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Stages of Alzheimer’s Disease

Stages of Alzheimer’s Disease

Dementias

“Memories are the threads that weave the fabric of our lives, shaping who we are and who we become.” – Elizabeth Loftus

    Stages of Alzheimer’s Disease

    Alzheimer’s disease is a complex condition that affects millions of individuals worldwide, impacting not only those diagnosed but also their families and caregivers. Understanding the progression of Alzheimer’s is crucial for providing appropriate care and support at each stage of the disease. In this article, we’ll explore the seven stages of Alzheimer’s Disease, highlighting the areas of the brain affected, common symptoms experienced, and available treatments for each stage.

    Stage 1 – No Impairment

    Area of the Brain: No noticeable changes.

    Symptoms: No memory problems or cognitive decline.

    Treatments: Focus on maintaining a healthy lifestyle, including regular exercise, a balanced diet, and mental stimulation.

    Stage 2 – Very Mild Decline

    Working Memory

    Working Memory

    Do you find it challenging to remember things you just learned or heard? This could be a sign of dementia.

    More Examples

    Area of the Brain: Minimal changes, primarily in the hippocampus.

    Symptoms: Occasional forgetfulness, such as misplacing keys or forgetting names.

    Treatments: Continued emphasis on lifestyle factors, along with memory aids and cognitive exercises.

    Stage 3 – Mild Decline

    Slower Retrieval and Rapid Forgetting

    Slower Retrieval and Rapid Forgetting

    Finding it takes longer to recall information, and forgetting things more quickly.

    More Examples

    Immediate Recall Difficulty

    Immediate Recall Difficulty

    Struggling to remember information right after learning it.

    More Examples

    Area of the Brain: Further deterioration in the hippocampus and other regions involved in memory and learning.

    Symptoms: Noticeable memory lapses, difficulty finding the right words, and challenges with planning and organization.

    Treatments: Introduction of medications such as cholinesterase inhibitors to help manage cognitive symptoms, along with support from caregivers and memory care programs.

    Stage 4 – Moderate Decline

    Prospective Memory Challenges

    Prospective Memory Challenges

    Difficulty remembering to perform tasks in the future without external reminders.

    More Examples

    Episodic Memory

    Episodic Memory

    Trouble remembering specific events or experiences from your past.

    More Examples

    Area of the Brain: Significant damage in multiple brain regions, including the frontal and temporal lobes.

    Symptoms: Increased memory loss, difficulty performing tasks independently, mood swings, and confusion about time and place.

    Treatments: Additional medications, such as memantine, may be prescribed to manage cognitive symptoms. Occupational therapy and support services become more important for daily functioning.

    Stage 5 – Moderately Severe Decline

    Autobiographical Memory Changes

    Autobiographical Memory Changes

    Memories across your lifespan become less detailed and more vague.

    More Examples

    Area of the Brain: Extensive damage throughout the brain, affecting communication between neurons.

    Symptoms: Severe memory impairment, inability to recall personal details, challenges with basic activities of daily living, and behavioral changes.

    Treatments: Intensive support from caregivers, including assistance with personal care and supervision. Behavioral interventions and communication strategies are crucial.

    Stage 7 – Very Severe Decline

    Area of the Brain: Severe neuronal loss and widespread brain damage, resulting in complete dependence on others for care.

    Symptoms: Loss of verbal communication, minimal responsiveness, and severe physical impairment.

    Treatments: End-of-life care focuses on comfort and dignity, with a focus on pain management and emotional support for both the individual and their loved ones.

    Stage 6 – Severe Decline

    Area of the Brain: Severe atrophy and damage in all brain regions, leading to profound cognitive and physical decline.

    Symptoms: Loss of awareness of surroundings, difficulty recognizing familiar faces, incontinence, and limited mobility.

    Treatments: Palliative care focuses on maximizing comfort and quality of life. Supportive therapies, such as music and art therapy, can provide comfort and stimulation.

