Alzheimer's Disease Stages - Dementia Types - Alzheimer's Symptoms

Whole brain atlas -- Scroll to Degenerative Disease : Alzheimer's disease
Keith A. Johnson, Harvard Univ ; J. Alex Becker, Massachusetts Inst Technology

Alzheimer's disease (Pictures scattered on several pages)
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Pathology of Degenerative CNS diseases : Alzheimer's disease
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MEDLINEplus Health Encyclopedia : Alzheimer’s disease
A.D.A.M. / National Library of Medicine

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MEDLINEplus Health Encyclopedia : Alzheimer’s disease : Symptoms
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MEDLINEplus : Alzheimer’s disease : Symptoms / Diagnosis
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Alzheimer's Disease - Stages of Dementia

By the Alzheimer's Association

Use your browsers back button to navigate this "Stages of Dementia" menu.

Stage 1: No impairment
Stage 2: Very mild decline
Stage 3: Mild decline
Stage 4: Moderate decline (mild or early stage Alzheimer's Disease)
Stage 5: Moderately severe decline (moderate or mid-stage Alzheimer's Disease)
Stage 6: Severe decline (moderately severe or mid-stage Alzheimer's Disease)
Stage 7: Very severe decline (severe or late stage Alzheimer's Disease)
Alzheimer's Related Resources

Experts have documented common patterns of symptom progression that occur in many individuals with Alzheimer’s disease and developed several methods of “staging” based on these patterns. Progression of symptoms corresponds in a general way to the underlying nerve cell degeneration that takes place in Alzheimer’s disease. Nerve cell damage typically begins with cells involved in learning and memory and gradually spreads to cells that control every aspect of thinking, judgment, and behavior. The damage eventually affects cells that control and coordinate movement.

Staging systems provide useful frames of reference for understanding how the disease may unfold and for making future plans. But it is important to note that all stages are artificial benchmarks in a continuous process that can vary greatly from one person to another. Not everyone will experience every symptom and symptoms may occur at different times in different individuals. People with Alzheimer’s live an average of 8 years after diagnosis, but may survive anywhere from 3 to 20 years.

The framework for this section is a system that outlines key symptoms characterizing seven stages ranging from unimpaired function to very severe cognitive decline.

Within this framework, we have noted which stages correspond to the widely used concepts of mild, moderate, moderately severe, and severe Alzheimer’s disease. We have also noted which stages fall within the more general divisions of early-stage, mid-stage, and late-stage categories.

Stage 1: No cognitive impairment

Unimpaired individuals experience no memory problems and none are evident to a health care professional during a medical interview.

Stage 2: Very mild cognitive decline

Individuals at this stage feel as if they have memory lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses, or other everyday objects. But these problems are not evident during a medical examination or apparent to 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 deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include:

Word- or name-finding problems noticeable to family or close associates
Decreased ability to remember names when introduced to new people
Performance issues in social or work settings noticeable to family, friends, or co-workers
Reading a passage and retaining little material
Losing or misplacing a valuable object
Decline in ability to plan or organize

Stage 4:Moderate cognitive decline (Mild or early-stage Alzheimer's disease)

At this stage, a careful medical interview detects clear-cut deficiencies in the following areas:

Decreased knowledge of recent occasions or current events
Impaired ability to perform challenging mental arithmetic-for example, to count backward from 100 by 7s
Decreased capacity to perform complex tasks, such as marketing, planning dinner for guests, or paying bills and managing finances
Reduced memory of personal history
The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations

Stage 5:Moderately severe cognitive decline (Moderate or mid-stage Alzheimer's disease)

Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage, individuals may:

Be unable during a medical interview to recall such important details as their current address, their telephone number, or the name of the college or high school from which they graduated
Become confused about where they are or about the date, day of the week, or season
Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s
Need help choosing proper clothing for the season or the occasion
Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children
Usually require no assistance with eating or using the toilet

Stage 6:Severe cognitive decline (Moderately severe or mid-stage Alzheimer's disease)

Memory difficulties continue to worsen, significant personality changes may emerge, and affected individuals need extensive help with customary daily activities. At this stage, individuals may:

Lose most awareness of recent experiences and events as well as of their surroundings
Recollect their personal history imperfectly, although they generally recall their own name
Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces
Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet
Experience disruption of their normal sleep/waking cycle
Need help with handling details of toileting (flushing toilet, wiping, and disposing of tissue properly)
Have increasing episodes of urinary or fecal incontinence
Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions (for example, believing that their caregiver is an impostor); hallucinations (seeing or hearing things that are not really there); or compulsive, repetitive behaviors such as hand-wringing or tissue shredding
Tend to wander and become lost

Stage 7: Very severe cognitive decline (Severe or late-stage Alzheimer's disease)

This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak, and, ultimately, the ability to control movement.

Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered
Individuals need help with eating and toileting and there is general incontinence of urine
Individuals lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid. Swallowing is impaired.

Alzheimer's Related resources

Alzheimer's Disease Basic Facts and Statistics

Studies Emphasize New Risk Factor for Dementia & Alzhiemer's

By Allen S. Josephs, M.D.

My job as a neurologist can, at times, be very trying. When a patient in the hospital suffers a major cardiovascular event and loses blood and oxygen to the brain, it is the neurologist who typically has to tell the family that there is irreversible brain damage, and that their loved one will never awaken again. At other times, I have the heartbreaking task of informing a patient that they have a malignant brain tumor or other devastating neurological illness that will take their lives. Fortunately, these situations do not come up very often. However, what I do diagnose on a more a regular basis is new-onset dementia. It seems like every couple of days in the office, I am seeing a new patient who is usually brought in by their family because of difficulties with thinking. Unfortunately, the medical treatment for dementia, even as we approach the year 2005, is dismal, at best.

In recent years, there has been increasing data in the medical literature suggesting that elevations in homocysteine are associated with cognitive impairment. I came across an interesting article in the November-December 2004 issue of the American Journal of Geriatric Psychiatry. This study, out of the Tufts-New England Medical Center, studied the relationship between homocysteine, folic acid, and vitamin B12, along with Magnetic Resonance Imaging (MRI) of the brain. It was found that those patients with the highest homocysteine levels were found to have abnormalities on their MRI known as white matter hyperintensities, which we frequently see in dementing patients. In addition, lower levels of folic acid were associated with abnormalities in two important structures in the brain known as the hippocampus and amygdala.

In another study, published in the Journal of Neurological Science, November 2004, researchers out of Australia found that higher homocysteine levels were related to an increased number of strokes and greater cognitive impairment, along with general brain atrophy. This study also showed that elevations of homocysteine increased the white matter hyperintensities as seen in the previously noted study. The author of the study concluded that homocysteine increases the risk of micro and macro vascular disease, as well as brain atrophy, and therefore, impaired cognition. The author indicated that remediation, or relieving, of high homocysteine levels should begin early in life.

In another recent study from Italy, researchers studied the relationship of homocysteine to specific cognitive abilities during normal aging. Sixty-two healthy and cognitively normal subjects between the ages of 65 and 91 years old were recruited. It was found that in healthy, elderly subjects, increased homocysteine levels were correlated to poor performance in specific levels of language ability. The author indicated that the study suggested that homocysteine could be an early marker for future cognitive impairment. Numerous other studies have indicated that elevated homocysteine and low levels of B vitamins accelerate atherosclerosis, the narrowing of the arteries, and increase the risk of heart attack and stroke.

I have an adage that I have been preaching to my patients for many years: The best way to treat a chronic illness is to prevent it. For those of you who know a family or friend who has a dementing illness, such as Alzheimer's disease or a similar type of condition, you know how devastating this can be. For those of you are fortunate enough not to have been exposed to anyone like this, imagine losing the ability to do everyday tasks, such as writing a check, taking a shower, heating something up in a microwave, or even just putting on a shirt. Dementing illnesses rob you of your very being. In the later stages of Alzheimer's disease, patients will typically not recognize family members, and will function at an infant-like stage, becoming incontinent, as well as being unable to feed themselves or function at any reasonable level. I feel worse for the family members than I do the patients with Alzheimer's at later stages, as the afflicted individuals have no apparent understanding of what has happened to them. However, for the caregivers, it is a 24/7 nightmare that only gets worse with time.

