Alzheimer’s disease defies doctors and scientists. On the one hand, efforts are made to identify the causes of the disease – in order to seek early treatment. At the other end, experts seek to describe what happens at each stage of Alzheimer’s disease to understand the behavior of the disease in the human body and support patients and their families.
This week, research from the University of Coimbra, Portugal, identified a region of the human brain as the area where the first changes caused by Alzheimer’s disease occur. The study paves the way for further research that may point to treatment options. According to the scientists, in the posterior cingulate, three symptoms typical of the early stages of the disease appear: neural inflammation, accumulation of amyloid proteins (insoluble in the human body) and apparently compensatory neuronal activity, in which a region of the brain tries to act to compensate for the operating deficit presented by another.
The disease is known to show symptoms only after years of protein accumulation, posing the challenge of diagnosing it before it becomes visible. The stages of Alzheimer’s disease were defined by Dr. Barry Reisberg, director of the disease research and education program at New York University School of Medicine. This division is used by experts around the world, sometimes simplified to five or even three steps.
The seven stages of Alzheimer’s disease
- No symptoms of dementia
Regardless of age, anyone can be mentally healthy. Possible memory loss is considered normal in all age groups. As we age, it is natural for these failures to occur more often and do not necessarily indicate a more serious problem.
- Subjective memory loss/age-related forgetfulness
Many people over the age of 65 complain of cognitive and functional difficulties. Older people with these symptoms complain that they cannot remember names as easily as five or ten years ago. They also often complain of not being able to remember where they put things. Several terms have been proposed to define this condition, but subjective cognitive decline is the most accepted terminology today.
Often parents and friends do not immediately notice this problem, but people with these symptoms decline faster than others of the same age who do not have the same problems. Research shows that this phase can last up to 15 years in people who have no other symptoms. “The disease begins with the accumulation of certain proteins in the brain and it can take 15 to 20 years before the first symptoms appear,” says doctor Otelo Correa dos Santos Filho, from Rio State University. (UERJ), principal researcher of the study. Brazilian part of the international study “Davos Alzheimer Collaborative”. “In this preclinical phase, there are no symptoms and daily life is not affected.”
- slight cognitive impact
People at this stage show subtle deficits, but they are already noticed by those close to them. They tend, for example, to repeat the same question over and over again. The ability to perform certain functions is compromised. It is common for those who have not yet retired to show a decline in their professional role. Those who need to learn new tasks have obvious difficulties. For those in strategic positions, it may be time to start planning for retirement. This can already be characterized as an early stage of Alzheimer’s disease and can last for about seven years. Yet, it is necessary to seek medical advice and expert diagnosis to understand the extent to which other health conditions may influence these conditions.
- Moderate cognitive decline/mild dementia
The diagnosis of Alzheimer’s disease at this stage can be made quite accurately. The most common functional deficit in this phase is a reduced ability to perform more complex tasks of daily living, impacting their ability to live independently. For example, paying your monthly bills, paying your rent, going to the market, shopping, choosing a meal at a restaurant can be complicated. People who used to cook now have difficulty preparing food.
Symptoms of memory loss become quite obvious at this point. Recent important events like a party or a visit from a relative can be forgotten. In general, this phase lasts about two years. “People are starting to have slight memory impairments, they lose track of time a bit, they have trouble managing finances, doing calculations, but the impact on day-to-day activities is still not very important”, explains the Uerj specialist.
- Moderately severe cognitive decline/moderate dementia
At this stage, people have symptoms that prevent them from living an independent life. The main functional change in this phase is difficulty in performing basic daily activities, such as choosing the most appropriate clothing for the weather conditions and the occasion, eating alone, paying bills, maintaining working conditions, household hygiene and clothing. They may also have behavioral issues, such as temper tantrums and suspiciousness.
From a cognitive point of view, they are often unable to remember major events or important aspects of daily life, such as their own address, the name of the President of the Republic and the weather. This stage generally lasts a year and a half. “At this stage, the patient begins to have so-called atypical behaviors, like going out in the street in pajamas, putting on a jacket but forgetting to wear the shirt”, illustrates the doctor.
- Severe cognitive decline/moderate dementia
At this point, patients lose the ability to dress, shower, brush their teeth, or go to the bathroom on their own. They begin to confuse or misidentify other people, even the closest ones. They do not remember the names of the schools where they studied, of the main political leaders of the country. At some point, they begin to have difficulty speaking. From a behavioral point of view, temper tantrums can be frequent. This phase can last from two to three years. “The patient is already unable to perform basic daily activities, already has considerable motor impairment and difficulty recognizing people,” said Otelo Correa dos Santos Filho. “Hallucination is not very common in Alzheimer’s disease, but it can occur at this stage.”
- Very severe cognitive decline/very severe dementia
At this stage, patients seek assistance with basic daily activities and for their own survival. The ability to speak is increasingly restricted until it is completely lost. The patient also loses the ability to walk on his own and even to sit. Joint stiffness is increasingly common, preventing the most basic movements and leading to physical deformities. A common cause of death is pneumonia, precisely because of the increasing difficulty in swallowing. This phase usually lasts one to three years. “This is the most serious and saddest phase of the disease, in which people with severe dementia are completely dependent for daily activities and are bedridden,” said the expert. “This is the ultimate stage of the disease,” he concluded.
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