    Bottom Line:

    Understanding the stages of Alzheimer’s disease is essential for navigating the challenges and providing appropriate care and support throughout the journey. While there is currently no cure for Alzheimer’s, early diagnosis and intervention can help manage symptoms and improve quality of life for individuals and their families. With ongoing research and advancements in treatment, there is hope for a future where Alzheimer’s is more effectively managed and ultimately cured.

    Warning Signs of Dementia

    Warning Signs of Dementia

    Dementias

    “Memory is the diary that we all carry about with us.” – Oscar Wilde

    Warning Signs of Dementia

    Memory changes as we age can be unsettling, leaving many of us wondering if what we’re experiencing is just a normal part of getting older or something more serious, like dementia. It’s important to recognize that there’s a subtle overlap between age-related memory changes and the warning signs of dementia. In this article, we’ll explore these warning signs in a way that’s easy to understand.

    Consider the following symptoms of Dementia: 

    Working Memory

    Working Memory

    Do you find it challenging to remember things you just learned or heard? This could be a sign of dementia.

    More Examples

    Episodic Memory

    Episodic Memory

    Trouble remembering specific events or experiences from your past.

    More Examples

    Immediate Recall Difficulty

    Immediate Recall Difficulty

    Struggling to remember information right after learning it.

    More Examples

    Slower Retrieval and Rapid Forgetting

    Slower Retrieval and Rapid Forgetting

    Finding it takes longer to recall information, and forgetting things more quickly.

    More Examples

    Prospective Memory Challenges

    Prospective Memory Challenges

    Difficulty remembering to perform tasks in the future without external reminders.

    More Examples

    Autobiographical Memory Changes

    Autobiographical Memory Changes

    Memories across your lifespan become less detailed and more vague.

    More Examples

    What can ‘offset’ these changes or help you cope with them?

    Intelligence, expertise, and using compensatory strategies can help cope with memory changes.

    Examples: 

    • Using tools like calendars or setting reminders on your phone to help remember important dates or tasks.
    • Using mnemonic devices to remember important information.
    • Writing notes to yourself to remember tasks or appointments.
    • Creating a daily routine to help remember daily tasks and activities

    Note: Memory specialists are trained with information that greatly exceeds these very simple everyday strategies found on the internet. Clinical oversight is recommended if you feel some of these symptoms have described you. 

     

    Bottom Line:

    If you or a loved one are experiencing these warning signs of dementia, it’s essential to seek help from a local memory specialist. While it can be challenging to confront these changes, getting an evaluation and discussing options early on can lead to better outcomes and quality of life. Remember, you’re not alone, and there are resources available to support you through this journey.

    References

    Baddeley, A. D., Kopelman, M. D., & Wilson, B. A. (2004). The essential handbook of memory disorders for clinicians. Chichester, West Sussex, England ;: J. Wiley.

    Cohen, C., Culver, C., Gomberg, D., Magai, C., & Malatesta, C. (1996). Emotional Expression During Mid- to Late-Stage Dementia. International psychogeriatrics, 8(3), 383-395. doi:10.1017/S104161029600275X

    Early Signs of Dementia in Women

    Early Signs of Dementia in Women

    Dementias

    “Memory is the treasure house of the mind wherein the monuments thereof are kept and preserved”.  Thomas Fuller

    Early signs of dementia in women:

    Early: This refers to the beginning stages or the initial phase of something. In the context of “early signs of dementia,” it means recognizing symptoms at an early stage before they become more severe or noticeable.

    Signs: Signs are indications or signals that suggest something is happening or present. In this case, “early signs” of dementia are the first noticeable changes or behaviors that may indicate the presence of dementia.

    Dementia: Dementia is a general term used to describe a decline in cognitive function (thinking, memory, and reasoning) severe enough to interfere with daily life. It is not a specific disease but rather a set of symptoms associated with various underlying causes.

    Introduction

    You may have heard that more women than men show early signs of dementia, but let’s set the record straight. Recent studies suggest there’s not enough evidence to support this claim. So, if you’re a woman, don’t fret – your risk of dementia isn’t higher just because of your gender (Beam et al., 2018).

