Stages of Alzheimer’s Disease, Part Two

The most detailed roadmap of Alzheimer’s disease was actually given to me by a friend who printed off an article she had found. It’s still available at https://www.alzinfo.org/understand-alzheimers/clinical-stages-of-alzheimers/

This scale was developed by Dr. Barry Reisberg, a psychiatrist and the director of the Fisher Alzheimer’s Disease Education and Research program in New York. The staging system is mainly used in clinical settings to create a common language that informs where a patient with Alzheimer’s disease is on their course of the disease.

What I found most helpful was the wealth of specific symptoms mentioned in each stage as well as a time frame for each stage. Examples of deficits in daily function, cognition, speech and emotion are given.

This system is also a seven stage system, but it differs from the seven stage system I discussed last week from WebMD. The stages used by this scale once symptoms are overt are: mild, moderate, moderately severe, and severe, but also include substages in the last two stages.

In Reisberg’s staging, Mild Alzheimer’s disease includes some discrete functional deficits in managing finances and planning complex social gatherings. Specific cognitive deficits and emotional responses are also addressed. According to this article, this stage lasts, on average, 2 years.

Moderate Alzheimer’s disease is mainly characterized by initial losses of activities of daily living, making it impossible for a person to live alone completely. This stage lasts about 1.5 years.

Moderately severe Alzheimer’s disease on this scale, is divided into 5 sequential substages, each detailing a specific loss of an activity of daily. Changes in cognitive, speech, and emotional health in this stage are also well detailed. This stage lasts an average of 2.5 years.

Severe Alzheimer’s disease is characterized by the need for patients to have continuous assistance with nearly all basic activities of daily life. Six functional substages are identified. This stage has the most variable time length, because if well cared for, and there are no other chronic illnesses, patients with severe Alzheimer’s disease can live almost indefinitely.

I know it’s confusing to hear of so many different scales for staging Alzheimer’s disease, and it doesn’t change the course of the disease to know its course. But I do think it’s helpful to to know what to expect going forward. It was for me anyway, and Harvey did follow this trajectory almost to the letter. Not everyone does of course.

For example, I did not anticipate that Harvey would have any difficulties with showering or brushing his teeth, but because they were listed on this scale, I wasn’t surprised when it happened. I also appreciated the explanation of emotional and behavioral changes at each stage. It helped me better understand his seeming denial of his deficits early on, and later, his resistance to care.

I hope this was helpful information. Doing your own research and finding a support group that will validate what you are experiencing with your loved one is also helpful.

Knowledge is power.