Alzheimer’s disease usually progresses steadily via the early and mild stages to the moderate and then the severe stage. On average, a person with Alzheimer’s will live for about 12 years after diagnosis, but this depends a lot on the individual and the duration of the disease can range from a few years to a few decades.
During the early stage, friends and relatives will often notice that the person with Alzheimer’s has certain difficulties in daily life, such as forgetfulness and not being able to remember familiar words straight away. The person may offer various explanations for the forgetfulness, such as he/she did not hear or make a mental note about the matter. However, Alzheimer’s reduces the person’s ability to comprehend his/her own situation.
A change in temperament, fatigue, difficulties concentrating, symptoms of stress, depression and generally doing things more slowly are all possible symptoms in the early stage. It may become more difficult to learn new things.
During the mild stage the ability to learn new things is considerably reduced and the person will become more and more forgetful. The person may stay at home more and more, stop doing the things that he/she previously enjoyed doing and avoid the company of other people. Making decisions may become more difficult and there may be a change in the way money is used. Behavioural problems, such as distress, depression, irritability and delusions may also be symptoms of the disease.
During the moderate stage, the symptoms are very obvious. The person will have considerable difficulty remembering things and may make up stories to try and conceal this. There may be problems with speech and remembering words. A person with Alzheimer’s may easily get lost in unfamiliar places and lose possessions. Use of domestic appliances is difficult if not impossible. Diet may become unbalanced due to a loss of appetite and the sleep-wake cycle may be disturbed. Everyday tasks, such as making food, going to the shops, taking care of personal hygiene and dressing will become more difficult. However, someone suffering from Alzheimer’s may still have relatively good social skills.
When Alzheimer’s disease reaches the severe stage the person will only be able to remember things every now and then and may not necessarily recognise close friends and relatives. Speaking and being understood is difficult, and restless and aggressive behaviour may increase. The ability to move will deteriorate and the person will not be able to cope alone any more.
It is a good idea to start medical treatment for Alzheimer’s disease as early as possible – preferably as soon as a diagnosis has been made. The medication will not cure the person, but it will maintain his/her ability to do things and reduce behavioural problems.
ACE (angiotensin-converting enzyme) inhibitors , i.e. donepezil, galantamine or rivastigmine, are primarily used to treat Alzheimer’s disease. If ACE inhibitors are not suitable for the person, treatment can begin with memantine. As the symptoms progress, a combination of an ACE inhibitor and memantine can be used.
In addition to medication, important factors in the treatment of Alzheimer’s disease are rehabilitation and leading an active lifestyle. Hobbies, close human relationships, healthy diet, exercise and regular sleep will make daily life easier and reduce behavioural problems. It is important for the person to remain independent and retain social contacts.
Using the brain in various ways by writing, drawing, playing games, solving crossword puzzles and with various memory exercises can fundamentally slow the progress of Alzheimer’s. Rehabilitation is tailored according to the person’s interests and is based on past hobbies.
When should I go and see a doctor?
It is a good idea to see a doctor if you find that forgetfulness is starting to affect your daily life or if friends and relatives start to notice that you are forgetting things. As we get older, committing things to memory and being able to recall things will naturally become harder, but we do not lose the ability to learn and forgetfulness should not affect daily life. When we are old, it should still be possible to recall the things that have already be committed to memory.
It is important for friends and relatives to react in time to changes in a person’s memory function, temperament or ability to do things, so that he/she can be referred for memory testing and more in-depth tests.
Merja Hallikainen, Clinical Research Director from the University of Eastern Finland’s Brain Research Unit was interviewed for this article.