    Understanding early signs of dementia in women isn’t easy. Dementia affects everyone differently, no matter their gender, but let’s try to develop our understanding of it!

    The Facts:

    Let’s start by looking at what recent studies tell us about dementia and its risk factors.

    According to Neergaard et al. (2016), there are certain things we can’t change (non-modifiable risk factors), like getting older and genetics that might make us more likely to develop dementia.

    There are other things we can change (modifiable risk factors), like how much we exercise, nutrition, chronic stress, sleep, and whether we smoke that play a big role in whether or not we begin experiencing early signs of dementia. Norton et al. (2014) found that things like not exercising enough and smoking could make us more likely to get dementia.

    Surprisingly, Neergaard et al. (2016) discovered that being a bit overweight when we’re older might not matter as much as we thought! Being obese doesn’t seem to make much of a difference according to the evidence. So, it’s not just about being thin or fat – it’s more complicated than that!

    Sex Differences in Early Symptoms:

    Now, let’s talk about the early signs of dementia and whether they’re different for women and men.

    In a study by Edahiro et al. (2023), they found that women with early-onset dementia were more likely to have trouble with their memory. Men, on the other hand, were more likely to feel irritable.

    Mendez (2012) also discovered that the first signs of dementia might not always be about forgetting things. Sometimes, they can be about having trouble with things like seeing things around us and paying attention.

    The most common symptoms of early-onset dementia across gender are as follows:

      1. Loss of memory (Edahiro et al., 2023)
      2. Difficulty in word generation (Edahiro et al., 2023)
      3. Loss of motivation (Edahiro et al., 2023)
      4. Increased mistakes in the workplace or domestically (Edahiro et al., 2023)
      5. Unusual behaviors or attitudes (Edahiro et al., 2023)
      6. Visuo-spatial dysfunction (Mendez, 2012)
      7. Executive dysfunction (Mendez, 2012)
      8. Attention impairment (Mendez, 2012)

    What can you do?

    Stay physically active: Engage in regular physical activity, such as walking, swimming, or dancing, to promote brain health and reduce the risk of dementia

    Manage depression: Seek support and treatment for depression if needed, as depression has been identified as a potential risk factor for dementia

    Stay mentally active: Keep your brain stimulated by engaging in activities that challenge your cognitive abilities, such as puzzles, reading, learning new skills, or socializing with others

    Monitor and manage other health conditions: Take steps to manage other health conditions that may increase the risk of dementia, such as diabetes, hypertension, and smoking

    Be mindful of early signs: Pay attention to any changes in memory, cognition, or behavior, and seek medical advice if you notice any concerning symptoms. Early detection and intervention can be crucial in managing dementia

    Bottom Line:

    So, what’s the bottom line? Even though some studies say women might show early signs of dementia more than men, it’s not necessarily the case. That said, there are some gender differences like women being more likely to experience memory difficulties in the early stages of dementia than men.  Dementia is a complicated thing, and lots of factors can play a part in whether we get it or not.

    I will forever tell everyone I know that there is no harm in seeking functional oversight of your cognition! Find a board-certified medical professional trained in memory, cognition, and neurological-based pathologies to evaluate you. This will allow you to remain in control of your brain health and manage modifiable risk factors.

    References

    Beam, C. R., Kaneshiro, C., Jang, J. Y., Reynolds, C. A., Pedersen, N. L., & Gatz, M. (2018). Differences Between Women and Men in Incidence Rates of Dementia and Alzheimer’s Disease. J Alzheimers Dis, 64(4), 1077-1083. doi:10.3233/jad-180141

    Edahiro, A., Okamura, T., Arai, T., Ikeuchi, T., Ikeda, M., Utsumi, K., . . . Awata, S. (2023). Initial symptoms of early‐onset dementia in Japan: nationwide survey. Psychogeriatrics, 23(3), 422-433. doi:10.1111/psyg.12949

