoming restless at night.
• Need help handling details of toileting.
• Have increasingly frequent trouble controlling their bladder or bowels.
• Experience major personality and behavioral changes, including suspiciousness and delusions (such as believing that their caregiver is an impostor)or compulsive, repetitive behavior like hand-wringing or tissue shredding.
• Tend to wander or become lost.
Stage 7: Very severe cognitive decline (Severe or late-stage Alzheimer’s disease). In the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases. At this stage, individuals need help with much of their daily personal care, including eating or using the toilet. They may also lose the ability to smile, to sit without support and to hold their heads up. Reflexes become abnormal. Muscles grow rigid. Swallowing is impaired.
Because Alzheimer’s affects different persons in different ways, it is difficult to place a person with Alzheimer’s in a specific stage, and stages may overlap. Alzheimer’s generally gets worse over time and is usually fatal. Although there are treatments for symptoms of Alzheimer’s, there currently is no cure.
However, according to the Alzheimer’s Association, current evidence suggests that strategies for general healthy aging may also help reduce the risk of developing Alzheimer’s. And you have probably heard about them before: control your blood pressure, weight and cholesterol; exercise both body and mind; eat a brain-healthy diet which includes fruits and vegetables and stay socially active.
So if you or a loved one shows signs of Alzheimer’s, see a doctor. There are treatment options available.
By: Matthew M. Wallace, CPA JD
Published edited November 2, 2014 in The Times Herald newspaper, Port Huron, Michigan as: Warning signs and stages of Alzheimer’s disease