These are chilling words meant to call all of you to action. Elevations of homocysteine can be easily treated with a combination of daily, optimal dosages of vitamin B6 (50 - 100 mg), B12 (500 mcg - 5,000 mcg of the methylcobalamin form) and folic acid (800 mcg - 4 mg) . Some people may require adding trimethylglycine (500 mg - 6,000 mg), N-acetyl cysteine (600 mg) , and the amino acid SAM-e (400 - 800 mg) to achieve desired homocysteine levels of 7 or less. The Nutraceutical Sciences Institute (NSI) Synergy line of products, which are formulated by medical doctors, all contain excellent forms and doses of B vitamins that are the first step to promoting healthy homocysteine levels. Bear in mind, your typical multi-vitamin has the wrong form of B12 and only pitiful amounts of these critically important B vitamins. It is important to point out that the form of B12 NSI is using in its capsules is the active form of B12, and it achieves blood levels similar to B12 injections, without the need for sublingual dosing or injections. While NSI offers trimethylglycine, SAM-e, and N-acetyl cysteine as stand-alone products, they are also available in some of the more elaborate Synergy formulas, such as Synergy Supreme. Further, NSI has a breakthrough superior, medical doctor-formulated product called "Homocysteine Formula" that can be taken as a stand-alone or added to your current multi-vitamin. I've said this before and I will say it again now: If you have never had your homocysteine level checked, now is the time. Homocysteine levels are more important than your cholesterol level, and should be monitored as or more frequently. Aim low: a level of 7 or less is ideal, but many people have much higher than the ideal!

Remember: The best way to treat a chronic illness is to prevent it!

Cognitive Decline Delayed by Fish Oils

By HealthDay News 4-10-2007

Omega-3 fatty acids from fish may help prevent age-related cognitive decline, according to two new studies.

In one study, Dutch researchers examined the diet and cognitive function of 210 men, ages 70 to 89, who did not have Alzheimer's disease. The men were assessed in 1990 and again in 1995.

The researchers concluded that consumption of approximately 400 milligrams of omega-3 fatty acids per day (equivalent to eating six servings of lean fish per week or one serving of fatty fish per week) protects against cognitive decline.

In the other study, American researchers looked at omega-3 consumption and cognitive decline in 2,251 white males, ages 50 to 65, who were initially assessed between 1987 and 1989. The men were checked again three and nine years later.

The study found no association between baseline levels of omega-3 fatty acids in the men and overall cognitive decline. However, an analysis of specific types of cognitive decline did find that higher levels of omega-3 fatty acids were associated with protection against loss of verbal fluency.

This association was particularly strong in men with high blood pressure and dyslipidemia (disruption in the amount of lipids in the blood) but was not evident in men with major depression.

The studies were published in this month's American Journal of Clinical Nutrition. The authors of an accompanying editorial recommended that clinical trials be conducted to determine the effect of dietary fish, fish oil or both in elderly people at risk of cognitive decline and Alzheimer's disease.

Curcumin, the active constituent of the curry spice, turmeric, inhibits Alzheimers

"Curcumin has been used for thousands of years as a safe anti-inflammatory in a variety of ailments as part of Indian traditional medicine," Cole said. Recent animal studies "support a growing interest in its possible use for diseases of aging involving oxidative damage and inflammation like Alzheimer's, cancer and heart disease." Continue

Homocysteine and B vitamins relate to brain volume and white-matter changes in geriatric patients with psychiatric disorders

Elevated homocysteine and low folate were associated with radiological markers of neuropathology. Since no patient had clinically deficient folate, it may be important to rethink what defines functionally significant micronutrient deficiency and explore what this means in different age- and health-status groups.

Am J Geriatr Psychiatry. 2004 Nov-Dec

Can cognitive deterioration associated with Down syndrome be reduced?

This paper suggests that essential nutrients such as folate, vitamin B6, vitamin C, vitamin E, selenium, and zinc, as well as alpha-lipoic acid and carnosine may be partially preventive. Continue

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