    Fitzpatrick, A. L., Kuller, L. H., Lopez, O. L., Diehr, P., O’Meara, E. S., Longstreth, W. T., Jr., & Luchsinger, J. A. (2009). Midlife and late-life obesity and the risk of dementia: cardiovascular health study. Arch Neurol, 66(3), 336-342. doi:10.1001/archneurol.2008.582

    Mendez, M. F. (2012). Early-onset Alzheimer’s disease: nonamnestic subtypes and type 2 AD. Arch Med Res, 43(8), 677-685. doi:10.1016/j.arcmed.2012.11.009

    Neergaard, J. S., Dragsbæk, K., Hansen, H. B., Henriksen, K., Christiansen, C., & Karsdal, M. A. (2016). Late-Life Risk Factors for All-Cause Dementia and Differential Dementia Diagnoses in Women: A Prospective Cohort Study. Medicine, 95(11). Retrieved from https://journals.lww.com/md-journal/fulltext/2016/03150/late_life_risk_factors_for_all_cause_dementia_and.64.aspx

    Norton, S., Matthews, F. E., Barnes, D. E., Yaffe, K., & Brayne, C. (2014). Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurol, 13(8), 788-794. doi:10.1016/s1474-4422(14)70136-x

    Lewy Body Dementia and Rehabilitation

    Lewy Body Dementia and Rehabilitation

    Conditions We Treat, Dementias, Neurological Rehabilitation

    Lewy Body Dementia 

    Schedule an appointment to establish care
    Learn more about Lewy Body Dementia
    Lewy Body Dementia LBD Explain Lewy Body Proteins

    Lewy Body Dementia is a condition that looks different for each person, but the way the disease works in the brain, known as pathogenesis, follows the same general pattern. Some specialized physical, occupational, and speech therapists are trained in understanding how the disease spreads through the brain and how it impacts different functions over time. These changes are specific to Lewy Body Dementia, making your journey with LBD different from someone with Alzheimer’s, frontotemporal dementia, or Parkinson’s.

    If you’ve been diagnosed with LBD, it’s important to start building your long-term management team. While you won’t need therapy or medical appointments all the time, you will benefit from having periods of therapy when changes in your body or function start to appear. Having someone to contact when these changes happen ensures you can get the right support at the right time. Early diagnosis and intervention are key to maintaining as much independence and function as possible throughout the course of the disease.

    What is Lewy Body Dementia?

    Lewy Body Dementia (LBD) is the second most prevalent progressive neurodegenerative diagnosis causing dementia. It is second to Alzheimer’s disease (AD), but differs in many ways. It is signified by lewy body proteins that appear in various parts of your brain affecting thinking, functional activities, judgement, executive function, functions of the autonomic nervous system, and mobility.

    The Lewy Body Association  has more information regarding the difference between Alzheimer’s Disease (AD) and Lewy Body Disease (LBD).

    Learn more about Lewy Body Dementia
    Schedule an appointment to establish care

    What do I do if I’ve been diagnosed with Lewy Body Dementia (LBD)?

    After receiving an LBD diagnosis, it is important to establish a long-term therapy team including occupational therapy, speech therapy, and physical therapy familiar with the progression of this diagnosis. By establishing a small therapy team that will be able to remain with you throughout the stages of Lewy Body Dementia, you will be able to maximize your physical function, maintain your performance in functional activities, and ensure you remain in control of your symptoms instead of the other way around.

    Schedule an appointment to establish care

    Symptoms of Lewy Body Dementia

    • Runny Nose
    • Visual hallucinations (detailed)
    • Delusions 
    • Agitation and frustration
    • Difficulty multi-tasking or remaining on task 
    • Information processing difficulties 
    • Stooped posture (similar to Parkinson’s disease)
    • Overall movements and mobility slowing down
    • Balance and coordination decline 
    • Walking turns into a ‘shuffle’ 
    • Voice becomes more quiet 

    For more symptoms of Lewy Body Dementia, head to Alzheimer’s Association. 

    What are my options after receiving an LBD diagnosis?

    Although there are neurocognitive enhancement medications, one of the most important things you can do for yourself is to seek out a team of therapists as early as possible. With the right early intervention strategies you can improve your symptoms and/or control the speed at which you experience decline.

