The 4 Phases of Alzheimer's Disease

Families often ask about the course of Alzheimer's disease and some of the behaviors they can expect to encounter along the way. My grandmother was believed to have Alzheimer's disease, and I know first-hand how it was to cope and watch as these phases passed her by.

As with anyone who has a loved one suffering from a disease, I had done my fair share of homework. I studied the topic, learned the phases and prepared myself for what was to come. It is a deterioration process that, unfortunately, has affected millions. If you suspect someone you love might have Alzheimer's, please read on, as I believe you will find a remarkable coincidence to what I have written in comparison to your loved one's actions. Remember as you read them that some of the symptoms will over-lap, vary in sequence and in the rate at which they progress. The symptoms reflect a continuous decline, yet some may be absent in individual patients, depending on the area of the brain affected, the extent of the disease and the victim's previous personality.

Phase I:

The onset is subtle, and usually the family is unsure anything is wrong.

Functional and Mental Changes: Short-term memory loss. They are unable to find the right word, particularly nouns. They may forget familiar names, telephone numbers and may write many reminder notes and then lose the notes. They may wear the same articles of clothing repeatedly. Their judgment may be impaired early on to where they may dress inappropriately for the weather. They become skilled at covering up by using family members to fill memory gaps and often blame problems on fatigue, stress, and even people. They generally use simple judgment and logic to overcome these memory gaps. They anger and get disoriented easily, and they may hide things.

For as many characteristics as this phase has, it defines in ideal description the beginning of what my grandmother was going through. Our family noticed all of these areas, particularly the absent mindedness and the short term memory. We would call her one day and tell her about an appointment the next day, and by the end of our conversation we'd remind her again of the same appointment before hanging up, and she had already forgotten. As time grew on, she took over the other descriptions as well, repeated the wear of her clothing, and we had to remind her to bathe sometimes because she would forget. There for a while she was constantly misplacing things, as her forgetfulness was starting to consume her days. She was very moody, and could become upset over nothing at all. She was terrible with names, and she would get herself frazzled over most anything.

Phase II:

Functional and Mental Changes: They have a greater difficulty with memory, retaining new information, decision-making, calculations and following a simple story line. They are becoming more noticeably forgetful. They may not be remembering to pay bills, take medication, or even remembering to turn the stove off. They seem to be lacking the manners in which they were normally used to exercising, and they are becoming noticeably more self-absorbed. They may seem less interested in family or friends, as well as mistaking concern (by family) as interfering. They may withdraw themselves socially altogether. The deterioration process continues with forgetting to bathe, as well as tending to their other basic hygiene needs. They become restless at night, and although they can still follow instruction, they may need guidance or direction to do so.

I think in my grandmother's case, Phase II was just an amplified version of Phase I. It was about this time that our family determined that we were indeed correct with our intuition that something was wrong. We were becoming more concerned with her forgetfulness, and we would take more and more trips to her home. We lived a great distance away from her so this made our travels difficult to frequent them, but we would split our visits among other family members who would also make the trips out to see her. We initiated more calls to her, and started having neighbors check in on her to make sure she hadn't forgotten to turn an appliance off as well as tending to her basic health needs. She began to walk with a shuffle, and she had difficulty following a conversation. She would respond to questions with an answer that was completely unrelated, and she used words incorrectly. She had a noted loss of coordination and often needed assistance walking or sitting. She suffered from paranoia and would often dream frequently and incorporate her dreams into her day to day life as if they really happened. She would talk about her past and talk about visiting places and talking to people who existed only decades ago in her lifetime.

Phase III:

Functional and Mental Changes: They become unable to feed themselves and loose control over bladder and bowels. There is a drastic weight loss noted, and they become very delusional. They live in a world of make-believe and seldom recognize any close family members. They are unable to recognize dangers and their judgment has become completely impaired. Their words are rarely distinguishable, and they become completely unable to do anything for themselves. They become quite aggressive and hostile and may experience many violent outbursts and tendencies. They may not be able to walk at all, possibly bound to a wheelchair. During this phase is generally when the family notes the drastic progression of the disease as well as the level of deterioration that is taking place, and beginning to prepare for Phase IIII. They may just sit there and stare off into space while their family surrounds them. Family becomes desperate for them to stop and suddenly recognize their surroundings, but they do not. Their health is poor, and their aggression sometimes causes harm to those around them. From Phase III to Phase IIII, it goes very quickly.

My grandmother was placed in a nursing home at some point between Phase II and Phase III. I remember this phase well because these were my final memories of her. She was bound to a wheelchair and she wore diapers because she could not control her bladder or her bowels. She had to have assistance eating, turning, talking, and even moving around. She recognized no one and she either chose not to speak at all and stared off into space, or she would lash out at nurses, family, and anyone who was nearby. She would hallucinate constantly, had many violent tendencies and many people were afraid of her, despite her (now) 90 pound frame. She was once a healthy, happy and plump "Grandma", a strong German woman who wore a bun in her hair and she would serve a 10 course meal every meal of the day if her visitors allowed her. It was so sad to stand back and witness the deterioration process of this disease take over her mind, body and robbed her spirit such as it did. She continued to loose weight and often didn't eat much at all. The staff at the nursing home warned us and prepared us for the inevitable. We knew it wouldn't be long and the Lord would bring her to his side.

Phase IIII:

Functional and Mental Changes: This phase is very abrupt and short. They loose the ability to eat or swallow at all. Their entire system shuts down and ceases. There isn't much to elaborate on in this phase because it is the end of a very long struggle and fight. It is said that the most frequent cause of death is pneumonia, although the other causes such as malnutrition, dehydration, and immobilization come as no surprise.

As her family, we suffered right along with her, and as devastating as the end was we were thankful she was no longer suffering. The Lord took her to heaven and without doubt she was reunited with "Grandpa" and they are now looking down on us; their children, grandchildren and great-grandchildren.

Again, if someone you love is currently going through these phases the best thing you can do is educate and prepare yourself so you are not going through this with question and doubt. Naturally it is difficult to come to terms with the disease, but please take comfort in the support of your family that surrounds you and make the final transition for your loved one as pleasant as possible, and God bless you.