INTRODUCITON

Dementia is a syndrome consisting of a number of symptoms that include loss of memory, judgment and reasoning, and changes in mood and behaviour. These symptoms may affect a person's ability to function at work, in social relationships or in day-to-day activities. Sometimes dementia-like symptoms can be caused by conditions that may be treatable, such as depression, thyroid disease, infections or drug interactions. However, if the symptoms are not treatable and progress over time, they may be due to damage to the nerve cells in the brain. A person should seek a thorough medical assessment if any of these symptoms are present.

Alzheimer's disease, the most common form of dementia, accounts for 64% of all dementias in Canada. The features of Alzheimer's disease include a gradual onset and continuing decline of memory, as well as changes in judgment or reasoning, and inability to perform familiar tasks.

Alzheimer's disease is a progressive, degenerative disease that destroys vital brain cells. As each area of the brain is affected, certain functions or abilities can be lost.  The losses affect the individual's ability to think, to remember, to understand and to make decisions. In addition to affecting a person's mental abilities, Alzheimer's disease affects moods and emotions. Along with loss of abilities, changes in behaviour occur. Gradually, independence disappears.

APPROACH TO CARE

It is important to remember that the approach to care can enhance the individual's quality of life. The Alzheimer Society developed the Guidelines for Care to ensure that people with Alzheimer's disease receive the special type of care that reflects the unique nature of the disease.

A person-centred approach to care recognizes that each individual deserves to be treated with dignity and respect. By understanding the person's personality, life experiences, support systems and ways of coping, the individual's physical, social, emotional and spiritual needs can be met. 

Although the person loses many abilities as the disease progresses, it is helpful to focus on the abilities that do remain, such as the senses of touch and hearing, and the ability to respond to emotion.

DURATION OF THE DISEASE

The progression of Alzheimer's disease varies from person to person and can span three to twenty years (the average length of the disease is between eight and twelve years). The progression can be described as a series of stages, providing a guide to the pattern of the disease, which can help when making care decisions.

On staging system explains the disease in three stages: early, middle and late. Another staging system, often used by medical professionals, is the Global Deterioration Scale (also called the Reisberg Scale). This scale divides the disease into seven stages.

Whichever staging system is used, or if none is used, it's important to remember that the disease affects each person differently. The order in which the symptoms appear and the length of each stage will vary from person to person. There is no clear line when one stage ends and another begins. In many cases, stages will overlap.  Some people experience many of the symptoms in each stage, while others experience only a few. There may be fluctuations from day to day with a person appearing more confused one day, and less so another.

THREE STAGES OF ALZHEIMER'S DISEASE

1. Early Stage
A person in this stage will usually be aware of the diagnosis and will be able to participate in decisions affecting future care. Symptoms can include mild forgetfulness and communication difficulties, such as finding the right word and following a conversation. Some people stay involved in activities while others become passive or withdrawn. The individual may also be frustrated by changing abilities and may become depressed or anxious.  It is important to monitor the emotional well-being of the person.

2. Middle stage
This stage brings a further decline in the person's mental and physical abilities. Memory will continue to deteriorate as the person forgets personal history and no longer recognizes family and friends. Increased confusion and disorientation to time and place will result in requiring assistance in many daily tasks, such as dressing, bathing, using the toilet.

In this stage, some people become restless and pace or wander. Registering the person with the Alzheimer Wandering Registry will provide peace of mind should he/she become lost. In response to the loss of abilities, a person may react in a number of ways. For example, he or she may become less involved in activities or repeat the same action or word over and over again. It can be helpful to understand more about the disease and develop strategies to deal with these situations. Your local Alzheimer Society can provide education, resources and support.

3. Late stage
In this last stage, the person becomes unable to remember, communicate or look after him/herself. Care is required 24 hours a day. Eventually, the person will become bed-ridden, have difficulty eating or swallowing, and lose control of bodily functions. This stage eventually ends with the person's death, often from secondary complications such as pneumonia. 

The Global Deterioration Scale (GDS)

Some health-care professionals use the Global Deterioration Scale, also called the Reisberg Scale, to measure progression of Alzheimer's disease. The scale divides Alzheimer's disease into seven stages of decreasing ability.

Modified from Global Deterioration Scale, Reisberg, 1982.