    What type of intervention is used by a neuro-centered rehabilitation team?

    Learn more about Lewy Body Dementia
    Schedule an appointment to establish care

    How can outpatient occupational therapy help after a dementia diagnosis?

    • Once given a dementia diagnosis, we can ‘stage’ your dementia progression through specific screens and assessments so that you always feel in control of your circumstances.
    • Make recommendations for adaptive equipment, durable medical equipment, and mobility aids throughout each stage
    • Provide a hybrid approach to rehabilitation and maintenance grounded in neurocentric principles offering you an inclusive rehab program.

    Early Memory Loss and Confusion

    Early Memory Loss and Confusion

    Conditions We Treat, Dementias, Neurological Rehabilitation, Progressive Neurological Diseases

    Early Memory Loss and Confusion

    Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.

    Symptoms of Early Memory Loss and Confusion You Should Take Seriously

    If you are experiencing signs and symptoms of early memory loss, it is important to take them seriously. Although there are a variety of factors why you would be having difficulty remembering information, any brain changes should be a concern.

    Some symptoms of early memory changes include:

    • Word-finding difficulties to items you should know 
    • Forgetting details of what was said in a conversation or phone call that took place less than 10 minutes ago
    • Frequently forgetting why you entered a room (more than 3 times a day) 
    • Getting lost when driving to locations you have frequently visited 
    • Personality changes (lethargic, increased desire to be alone, irritable, short-tempered)
    • Sleeping more
    • Harder time managing finances and appointments
    • Increasing difficulty managing tasks you are used to managing (multi-tasking) 
    • Work performance is being affected at your place of employment

    Causes of Early Memory Loss and Confusion

    • Stress
    • Alcohol and Drugs Misuse
    • Anxiety and Depression
    • Prescription side-effects
    • Neurodegenerative Illness
    • Stroke
    • Traumatic Brain Injury 
    • Oxygen Loss
    • Brain Infections

    Neurodegenerative Illnesses

    • Alzheimer’s disease
    • Vascular cognitive impairment
    • Dementia with Lewy bodies 
    • Stroke
    • Frontotemporal dementia
    • Parkinson’s disease
    • Huntington’s disease
    • Traumatic brain injury

    Find out more specific information about your diagnosis:

    How can occupational therapy benefit you if you are having early memory loss? 

    Occupational therapy can greatly benefit you if you are concerned about specific symptoms. Early memory loss is a sign that something somewhere in your brain is not functioning as optimally as it could. Just as you would not ignore your right arm if you were having difficulty raising it, you should not ignore memory loss. With the right early intervention strategies, you can improve your symptoms. You will also have a healthcare professional to monitor your confusion each year in order to provide early intervention if the need arises.

      Occupational Therapy Interventions to Improve Your Memory

      What type of intervention is used by a neuro-centered rehabilitation team?

      Helpful Page Definititions

      Instrumental Activities of Daily Living (IADLs)

      Instrumental Activities of Daily Living (IADLs) are essential for independence in life roles and required for aging in place. There are 8 activities core activities for independence including cooking, cleaning, communication, taking and managing medication, handling your personal finances, transportation and community mobility, shopping

      Cooking - The ability to follow a recipe and having the stamina to prepare a meal for yourself and/or your family

      Cleaning -   The ability to perform light housekeeping including making your bed, doing your laundry, washing the dishes, taking out the trash, vacuuming, sweeping, cleaning your bathroom, etc. 

      Communication - The ability to use the telephone, the computer, have conversations with people (familiar and strangers), communicate your needs clearly.

      Taking medication - The ability to sort and organize your medication or determine a compensatory method to do so as well as taking the appropriate dosage at the appropriate time. 

      Personal Finances - The ability to establish an organization method to understand financial responsibilities and pay your bills on time. 

      Transportation - Whether you are driving, calling for a driving service like a taxi or Uber, or taking public education. You must have a defined action plan for community mobility and transportation.

