Identifying the Signs of Alzheimer's and Dementia

What to Do If You Suspect You Have Alzheimer’s or Dementia 

Cognitive changes are to be expected as you grow older, but sometimes these changes can feel more severe than the usual misplacing your keys and glasses, or occasionally forgetting some plans or appointments. If you suspect that you or a loved one may be experiencing cognitive decline that’s beyond what is considered normal, here is a breakdown of what to do next. 

1. Make an appointment with your Primary Care Physician right away. Your PCP may do some initial testing or listen to your symptoms and refer you to a neurologist or a neuropsychologist for formal testing. Get an appointment on the books as soon as you’re noticing a shift in behavior. 
2. Write down in detail exactly what you’re seeing so that you can discuss it with your physician. Get specific about when you started to notice it, what you’re seeing, and how it’s impacting your daily life. You should also take note of any new medications that have been started or other life changes that have occurred recently. Pay close attention to tempo, as memory loss that feels very sudden is usually something other than dementia.
3. Take the at-home SAGE assessment. The Self-Administered Gerocognitive Exam (SAGE) is a free online screening tool for early stage dementia that can detect mild cognitive impairment (MCI), which is often one of the earliest signs of dementia. The SAGE test is available in 12 different languages, with 4 different versions of the test for each. You only need to take ONE of the four, they are all at similar levels of difficulty and the version you take will not impact the results. You can find the downloadable versions here and the digital version here. For the digital version, you may have to sign up for a free trial via the website or app, and may be charged if you do not remember to cancel before the trial period ends. 

Understanding the 7 Stages of Dementia

Understanding how Dementia and Alzheimer’s progresses is essential to identifying and managing the symptoms. While the stages don't always fall into clear boxes and the symptoms can vary, these stages are a good guide to help you plan for your care, understand what to expect, and explain your condition to your loved ones. According to Penn Medicine, the stages progress as follows: 

1. Before Symptoms Appear

Alzheimer’s disease usually starts silently, with brain changes that begin years before anyone notices any real symptoms. The only way to detect dementia or Alzheimer’s during this stage is through a PET scan or imaging test that monitors brain function.

2. Basic Forgetfulness

This stage of Alzheimer’s can often look like normal age-related forgetfulness. This can look like memory lapses, including forgetting people’s names or where they left their keys. However, day-to-day functions and activities such as driving, working and being social are still possible. You may notice these memory lapses becoming more frequent.

3. Noticeable Memory Difficulties

Most people are commonly diagnosed at this stage or after. This stage is when you start to see noticeable changes in thinking, functioning, and reasoning. This could look like forgetting something they just read, asking the same question over and over, or struggling to remember names. If you notice you or a loved one exhibiting any of these symptoms, do not delay speaking to your doctor to help treat and manage the symptoms.

4. More Than Memory Loss

During this period — which can last many years — the problems in thinking and reasoning that you noticed in the last stage get more obvious, and new issues appear. The small memory lapses feel more severe and noticeable. Memories of the distant past will usually be significantly better than memories of day-to-day information, such as what you ate or saw on the news earlier that day. Other symptoms of this phase include: forgetting what month or season it is, having trouble cooking meals or even ordering from a menu, being unable to do tasks with multiple steps, and increased risk of wandering or getting lost.

5. Decreased Independence

During this period, living independently gets increasingly more difficult as you may struggle to complete day-to-day tasks, take medication, and possibly even remember your loved ones. You may also experience emotional changes, such as hallucinations or paranoia that others are against you. Delusions are also common, like thinking you are late for work, even though you may be retired. Feeding yourself, or using the restroom will also get harder as you are in this stage — and you could also experience changes in sleep pattern and noticeable weight loss.

6. Severe Symptoms

For a person with Alzheimer's, many basic abilities, such as eating, walking, and sitting up, fade during this period. In this stage, people with Alzheimer's disease need a lot of help from caregivers. Many families find that, as much as they may want to, they can no longer take care of their loved one at home. If you feel like that applies, you may want to look into full-time care or a nursing home that specializes in Alzheimer’s and dementia care. Ideally, you’ve discussed your preferences with your family and loved ones already, as communicating your thoughts and what you’re experiencing can also become difficult at this time.

7. Lack of Physical Control

This stage is understandably the hardest. In addition to your body shutting down, your body can also become extremely vulnerable to infections, such as pneumonia. Pneumonia is very common in people with Alzheimer’s that has progressed this far, and is likely to cause prolonged hospital stays for adequate treatment. It is the most common cause of death in people with Alzheimer’s, and is twice as fatal for people with Alzheimer’s than those without. To help avoid infections, keep your teeth and mouth clean, treat cuts and scrapes with an antibiotic ointment right away, and make sure you get your flu shot every year.  

