Alzheimer’s Disease (AD), the most common form of dementia, affects more than 5 million people in the United States today, and that number is climbing. Alzheimer’s is the sixth leading cause of death in the US, and the fifth leading cause of death for those 65 years of age and older. Unfortunately, there is currently no discovery on how to prevent or cure AD.
AD is caused by the development of plaques (beta-amyloid peptides) and tangles (altered tau proteins) on neurons in the brain, affecting communication between the neurons and causing progressive changes in brain function which eventually leads to shrinkage of the brain tissue and brain cell death. As the disease process advances, damage to areas of the brain controlling learning, memory, thinking and planning occurs in the early to mid-stages. In the later stages, the deterioration progresses to the other areas of the brain, resulting in a total loss of function in all systems of the body, which eventually leads to death.
There are three general stages of AD – the early (mild) stage, the middle (moderate) stage and the late (severe) stage. In the early stages, one will begin to experience some mild to moderate decline in memory and concentration, such as forgetting names and words, misplacing things in strange places, difficulty with making decisions, planning, logic and problem-solving, and getting lost in familiar places. Many will also have difficulties communicating and expressing themselves or comprehending written or spoken language. Personality changes may become noticeable—they may become easily agitated or frustrated, more irritable and anxious. Some will develop apathy or a “lack of filter” and become insensitive to others feelings—blurting out hurtful or inappropriate comments. Some develop strange behaviors such as hoarding, forgetting to eat/eating constantly or using objects for things other than their intended purpose.
In the middle stages, the declines seen in the early stages continue to progress and become more debilitating. They also develop new cognitive problems and difficult behaviors such as wandering, aggressiveness, hallucinations, paranoia, compulsiveness and depression. Repetitive behaviors and changes in sleeping patterns are also common. Some may become incontinent of bowel or bladder, at times. The behaviors tend to increase in the late afternoon or early evening, which is called “sundowning”. Their dependence on their caregivers increases, and with this stage being the longest and the most challenging, caregiver strain is also a common issue. The majority of our residents in Journeys are in this stage.
The late stage is the final stage of the process. We often see a complete deterioration of the personality, ability to communicate, and bodily function. They will lose all ability to care for themselves and require total dependence on caregivers. They will often not recognize family or friends, become unable to communicate their needs, and eventually lose the ability to perform even the most basic bodily functions and mental abilities. The wild behaviors seen in the middle stage disappear as the mind and body dull. They may lose the ability to walk, talk, feed themselves, or become bedridden. Their overall health will begin to decline and, at this point, the body begins to shut down. Many will become unresponsive to their environment, stop eating or drinking and sleep much of the time until death occurs.
Risk factors associated with AD include advanced age, family history of Alzheimer’s and genetics, high blood pressure, high cholesterol, smoking, depression, diabetes, obesity and excessive alcohol intake. Diets with increased amounts of high-fat dairy like butter, red meat, and organ meats may increase the risk of AD.
Research continues for preventative measures and for a cure. In the meantime, there are support services available for those suffering from AD, their families and loved ones, and for their caregivers. The Alzheimer’s Association, www.alz.org, is an excellent, reliable resource for information and advice, current research, and can assist with locating support services in your area.
At Journeys, we work diligently to make an undesirable situation better for residents, family and friends. Alzheimer’s may be the diagnosis, but we want to be the support.
Contributed By: Heather Armstead (Journeys Neighborhood MDS Coordinator)
Alzheimer’s Disease and Related Disorders: Handle With Care. Jennifer Moore RN-BC, DNS-CT for Relias Learning 2015
Dementia Care-Managing Challenging Behaviors. Cheryl Swann RN-BC, BSN, WCC, LHNA for Relias Learning 2016
Nutritional Interventions for Alzheimer’s Disease. Mary Litchford PhD, RD, LDN for Relias Learning 2016