      Shopping - The ability to plan transportation, plan a grocery/clothing list of needs for yourself and your home, have the stamina to collect your items at the store, and be able to get them into your house. 

      Activities of Daily Living

      Occupational therapists are trained in occupations and activity analysis. An occupation is an activity that you believe is important to your life. There are many levels of occupations, but activities of daily living (ADLs) are the most personal activities and are usually the ones people find most important if they were to lose the ability to complete them.  

      ADLs include:

      • Bathing and showering
      • Getting dressed
      • Going to the bathroom
      • Walking and getting up and down from a chair or car
      • Eating and swallowing
      • Feeding 
      • Sexual activity 
      • Personal hygiene and grooming
      • Being able to use personal care devices like adaptive equipment and durable medical equipment 
      Progressive Neurological Disorders (PND)

      Progressive Neurological Disorders (PNDs) are diagnoses that are progressive in nature and cause a decline in function throughout their progression. They are also known as neurodegenerative diseases. The decline can be seen over decades, years, months, or even weeks. 

      Some common examples of PNDs include Multiple Sclerosis, Parkinson's disease, Lewy Body Dementia, Lou Gerhig's Disease, Alzheimer's disease, Motor Neuron Disease, and Huntington's disease. 

      Early intervention for any neurodegenerative disease is critical to maintaining function for as long as possible. Restoration in early stages and maintenance throughout a disease progression can benefit your quality of life and reduce caregiver burden. 

      Neuromuscular Re-education

      NMRE is used by neurocentric occupational therapists to improve communication between your muscular system and nervous system. By promoting this stream of communication, you close the circle of recovery. Without NMRE, you can have the biggest muscles in the world and still experience mobility deficits due to poor reaction time, coordination, and mixed signals. 

      Heavy Work

      Heavy work is also known as resistance training and can utilize isometric and isotonic movements with or without external weights while focusing on eccentric and concentric muscle contractions. By partnering heavy work with visual perceptual tasks and neural recruitment visualization, increased carryover and recovery is experienced. 

      Neurodevelopmental Techniques (NDT)

      NDT is a hands-on approach used by occupational therapists to provide deep pressure to key parts of your body during repeated movements. Your movement mixed with repetition and deep pressure creates and stores new motor patterns in your brain in order to re-establish mobility and speed up recovery. 

      Proprioceptive Neuromuscular Facilitation (PNF)

      NDT is a hands-on approach used by occupational therapists to provide deep pressure to key parts of your body during repeated movements. Your movement mixed with repetition and deep pressure creates and stores new motor patterns in your brain in order to re-establish mobility and speed up recovery. 

      Cross Crawl Techniques

      A cross-crawl technique is used in movement and mobility training of both upper body and lower body. By recruiting both sides of your brain using opposite movement patterns we strengthen the communication across the two sides of your brain known as your corpus collosum. 

      Neurocognitive Strategies

      When combining neurcogitive skills and functions with motor elements, true cognitive rehabiliation can take place (memory, recall, sequencing, etc.). We include the domains of neurocognition like language, calculation, executive functioning, complex attention, perceptual-motor, and reasoning while training your body in order to increase neural plasticity and neural re-patterning. 

      Comprehensive Evaluation

      Occupational therapists treat the entire person. Much like your primary care physician, we were required to learn elements of the entire body so that we could treat holistically (a one stop shop). Because of this, your outpatient rehabilitation specialist will perform an evaluation that assesses the following things: 

      • Personal history
        • Who are you? What do you do? What makes you tick? Why are you seeking outpatient therapy?
      • Physical function (upper body and lower body)
        • Strength, range of motion, and flexibility 
      • Neuromuscular function (brain to muscle communication)
        • Coordination, speed, agility, and reaction time 
      • Cognitive and Mind health
        • Short term memory, recall, information processing, and perception of illness 
      • Occupational Inventory (Activity and role inventory)
        • Roles you play like a caregiver, spouse, parent, employee, etc. 
        • Mobility inventory like the places you need to go 
        • IADL inventory and what activities are required for you to be independent 
        • Other activities that are important to you