Understanding the Different Types of Dementia

While Alzheimer’s accounts for 60-80% of dementia cases, it is not the only form of dementia. There are various types of dementia you should watch for as you age, and each one has its own characteristics, causes, and signs to watch for. The most common types of dementia are:

Alzheimer's 

• The most common type of dementia
• Symptoms gradually worsen over time
• Usually begins with a mild memory loss, and eventually affects the ability to carry on a conversation and carry out daily tasks such as dressing and bathing.

Vascular Dementia

• Second most common type of dementia
• Symptoms may occur suddenly following a stroke, or may happen gradually over time
• Someone may stay the same for months, then suddenly get a little worse

Lewy Body Dementia

• Brain changes and symptoms are like Parkinson's Disease
• Changes in alertness and attention occur
• Someone may be alert and appropriate one day and confused and fearful the next day
• Physical traits may include a stooped posture, or a shuffling walk which may lead to an increased risk of falls
• May include visual hallucinations, which are usually not scary

Frontotemporal Dementia

• Affects the front and side lobes of the brain
• Is more common in middle-aged adults rather than older adults
• Someone may talk in a jumbled fashion that is difficult to understand
• May have trouble getting the words out and be frustrated due to having trouble speaking
• May curse or anger easily
• May behave out of character and say things that are rude or not appropriate

Mixed Dementia

• A condition in which a person has more than one type of dementia
• Alzheimer's disease + vascular dementia is the most common mixed dementia

Reversible Dementia

• Some treatable health conditions have dementia-like symptoms
• Once the conditions are treated, the dementia-like symptoms may be resolved
• Early identification and treatment of these conditions could be beneficial by preventing worsening of the condition, and by preventing hospitalization
• Examples of conditions that may cause dementia-like symptoms:
  
  • Chronic infections
  • Urinary tract infections
  • Pneumonia
  • Side-effects from certain medications
  • Vitamin deficiencies, including B12 and D
  • Alcohol and drugs
  • Untreated emotional problems, such as stress, anxiety, or depression
  • Untreated thyroid disorder
  • Organ failure
  • Blood clots, tumors, or infections in the brain

Parkinson's disease 

• A brain disorder that leads to shaking, stiffness, difficulty with walking, balance, and coordination
• Symptoms usually begin gradually and get worse over time. 
• Not a type of dementia, however, up to 70% of people with Parkinson's may develop dementia

Delirium 

• A condition that causes a person to become confused
• A physical problem that can cause temporary change in a person's thinking
• Usually starts over a few days and often gets better with treatment

What To Do If You’ve Been Diagnosed with Dementia or Alzheimer's

If you or a loved one has been diagnosed with Alzheimer’s disease or a related dementia, it may be difficult to think beyond the day to day. You may feel numb, scared, and find it difficult to take everything in. Give yourself time to adjust to what a dementia diagnosis means for you. That being said, when you feel ready, making some essential decisions and preparing yourself for what’s to come will help you and your loved ones navigate this difficult condition. Planning ahead will also ensure that you can communicate your preferences, needs and wants with your loved ones while you’re still able to communicate clearly. 

• Get your essential documents in order.
  
  • Create a will: Talk to your attorney and set up a will that clearly outlines how you want your assets distributed in the event of your death.
  • Organize bank statements, investment or retirement accounts, mortgage papers, etc.
• Choose someone to have lasting Power of Attorney. 
  
  • You can grant one or more people power of attorney to manage your affairs, including your money, property, and medical treatment, if it becomes medically necessary.
  • You can choose anyone you trust to be your attorney (usually a close friend or family member), but they must be over 18.
  • Make sure they know you’re choosing them, and clearly understand your wishes and how you would like important decisions to be handled.
• Make an advanced care plan. 
  
  • Set up your advance directives such as your living will and healthcare proxy.
  • Advance directives are legal documents that outline your preferences and apply only if you are unable to make decisions. Doctors and other providers follow these directives for your medical treatment. 
  • Use CompassCare’s 7 Choices document to help convey your wishes to your loved ones. 
  • Decide if you want a Do Not Resuscitate order. 
  • Fill out a MOLST form.
• Memorialize your life story
  
  • Create a memory book of moments and memories you want to remember
  • This will help stimulate your brain, give you an activity to do with your loved one, and serve as a reminder of your happiest moments as your condition progresses. 
  • It’ll also help your loved ones have a physical memento of your life to share with friends and family.
• Create systems to take extra care of your health.
  
  • Make sure you’re eating a healthy and balanced diet.
  • Exercise daily — whether it’s gardening, going on a walk or doing yoga.
  • Make sure your vaccines are up to date, especially the flu vaccine
  • Get regular check ups with all your doctors, including your dentist.
  • Talk to your doctor if you’re experiencing low moods or depression. 

Being diagnosed with Alzheimer’s or another form of dementia can be extremely scary and overwhelming. While there is no cure, the more you and your loved ones know what to expect, the more prepared you’ll be to navigate these changes as they come.